Research Portfolio Submitted in Part Fulfilment of the requirements for the Degree of Doctorate in Clinical Psychology

: 1) Childhood cognitive vulnerability factors for Post-Traumatic Stress disorder: A systematic review of longitudinal studies; 2) Barriers and facilitators to implementing Structured Clinical Management within a Community mental health team; 3) Cognitive risk factors for trauma exposure and PTSD in a longitudinal cohort sample of children living in high adversity in South Africa.

Abstract

LRP: Childhood cognitive vulnerability factors for Post-Traumatic Stress disorder: A systematic review of longitudinal studies.
Identifying risk factors for the development of post-traumatic stress disorder (PTSD) following trauma exposure is an important area of study. Poor cognitive abilities have been associated with PTSD, but it is unclear whether they are risk factors or consequences of the disorder. This systematic review focused on longitudinal research which investigates the associations between cognitive abilities measured in childhood and the development of PTSD in later life. Six longitudinal studies (five independent samples) of good empirical quality were found that investigated two pre-trauma cognitive vulnerability factors, general intelligence and verbal ability. Low intelligence was found to significantly increase risk of PTSD across studies (three studies). Poor verbal ability was also consistently found to increase risk of PTSD across studies (two studies). Findings suggest that low intelligence and verbal ability are significant predictors of developing post-traumatic stress disorder (PTSD) after a traumatic event, but not necessarily of being exposed to the traumatic event itself.

SRP: Barriers and facilitators to implementing Structured Clinical Management within a Community mental health team.
Borderline personality disorder is a significant mental health presentation of emotional instability. People with the disorder struggle with relationships and are at increased risk of self-harm and death by suicide. There is little research on borderline personality disorder that focuses on implementing evidence-based interventions in clinical settings. This study aimed to explore barriers and facilitators of implementing Structured Clinical Management (SCM) within an adult community mental health service. A proportion of the clinicians in the team (n = 11) completed a qualitative survey to gather opinions about SCM implementation in the team. Thematic analysis was completed, and four key themes emerged. Clinician’s perspective of the intervention, clinician’s perspectives of the benefits to the service user, team characteristics, and implementation infrastructure all influenced the implementation of SCM. These themes acted as facilitators and barriers for the change process. Findings are similar to the domains outlined in the practical, robust implementation and sustainability model (PRISM) and are supported in previous implementation research in mental health settings. This study contributes to increasing awareness and understanding of the crucial factors to consider when implementing SCM within mental health settings.

MRP: Cognitive risk factors for trauma exposure and PTSD in a longitudinal cohort sample of children living in high adversity in South Africa.
Childhood cognitive factors have been associated with an increased risk of developing post-traumatic stress disorder (PTSD). Studies have not been conducted on this topic in low- and middle-income countries where environmental factors (life stressors) place children at increased risk of experiencing trauma. This study aimed to determine the association between childhood cognitive abilities (general intelligence, verbal ability, and executive functions) assessed at age five and the development of PTSD at age eight in a birth cohort in high-adversity areas in South Africa. Using data from The Philani Mentor Mother cohort study (n = 920), logistic regression models were run to determine group differences in cognitive abilities while controlling for socioeconomic and intervention status. Cognitive abilities between children exposed and not exposed to trauma and between children with elevated post-traumatic stress and no post-traumatic stress were compared. Findings showed no significant differences in cognitive abilities between children exposed to trauma, children with post-traumatic stress, and healthy controls. The number of types of trauma exposure was robustly linked to an elevated post-traumatic stress symptom, with each additional trauma type increasing the risk of an elevated PTSS symptom by 1.9 times (CI 1.08-3.39). More longitudinal research is needed to examine the relationship between cognitive abilities and PTSD in older children in diverse settings to determine whether lower cognitive abilities increase an individual’s risk of developing PTSD.

Date of Award	26 Mar 2025
Original language	English
Awarding Institution	University of Bath
Supervisor	Sarah Halligan (Supervisor) & Jennifer Allen (Supervisor)