Emergency medical service (EMS) ambulance employees play a critical role in emergency healthcare delivery. However, work-related experiences can compromise their mental health and job satisfaction. Despite available supportive services offered by EMS organizations, employee uptake remains low, while mental ill health and suicide rates remain higher than those of the general population. Understanding barriers to and enablers of such support is crucial for addressing factors that connect employees with the services designed to help. This systematic review identified 34 relevant articles and utilized an innovative process of integrating quantitative and qualitative aspects of the primary and gray literature to provide a qualitative synthesis of barriers and facilitators as perceived by EMS employees. Themes of employee (in)ability to ask for help, tailored person-centered support, and education and training about mental health were overarched by organizational culture. Barriers included perceived organizational obligation rather than genuine care, alongside machismo and stigma. Enablers included valuing and acknowledging employee risk by providing time and normalizing support utilization at work. Reframing machismo from dominance, competition, and toughness to respect, perseverance, and courage; promoting adaptive coping; and providing time and training were essential. Future research should aim to understand the factors influencing employee utilization of supportive interventions based on these themes.

Background: This single-blind, superiority randomised controlled trial will evaluate the efficacy of cognitive therapy (CT) coaching for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) for health and social care workers in the UK compared to a waitlist condition. Methods: The trial will include two parallel conditions (intervention and waitlist) using a 1:1 allocation ratio. Assessors of treatment outcome will be blinded to trial condition. Ninety-two participants who meet criteria for PTSD or MDD will be randomly allocated to the intervention or waitlist condition, minimising for key clinical characteristics. Participants allocated to waitlist will be offered the SHAPE intervention afterwards. The intervention will be tailored CT coaching for PTSD and MDD called SHAPE. The primary assessment point is 8 weeks post-random allocation. Further assessment points are 4 weeks post-random allocation and 6 months after receiving the intervention to measure the long-term effects of SHAPE. The primary outcome is SCID-5 diagnosed PTSD and MDD at 8 weeks post-random allocation. The PTSD Checklist for DSM-5 (PCL-5) and the Patient Health Questionnaire (PHQ-9) will be used as secondary measures of PTSD and MDD to assess for symptom severity. Other secondary measures will assess for posttraumatic cognitions, responses to intrusive memories, resilience, wellbeing, and symptom severity for generalised anxiety disorder and insomnia. Health economic analyses will compare the two conditions on quality of life at 8 weeks post-random allocation and compare productivity loss, resource use, and health problems at pre- and post-intervention for everyone who received SHAPE. Patient and provider experience of the SHAPE intervention will be assessed by semi-structured interviews at post-intervention. Discussion: This trial will be the first to evaluate the efficacy of CT coaching for PTSD and MDD for UK health and social care workers compared to a waitlist control. Since PTSD symptoms can improve naturally over time, comparison to a waitlist condition allows intervention effects to be distinguished from the effects of time alone. Findings from this trial will inform adaptations that may make the intervention more precise and effective. Trial registration: ISRCTN57105098. Registered prospectively on February 21, 2023.

Lay SummaryAnxiety is a common problem for neurodivergent children and young people, however it can be very challenging to identify and to manage. In a national survey, many neurodivergent children and young people and their parents expressed their frustration with not getting the right support and not “being treated seriously until at a crisis point” (National Autistic Society, 2021). As a first step to understand what has been done and what else can be done to manage anxiety problems among neurodivergent children and young people, we will explore what interventions are currently offered by child and adolescent mental health services in a large NHS Trust to autistic children and young people who have problems with anxiety, and what the outcomes of these interventions are (if recorded). We will search the structural data field in current medical records and free-text clinical notes using a Natural Language Processing (NLP) model.AbstractBackground: Anxiety problems are more prominent in neurodivergent children and young people than in their neurotypical peers. Such high rates of comorbidity are important to recognise as this comorbidity is associated with a greater risk of adverse outcomes, including self-harm and suicidality, than either condition on its own. While both pharmacological and psychological treatments are often prescribed for anxiety problems in autistic children and young people, as well as in those with ADHD, the evidence base for their effectiveness has so far been inconclusive, and little is known about their treatment outcomes in routine care. Methods: This study aims to explore the nature and outcomes of anxiety treatments for autistic children and young people and for those with ADHD using pseudonymised electronic health record data. Longitudinal trends of both structured records of diagnoses (as recorded by ICD-10 codes), demographic information, treatment team and free-text clinical notes on presenting problems, indication of treatments, treatment provision, treatment outcomes and side effects, will be extracted and analysed. Free-text clinical notes will be processed to extract key concepts of interest using Natural Language Processing.Discussion: This study will explore what treatments are available for autistic children and young people, and those with ADHD, in routine care, as well as treatment outcomes. However, due to the nature and availability of data, the findings will inevitably be limited in their generalisability, which we aim to address in future phases of research.

Objective: This implementation report documents the integration of an NLP-based data extraction tool within the Oxford Health NHS Foundation Trust’s Child and Adolescent Mental Health Services (CAMHS) to identify and analyse treatment options and outcomes for anxiety in autistic and ADHD youth using electronic health records (EHRs). We evaluate the implementation process through the lens of Normalisation Process Theory (NPT) to understand how the documented interventions were adopted and to identify factors influencing its normalisation into routine research practice.Methods: A multidisciplinary team implemented an NLP pipeline to automatically extract information on presenting problems, treatments, and outcomes (e.g., engagement, clinical outcomes, side effects) from pseudonymised EHR free-text notes. The implementation followed an iterative seven-phase roadmap: (1) defining research questions; (2) identifying key constructs; (3) co-developing an annotation schema; (4) training human annotators; (5) resolving annotation discrepancies; (6) large-scale annotation of EHR data; and (7) NLP model development and evaluation. Throughout, we applied NPT to guide implementation and evaluate progress. Quantitative outcomes (such as volume of data processed, annotation reliability, and NLP model performance) and qualitative feedback were collected to assess implementation success.Results: The NLP intervention was successfully deployed in a real-world clinical research setting, extracted data from 454,127 clinical notes across 5,906 patients. The annotation process achieved a high inter-annotator agreement (Krippendorff’s α = 0.86; 95% CI 0.83–0.88) after iterative schema refinement, and the trained NLP model demonstrated acceptable accuracy in identifying medications (F1-score = 0.9; 95% CI 0.89, 0.91) and anxiety-related information (F1-score = 0.79; 95% CI 0.77, 0.8). The NPT-based evaluation revealed that coherence of a shared understanding of the NLP tool’s purpose and value was established among the team. Cognitive participation was generally strong, clinicians and researchers showed growing interest and involvement in the NLP-enabled research workflow. Collective action was facilitated by clear protocols, though challenges such as variability in data quality and the learning curve for new technology impeded smooth operation at times. Through reflective monitoring, the team identified needs for ongoing training and infrastructure improvements. No major adverse event or harm was reported, though additional time was required for data access and computational setup, which considerably extended the project timeline.

Background : This single-blind, superiority randomised controlled trial will evaluate the efficacy of cognitive therapy (CT) coaching for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) for health and social care workers in the UK compared to a waitlist condition. Methods : The trial will include two parallel conditions (intervention and waitlist) using a 1:1 allocation ratio. Assessors of treatment outcome will be blinded to trial condition. Ninety-two participants who meet criteria for PTSD or MDD will be randomly allocated to the intervention or waitlist condition, minimising for key clinical characteristics. Participants allocated to waitlist will be offered the SHAPE intervention afterwards. The intervention will be tailored CT coaching for PTSD and MDD called SHAPE. The primary assessment point is 8-weeks post-random allocation. Further assessment points are 4-weeks post-random allocation and 6-months after receiving the intervention to measure the long-term effects of SHAPE. The primary outcome is SCID-5 diagnosed PTSD and MDD at 8-weeks post-random allocation. The PTSD Checklist for DSM-5 (PCL-5) and the Patient Health Questionnaire (PHQ-9) will be used as secondary measures of PTSD and MDD to assess for symptom severity. Other secondary measures will assess for posttraumatic cognitions, responses to intrusive memories, resilience, wellbeing, and symptom severity for generalised anxiety disorder and insomnia. Health economic analyses will compare the two conditions on quality of life at 8-weeks post-random allocation, and compare productivity loss, resource use, and health problems at pre and post intervention for everyone who received SHAPE. Patient and provider experience of the SHAPE intervention will be assessed by semi-structured interviews at post-intervention. Discussion : This trial will be the first to evaluate the efficacy of CT coaching for PTSD and MDD for UK health and social care workers compared to a waitlist control. Since some individuals with PTSD experience change in their symptoms over time, comparison to a waitlist condition allows intervention effects to be determined over those associated with the passage of time. Findings from this trial may inform adaptations that may make the intervention more precise and effective. Trial registration : ISRCTN57105098. Registered prospectively on February 21, 2023.