When a child is diagnosed with a life threatening condition, one of the most challenging tasks facing healthcare professionals is to communicate this to the child, as well as to their parents or caregivers. Evidence-based guidelines are urgently needed for all healthcare settings, from tertiary referral centres in high income countries to resource limited environments in low and middle income countries, where rates of child mortality are high. We place this narrative review in the context of children's developing understanding of illness and death. We review the impact of communication on children's emotional, behavioural and social functioning, as well as treatment adherence, disease progression and wider family relationships. We consider the factors that influence the process of communication and the preferences of children, families and healthcare professionals about how to convey the diagnosis. Critically, the barriers and challenges to effective communication are explored. Finally, we outline principles for communicating with children, parents and caregivers, generated from a workshop of international experts. Communication with Children and Adolescents about the Diagnosis of their own Life Threatening ConditionAlan Stein (AS) conceptualized and the designed the review. Louise Dalton (LD), Lucy Hanington (LH), Kim Fredman Stein (KFS) and AS undertook the literature searches and selected the studies. AS, LD and Elizabeth Rapa (ER) gathered the information from the studies and drafted the manuscript. Myra Bluebond-Langner (MBL), Sue Ziebland (SZ), Emily Harrop (EH), Ruth Bland (RB), Brenda Kelly (BK), Tamsen Rochat (TR) and KFS provided specific input to different sections of the manuscript; Communication Expert Group commented on drafts of the manuscript and contributed to the development of the guidelines. LD and ER compiled the tables. All authors have read and approved the final version of the Review. Conflict of Interest statementsEH declares she is deputy chair of the NICE clinical guideline development committee for NG61 (End of Life Care in Infants, Children and Young People). All of the other authors declare no Conflicts of Interest Role of funding sourceThe funder of the study had no role in any aspect of the review.

Background Excessive alcohol use is common in young people and is associated with a range of adverse consequences including an increased risk of depression. Alcohol interventions are known to be effective in young people, however it is not known if these interventions can also improve depression. Objective To investigate whether psychosocial interventions principally targeting excessive alcohol use in young people reduce depression symptoms compared to controls. Design We conducted a systematic review and meta-analysis of controlled intervention trials, that measured depression symptoms at follow-up. We used a generic inverse variance random effect meta-analysis to pool the standardised mean difference in change in depression symptoms from baseline to follow-up between intervention and control arms. We used I2 to measure heterogeneity, the Cochrane tool for randomised trials to assess risk of bias, and Egger’s tests to assess small study bias. Data sources APA PsycNET, PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Embase (including MEDLINE), and clinicaltrials.gov were searched for relevant studies published from inception to December 2020. Reference lists of studies were also searched, and authors contacted where articles presented insufficient data. Study eligibility criteria Intervention studies that primarily targeted existing excessive alcohol use in young people (aged 10 to 24) and assessed depression outcomes at baseline with a minimum of four-week follow-up. Results Five studies were included in the meta-analysis. Interventions targeting excessive alcohol use were associated with a reduction in depression symptoms from baseline to follow-up when compared to control, standardised mean difference = − 0.26, and 95% confidence interval [− 0.41, − 0.12], p < .001. Conclusions This study found evidence that interventions primarily targeting excessive alcohol use can reduce depression symptoms in young people. However, this finding should be taken with caution given concerns about risk of bias in all studies. More research is needed to examine whether these findings generalise beyond populations of undergraduate students primarily living in high income countries. Trial registration PROSPERO registration number: CRD42020177260.

Introduction High smoking prevalence leads to increased morbidity and mortality in individuals with depression/anxiety. Integrated interventions targeting both smoking and mood have been found to be more effective than those targeting smoking alone, but the mechanisms of change of these interventions have not been investigated. This qualitative study aimed to understand participants' experiences of the mechanisms underlying change in smoking behaviour following an integrated cognitive behavioural technique‐based intervention for smoking cessation and depression/anxiety. Methods This study was embedded within an ongoing randomized‐controlled acceptability and feasibility trial ( http://www.isrctn.com/ISRCTN99531779 ). Semistructured interviews were conducted with 15 IAPT service users. Data were analysed using thematic analysis. During the interviews, participants were asked open‐ended questions about their quitting experience and perception of how the intervention aided their behaviour change. Results Five themes were identified. Acquiring an increased awareness of smoking patterns : participants described an increased understanding of how smoking was contributing towards their mental health difficulty. Developing individualized strategies : participants described acquiring ‘a couple of tricks up your sleeve’ that were helpful in making smoking cessation feel more ‘manageable’. Practitioner style as ‘supportive but not lecture‐y ’: participants expressed how important the therapeutic alliance was in helping change their smoking behaviour. Importance of regular sessions : participants expressed the importance of ‘having someone that's checking in on you’. Having the opportunity to access the intervention at ‘the right time ’: participants described the intervention as the ‘push’ that they ‘needed’. Conclusions Participants identified key factors towards smoking behaviour change. Perceived increased awareness of how smoking negatively impacted participants' mental health, and the opportunity to be offered smoking cessation treatment in a ‘non‐judgemental’, ‘supportive’ environment, with regular sessions and individualized strategies contributed to successful smoking cessation outcomes. If similar results are found in more diverse samples, these aspects should be embedded within integrated interventions for smoking cessation and depression/anxiety. Patient or Public Contribution Persons with lived experience of depression, anxiety and tobacco addiction contributed towards the design of the interview schedule, participant information sheets and the debriefing process. This was to ensure that interview questions were relevant, nonjudgemental and acceptable for those who did not manage to quit smoking.

Prospective memory (PM), remembering to remember, is crucial to everyday functioning. Understanding factors associated with PM impairments is thus important. One likely factor is rumination: a common cognitive process comprising repetitive self-focused thoughts. We investigated whether rumination is associated with impaired PM, and whether any associated impairment is exacerbated with negative stimuli. A sentence-rating task with sentences varying in valence was used with embedded PM cues in a non-clinical sample (N = 60). State rumination, two trait rumination subtypes (reflective pondering and brooding), and mood were measured in relation to PM cue detection and response times. Results showed that state rumination was associated with impaired PM cue detection and slower response times to PM cues embedded in negative sentences (not positive or neutral). Trait brooding (not reflective pondering) was associated with slower PM response times. These findings indicate that state rumination and trait brooding are associated with dissociable PM impairments.

Introduction: Improving Access to Psychological Therapies (IAPTs) Services could offer smoking cessation treatment to improve physical and psychological outcomes for service users, but it currently does not. This study aimed to understand participants' views and experiences of receiving a novel smoking cessation intervention as part of the ESCAPE trial (intEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety). We used the Capability, Opportunity and Motivation Model of Behaviour (COM-B) to understand the (i) acceptability of the integrated smoking cessation treatment, (ii) views of psychological well-being practitioners' (PWPs) ability to deliver the smoking cessation treatment and (iii) positive and negative impacts of smoking cessation treatment.Methods: This was a qualitative study embedded within a feasibility randomizedcontrolled trial (ESCAPE) in primary care services in the United Kingdom (IAPT).Thirty-six participants (53% female) from both usual care and intervention arms of the ESCAPE trial, including both quitters and nonquitters, were interviewed using semi-structured interviews. Data were analysed using a framework approach to thematic analysis, using the COM-B as a theoretical frame.Results: Psychological Capability: Integrated smoking cessation treatment was acceptable and encouraged participants to reflect on their mental health. Some participants found it difficult to understand nicotine withdrawal symptoms.Motivation: Participants were open to change during the event of presenting to IAPT. Some described being motivated to take part in the intervention by curiosity, to see whether quitting smoking would help their mental health.