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Depression treatments are typically less effective for young people than for adults. However, treatments rarely target loneliness, which is a key risk factor in the onset, maintenance and development of depression.
This study evaluated the efficacy of a novel loneliness intervention, Groups 4 Health (G4H), relative to the best-practice treatment of cognitive–behavioural therapy (CBT) in reducing loneliness and depression over a 12-month period (Australian New Zealand Clinical Trial Registry: ACTRN12618000440224).
The study was a phase 3 randomised non-inferiority trial comparing G4H with dose-controlled group CBT. Participants were 174 people aged 15–25 years experiencing loneliness and clinically significant symptoms of depression, who were not in receipt of adjunct treatment. Participants were recruited from mental health services in Southeast Queensland, Australia. Randomisation was conducted using computer software. Follow-up assessments and statistical analyses were masked to allocation. Both interventions consisted of five 75 min group-based psychotherapy sessions. The primary outcomes were depression and loneliness, with a non-inferiority margin of 2.20 for depression.
The trial enrolled 174 participants between 24 April 2018 and 25 May 2019, with 84 in the G4H condition and 90 in the CBT condition. All randomised participants were included in the intention-to-treat analyses (n = 174). The pre–post effect sizes for depression were dG4H = −0.71 and dCBT = −0.91. For loneliness, they were dG4H = −1.07 and dCBT = −0.89. At 12-month follow-up, the absolute difference between groups on depression was 1.176 (95% CI −1.94 to 4.29) and on loneliness it was −0.679 (95% CI −1.43 to 0.07). No adverse effects were observed.
G4H was non-inferior to CBT for depression and showed a slight advantage over CBT for loneliness that emerged after treatment completion.
International institutions are increasingly being challenged by domestic opposition and nationalist political forces. Yet, levels of politicization differ significantly across countries facing the same international authority as well as within countries over time. This raises the question of when and why the mass public poses a challenge to international cooperation. In this article, we develop a theoretical framework for understanding the nature and implications of politicization of international cooperation, outlining three scope conditions: the nature of public contestation, the activities of political entrepreneurs, and the permissiveness of political opportunity structures. By empirically examining these scope conditions, we demonstrate that politicization can have both stabilizing and destabilizing effects on international cooperation. Highlighting the systemic implications of politicization for international cooperation has important implications for international relations scholarship. Although international organizations may face challenges, they also have ways of being remarkably resilient.
There is evidence for the cost-effectiveness of health visitor (HV) training to assess postnatal depression (PND) and deliver psychological approaches to women at risk of depression. Whether this approach is cost-effective for lower-risk women is unknown. There is a need to know the cost of HV-delivered universal provision, and how much it might cost to improve health-related quality of life for postnatal women. A sub-study of a cluster-randomised controlled trial in the former Trent region (England) previously investigated the effectiveness of PoNDER HV training in mothers at lower risk of PND. We conducted a parallel cost-effectiveness analysis at 6-months postnatal for all mothers with lower-risk status attributed to an Edinburgh Postnatal Depression Scale (EPDS) score <12 at 6-weeks postnatal.
Intervention HVs were trained in assessment and cognitive behavioural or person-centred psychological support techniques to prevent depression. Outcomes examined: quality-adjusted life-year (QALY) gains over the period between 6 weeks and 6 months derived from SF-6D (from SF-36); risk-of-depression at 6 months (dichotomising 6-month EPDS scores into lower risk (<12) and at-risk (⩾12).
In lower-risk women, 1474 intervention (63 clusters) and 767 control participants (37 clusters) had valid 6-week and 6-month EPDS scores. Costs and outcomes data were available for 1459 participants. 6-month adjusted costs were £82 lower in intervention than control groups, with 0.002 additional QALY gained. The probability of cost-effectiveness at £20 000 was very high (99%).
PoNDER HV training was highly cost-effective in preventing symptoms of PND in a population of lower-risk women and cost-reducing over 6 months.
This study investigates the origins of discrete interpersonal emotions in team-member dyads using two independent samples from an education institute and a telecommunication services company in China. Results across both studies showed that the quality of team members’ dyadic relationships positively relates to interpersonal admiration, sympathy, and envy, and negatively relates to interpersonal contempt. Furthermore, teams’ cooperative goals moderate these dyad-level linkages. The association of relationship quality with interpersonal emotions is particularly pronounced in teams with less cooperative goals but buffered in teams with more cooperative goals. Finally, on the individual level of analysis, envy and contempt are inversely associated with team members’ work performance, objectively measured. These findings provide new insights about key antecedents and crucial moderators in the development of interpersonal emotions in Chinese work teams and reiterate the relevance of these emotions for tangible performance outcomes.
People who have read War and Peace more than once, and enjoyed it immensely, can often scarcely remember a thing about it.
The concept of redundancy employed in this essay is the one used in mathematics and linguistics to designate symbols that do not add information to a sequence. One of the hazards of teaching twentieth-century war literature is the tacit inference of redundancy by readers, namely that the representational conventions as well as the facts and values represented are ‘predictable from … context’. The claim that twentieth-century war writing is made superfluous by War and Peace (1869) is polemical, but it is also intended to do serious work: to draw attention to representations of war which are not predictable from context, and to renew questions such as why representing war as irrational, murderous activity is unefficacious, and why we would imagine otherwise.
The designs of War and Peace as war writing can be recognised as early as 1853, when Tolstoy published a story drawing on his own military experience in the Caucasus:
War always interested me: not war in the sense of manoeuvres devised by great generals – my imagination refused to follow such immense movements, I did not understand them – but the reality of war, the actual killing. I was more interested to know in what way and under the influence of what feeling one soldier kills another than to know how the armies were arranged at Austerlitz and Borodino.
In october 1099, following the conquest of Jerusalem, First Crusade forces led by Duke Godfrey of Bouillon laid siege to the city of Arsuf, about fifteen miles north of modern Tel Aviv. According to the early-twelfth-century chronicler Albert of Aachen, the city's defenders attempted to distract Godfrey by crucifying one of Godfrey's men, Gerard of Avesnes. They placed him on the city walls within sight of the siege forces. Dying yet still able to talk, Gerard begged Godfrey to avenge his suffering and death. Godfrey told Gerard that, unfortunately, he could not avenge him; diverting men to do so would cost them the city. Furthermore, he added, ‘Certainly if you have to die, it is more useful that you alone should die than that our decree and be violated and this city remain always unsafe for pilgrims. For if you die to the present life, you will have life with Christ in heaven.’ With that Gerard was left to his fate, while the crusaders continued to assault the city.
The assault failed dramatically, prompting reflection on the potential causes of God's disfavour. In particular, Godfrey's response to Gerard's request for vengeance was called into question. Arnulf of Chocques, the newly appointed patriarch of Jerusalem, roundly condemned Godfrey not only for abandoning Gerard to his fate, but especially for failing to avenge his death. Arnulf described Godfrey's actions as ‘treachery and hardheartedness … impiety … base filth of all crimes’.
The officer stared at him curiously, as though doubting the evidence of his own ears.
‘A war?’ he chuckled at last, as though the word had amused him. ‘I'm afraid you're rather simplifying the issue, aren't you? The conception of war, you know, is rather an old-fashioned one, don't you agree? There's surely not much distinction nowadays between being at war and being at peace.’
Most writing about British Cold War culture has concentrated on nuclearism, pacifism, decolonisation, socialism, postmodernism, Americanisation – in short, on everything but war. One effect of the attention paid to these various narratives has been to obscure the fact that citizens of the USSR and those of Western capitalist democracies alike understood and feared the Cold War as war, even if later accounts have tended to lose sight of what Holger Nehring has called the ‘warlike character’ of their experiences. If the Cold War is to have any explanatory force as a context for literary works beyond serving as a useful periodising shorthand, then we need to know in what sense, if any, the literature of the Cold War era understood itself as a war literature. ‘What kind of war was this?’ asks the historian Anders Stephanson. ‘The two sides never went to war with each other. There is no obvious beginning, no single moment of initial aggression, no declaration of war, no crossing of a certain line, and no open military engagement.
W. H. Auden wrote that the Great War was ‘the decisive experience’ of Wilfred Owen's life. In the absence of such experience, Auden and his generation struggled to find grounds from which to write during the 1930s. In the present essay, I show that Auden's ‘Journal of an Airman’, which is Book II of The Orators (1932), reflects the legacy of the Great War for interwar English writers and ‘the guilt that every noncombatant feels’, as he calls it. This guilt is a manifestation of a larger cultural turn that military historians have traced back to the Enlightenment, in which non-transmittable knowledge is understood to be gained exclusively through sensory experience on the battlefield. That knowledge grants combat veterans the ‘authority of flesh-witnessing’. After discussing this cultural turn and how it affected Auden and his generation, I explore how positions of optical dominance inform the ‘Journal of an Airman’ and the text's concern with the idea of the poet as wartime orator – elements that presage Auden's World War II poetics. I conclude by considering an often-overlooked episode in Auden's life, when he was sent to assess the effects of air bombing on German morale as part of the 1945 US Strategic Bombing Survey.
Josef stalin's claim that ‘one death is a tragedy, a million deaths … a statistic’ we might take as an aesthetic and moral gloss on another well-known comment, this one attributed to Napoleon Bonaparte: ‘A man like me does not give a shit about the lives of a million men.’ Stalin's statement makes two assumptions that this essay will question. It assumes that moral feeling – the sort formalised in tragedy – operates on the level of the individual, the one, and is not susceptible to multiplication (or, for that matter, division). It assumes additionally that statistics, the signs for large aggregates of human beings, do not occasion moral feeling. Apparently we do not feel the deaths of a million men with anything like the force we feel for the death of one, ‘a man’, as Napoleon says, ‘like me’.
Stalin contributes to an ongoing debate in moral philosophy, set here in the context of modern mass warfare, a context embracing the Napoleonic era as well as our own. The terms of the debate and its governing assumptions were laid out helpfully, if bluntly, by C. S. Lewis in 1957. Writing in the gloom of the Cold War and against a utilitarian outlook, Lewis argued that none of us can possibly experience suffering on a scale other than that of the single person.
The fields were not sown or ploughed. There were no cattle or fowl in the fields. No cock crowed in the depth of night to tell the hours. No hen called to her chicks. It was of no use for the kite to lie in wait for chickens in March of this year nor for children to hunt for eggs in secret hiding places. No lambs or calves bleated after their mothers in this region. The wolf might seek its prey elsewhere and here fill his capacious gullet with green grass instead of rams. Larks soared safely through the air and lifted their unending songs with no thought of the whistling attacks of eyas or falcon. No wayfarers went along the roads, carrying their best cheese and dairy produce to market. Throughout the parishes and villages, alas! went forth no mendicants to hear confessions and to preach in Lent but rather robbers and thieves to carry off openly whatever they could find. Houses and churches no longer presented a smiling appearance with newly repaired roofs but rather the lamentable spectacle of scattered, smoking ruins to which they had been reduced by devouring flames. The eye of man was no longer rejoiced by the accustomed sight of green pastures and fields, charmingly colored by the growing grain, but rather saddened by the looks of the nettles and thistles springing up on every side.