I completed my BSc in Psychology and Neuroscience at the University of Liverpool (2004). After this I obtained my PhD from Trinity College Dublin in 2010. My PhD was concerned with exploring the link between depression and inflammation by studying the psychological impact of the Hepatitis C treatment Interferon-alpha. After completing my PhD I completed a postdoctoral fellowship in Psychiatry at McGill University in Canada (2011-2014) where we examined the link between depression and diabetes. I returned to the UK in 2014 to undertake a lectureship at Brunel University London (2014-2016) prior to joining the School of Psychology at the University of Surrey in 2016.
University roles and responsibilities
- Programme Leader for MSc Health Psychology
Study to investigate experiences of older people when moving into retirement communities
In the media
My main research interest is in physical and mental wellbeing. I have a particular focus on chronic conditions and psychosocial wellbeing in ageing populations. Ongoing projects I have in this area include examining the relationship between loneliness and health, investigating multimorbidity across the lifespan and the impact of ageing with cerebral palsy.
- Professor Christina Victor (Brunel University London)
- Dr. Jennifer Ryan (Royal College of Surgeons in Ireland)
- Dr. Silvia Liverani (Queen Mary's University London)
- Professor Jorg Huber (University of Brighton)
- Professor Mark Peterson (University of Michigan)
I teach on the following modules:
- Clinical Psychology (PSY3097)
- Contemporary Health Psychology and Professional Practice (PSYM115)
- Academic Research Training for Health Psychology (PSYM136)
- General Psychology
- Mental Health across the Lifespan
- Qualitative Research Methods.
Smith KJ. Overview of Haemochromatosis UK patient report. Hameochromatosis UK patient report launch event. House of Commons, UK, 31st October 2018.
Smith KJ. Psychosocial predictors of quality of life in adults with Usher Syndrome. 4th International symposium for Usher syndrome. Mainz, Germany, 21st July 2018.
Smith KJ. Social and emotional loneliness. Loneliness in older people (soledad en las personas mayores). UIMP (in association with the International Association of Gerontology and Geriatrics), Valencia, Spain, 23rd November 2017.
Smith KJ. Typologies of loneliness and social isolation in an English community sample. Autumn Research and Policy Forum on Loneliness with the Campaign to End Loneliness, in collaboration with Brunel University London. Brunel University London, London, UK, 30th October 2017.
Smith KJ. Investigating the association between loneliness and health (part of a symposium titled "Loneliness in older adults: Public health issue or moral panic"). Meeting of the British Society of Gerontology, Liverpool, UK, 10th-12th July 2019.
Smith KJ, Gavey S, Riddel N, Victor C. Investigating the association between inflammation and loneliness: A systematic review (part of a symposium titled "Loneliness in older adults: Public health issue or moral panic"). Meeting of the Gerontological Society of America, Boston, USA, 14th-19th November 2018.
Smith KJ, Kontari P. Risk of dementia associated with cardiometabolic abnormalities and depression. Meeting of the Gerontological Society of America, Boston, USA, 14th-19th November 2018.
Smith KJ, Peterson M, Victor C, Ryan J. Incidence of dementia in adults with cerebral palsy: a UK cohort study. Meeting of the Gerontological Society of America, Boston, USA, 14th-19th November 2018.
Smith KJ, Victor C. Investigating the longitudinal association between loneliness and cardiometabolic conditions. Meeting of the Gerontological Society of America, Boston, USA, 14th-19th November 2018.
Smith KJ, Peterson M, O'Connell N, Victor C, Liverani S, Anoyade N, Ryan J. The incidence of common mental illness in adults with Cerebral Palsy (as part of mini-symposium titled "Ageing with Cerebral Palsy: perspectives from the UK and USA"). European Association of Childhood Disability meeting, Tbilisi, Georgia, 28th-31st May 2018.
Chan C, Smith KJ (presenting author), Cockhaw W, Holmes-Truscott E, Ventura A, Browne J, Speight J. The relationship between social support, diabetes distress and blood glucose levels in people with diabetes: Diabetes-MILES Australia. Diabetes UK professional conference, London, UK 14th-16th March 2018
RESEARCH DESIGN AND METHODS A prospective community study in Quebec, Canada, was carried out between 2008 and 2013 (n = 1,064). Five yearly follow-up assessments (telephone interviews) were conducted. Baseline and the first three follow-up assessments were used to identify recurrent subthreshold depressive episodes (Patient Health Questionnaire [PHQ]-9). Functioning (World Health Organization Disability Assessment Schedule II [WHODAS-II]) and health-related quality of life (Centers for Disease Control and Prevention [CDC] unhealthy days) at 4- and 5-year follow-up assessments were the outcome measures.
RESULTS Nearly half of the participants suffered from at least one episode of subthreshold depressive symptoms. After adjusting for potentially confounding factors, the risk of poor functioning/impaired health?related quality of life was nearly three times higher (relative risk = 2.86) for participants with four subthreshold depressive episodes compared with participants with no/minimal depression. Results suggest a dose-response relationship: the risk of poor functioning/impaired health?related quality of life increased with the number of recurrent subthreshold depressive episodes even after controlling for potentially confounding variables (significant linear trend, P
CONCLUSIONS Recurrent subthreshold depressive symptoms might be an important risk factor for poor health outcomes in type 2 diabetes. Early identification, monitoring, and treatment of recurrent subthreshold depressive symptoms might improve functioning and quality of life in people with type 2 diabetes.
Results indicated a cross-sectional and longitudinal association between both CRP and IL-6 with depression in older adults, with inflammation leading to depression in longitudinal studies rather than depression to inflammation. However, there was notable heterogeneity between studies as results differed based on adjusting for confounders and on how inflammation and depression were measured. These sources of heterogeneity could explain differences in study results.
Previous research has indicated that there is an association between diabetes and anxiety. However, no synthesis has determined the direction of this association. Therefore, the aim of this study was to determine the longitudinal relationship between anxiety and diabetes.
We searched seven databases for studies examining the longitudinal relationship between anxiety and diabetes. Two independent reviewers screened studies from a population aged 16 or older that either a) examined anxiety as a risk factor for incident diabetes or b) examined diabetes as a risk factor for incident anxiety. Studies that met eligibility criteria were put forward for data extraction and meta-analysis.
In total 14 studies (n=1,760,800) that examined anxiety as a risk factor for incident diabetes and 2 studies (n=88,109) that examined diabetes as a risk factor for incident anxiety were eligible for inclusion in the review. Only studies examining anxiety as a risk factor for incident diabetes were put forward for the meta-analysis. The least adjusted (unadjusted or adjusted for age only) estimate indicated a significant association between baseline anxiety with incident diabetes (OR 1.47: 1.23-1.75). Furthermore, most-adjusted analyses indicated a significant association between baseline anxiety and incident diabetes. Included studies that examined diabetes to incident anxiety found no association.
There was an association between baseline anxiety with incident diabetes. Results also indicate the need for more research to examine the direction of association from diabetes to incident anxiety. This work adds to the growing body of evidence that poor mental health increases the risk of developing diabetes.
Importance: Cerebral palsy (CP) is considered a paediatric condition despite most people living into adulthood. Due to this we lack evidence in adults with CP, this includes a paucity of research examining mental health in this population.
Objectives: Determine the risk of depression and anxiety in adults with a diagnosis of CP compared with an age-, sex-, and practice-matched reference group of adults without CP, using primary care data.
Design, setting and participants: Retrospective longitudinal cohort study set in UK primary care. Data were analysed using Cox proportional hazards regression analyses adjusted for chronic conditions and visits to their physician. The study period ran from 1987 to 2015. Data for 1,705 adults aged 18 or older with CP and 5,115 matched adults who did not have CP were extracted. CP was identified using diagnostic codes, and each person with CP was compared with 3 age, sex and practice matched controls.
Exposure: Diagnosis of CP, with a second analysis accounting for co-morbidity of intellectual disability (ID).
Main outcomes: Time to diagnosis for depression or anxiety following the date of entry into the study in adults with CP (with and without ID) when compared with matched controls.
Results: The mean age of the CP and matched group was 33.3 and 46.8% (n=798) were female. People with CP had an increased adjusted hazard of depression (HR 1.28, 95% CI: 1.09-1.51) and anxiety (HR 1.40, 95% CI: 1.21-1.63) when compared with the matched reference group. When we accounted for ID co-morbidity there were 363 adults with CP who also had ID (mean age 32.1, 47.6% (n=159) female) and 1342 adults with CP who did not have ID (mean age 33.6, 43.8% (n=639) female). Only those people with CP and no co-morbid ID had a higher risk of incident depression (HR 1.44: 95% CI 1.20-1.72) and anxiety (HR 1.55: 95% CI 1.28-1.87) than their matched controls.
Conclusions: The results demonstrate that adults with CP have an increased risk of depression or anxiety. In particular, our results indicate that this association is driven largely by those individuals with CP with no co-occurring ID. Future work is needed in community-based samples in order to fully elucidate the causal mechanisms driving these associations.
Depression and cardiometabolic abnormalities are independently associated with a high risk of dementia. This study aimed to examine the association of comorbid depressive symptoms and cardiometabolic abnormalities with risk of dementia.
The sample comprised 4859 participants aged 50 or older without baseline dementia who took part in the English Longitudinal Study of Ageing (Waves 2-7). Depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression tool. Cardiometabolic abnormalities were defined as three or more cardiometabolic risk factors (inflammation, central obesity, raised triglycerides, low high-density lipoprotein (HDL) cholesterol, hypertension and hyperglycaemia or diabetes). Participants were classified into four groups based on presence of depressive symptoms and cardiometabolic abnormalities. Results were analysed using Cox Proportional Hazards Regression adjusted for covariates.
A total of 216 cases of incident dementia were reported over 10 years of follow-up. The group with high depressive symptoms only had an increased hazard of developing incident dementia during follow-up (HR 2.68, 95% CI [1.70 - 4.23]) which was attenuated after adjustment for baseline cognition. No evidence was found for an association of overall cardiometabolic abnormalities with incident dementia, though hyperglycaemia, hypertension and abdominal obesity with depressive symptoms had an unadjusted association with incident dementia. Only low-HDL cholesterol with depressive symptoms had an adjusted association with incident dementia (HR 0.18: 95% CI [0.04 ? 0.75]).
This work confirms depressive symptoms as a risk factor for incident dementia. However, low HDL-cholesterol with depressive symptoms may be protective against dementia, though more work is required to confirm this association.
Aim: To compare mortality rates for cardiovascular disease, cancer, and respiratory disease between adults with cerebral palsy (CP) and the general population.
Method: A cohort study was conducted using data from adults with CP in England, identified through a primary care dataset (the Clinical Practice Research Datalink), with linked data on death registrations from the Office for National Statistics. Cause of death was categorised according to ICD codes. Standardised mortality ratios were calculated to compare mortality rates between adults with CP and the general population, adjusted for age, sex, and calendar-year.
Results: 958 adults with CP were identified (median age at start of follow-up 31 yr; 52.5% males) and followed for a total of 7693 person-years. 142 patients (15%) died during follow-up. Adults with CP had an increased risk of death due to cardiovascular disease (SMR: 3.19, 95% CI 2.20 to 4.62) and respiratory disease (SMR: 13.59, 95% CI to 18.67), but not from malignant neoplasms (SMR: 1.42, 95% CI 0.83 to 2.45).
Interpretation: We found that adults with CP in England have increased risk of death due to diseases of the circulatory and respiratory systems, supporting findings from two studies that compared cause-specific mortality rates between adults with CP in the US and the general population. Further research is required into primary and secondary prevention of cardiovascular and respiratory disease in people with CP worldwide.
Current literature highlights higher prevalence rates of sleep difficulties amongst adults with an intellectual disability. However, no synthesis has been conducted to assess the effectiveness of existing interventions in this population. Thus, the aim of this review was to assess the effectiveness of sleep interventions in adults with an intellectual disability (ID).
Eight databases were searched to identify interventions for sleep difficulties amongst adults with an ID. The study quality was assessed with the Risk Of Bias In Non?randomised Studies ? of Interventions. Nine studies (n = 97) were eligible for inclusion in the review.
There was a notable study on heterogeneity in terms of the population, study design, intervention studied, sleep assessment and outcome assessments used. Eight of the nine studies reported improvement in sleep following intervention. However, these findings need additional support as only 97 participants involving a variety of interventions and measurement systems were used across all studies. Furthermore, eight of the nine studies had serious to critical risk of bias. The only study identified as having low risk of bias was a placebo?controlled randomised controlled trial for the use of melatonin.
This review highlights the need for objective measures such as actigraphy and studies with greater experimental control investigating sleep interventions in adults with ID.
Objective: This study aimed to compare the incidence of non-communicable diseases between
adults with and without cerebral palsy (CP).
Methods: A cohort study was conducted using primary care data from the Clinical Practice
Research Datalink. Cox models, stratified by matched set and adjusted for potential confounders,
were fitted to compare the risk of any non-communicable disease, cancer, cardiovascular disease,
type 2 diabetes, and respiratory disease between adults with and without CP.
Results: The analysis included 1,705 adults with CP and 5,115 age-, sex-, and general practice matched adults without CP. There was evidence from adjusted analyses that adults with CP had
75% increased risk of developing any non-communicable disease compared to adults without CP
(HR: 1·75, 95% CI 1·58 to 1·94). Specifically, they had increased risk of cardiovascular disease
(HR: 1.76, 95% CI 1.48 to 2.11) and respiratory disease (HR: 2.61, 95% CI 2.14 to 3.19). There
was no evidence of increased risk of cancer or type 2 diabetes.
Conclusions: Adults with CP had increased risk of non-communicable disease, specifically
cardiovascular and respiratory disease. These findings highlight the need for clinical vigilance
regarding identification of non-communicable disease in people with CP, and further research
into the etiology and management of non-communicable disease in this population.
People with cerebral palsy (CP) may be at increased risk of musculoskeletal conditions due to various factors including malnutrition and abnormal levels of skeletal loading. This study aimed to compare the incidence of osteoporosis, osteoarthritis and inflammatory musculoskeletal diseases between adults with and without CP.
A population based cohort study was conducted using data from the Clinical Practice Research Datalink collected between 1987 and 2015. Adults with CP were matched to adults without CP for age, sex and general practice. Cox models, stratified by matched set and adjusted for potential confounders, were fitted to compare the risk of osteoporosis, osteoarthritis and inflammatory musculoskeletal diseases.
1705 adults with CP were matched to 5115 adults without CP. Adults with CP had an increased risk of osteoporosis in unadjusted (Hazard Ratio (HR) 3.67, 95% Confidence Interval (CI) 2.32 to 5.80, p/Â/0.001) and adjusted (HR 6.19, 95% CI 3.37 to 11.39, p/Â/0.001) analyses. No evidence of increased risk of inflammatory musculoskeletal diseases was observed in unadjusted or adjusted analyses. For osteoarthritis no evidence of increased risk was seen in the unadjusted analysis, but evidence of an increased risk was seen when the analysis was adjusted for alcohol consumption, smoking status, and mean yearly general practice (GP) visits (HR 1.54, 95% CI 1.17 to 2.02, p/Â/0.001).
After accounting for potential confounding variables, we found that CP is associated with increased risk of osteoporosis and osteoarthritis. These findings provide the strongest epidemiological evidence to date for increased risk of osteoporosis and osteoarthritis in people with CP, and highlight need for clinical awareness of such conditions in this population.
Objective: Previous work suggests that diabetes stigma may be associated with poorer psychological wellbeing in people with type 2 diabetes. However, no study has determined whether social support might moderate this association. The primary aim of this study was to examine the association between diabetes-related stigma and symptoms of depression and anxiety. The secondary objective was to determine whether different forms of social support (i.e. generic social support or diabetes-specific social support) moderated the relationships between stigma and symptoms of depression and/or anxiety.
Research design and methods: An online survey was distributed through diabetes-related charities, social media and diabetes forums. Participants were 108 adults, aged 18 or older diagnosed with type 2 diabetes who lived in the United Kingdom (mean age 58.4 years old, 63.9% female). The survey asked about diabetes stigma, depressive symptoms, anxiety symptoms, generic social support and diabetes-specific social support. Data was analysed using linear regression; firstly, to determine the direct association between diabetes-stigma with depressive and anxiety symptoms, and then to examine whether generic and diabetes-specific social support moderated those associations.
Results: Type 2 diabetes-related stigma predicted depressive symptoms after adjusting for all covariates (² = 0.284, p Â .05). Type 2 diabetes-related stigma predicted anxiety symptoms when sociodemographics were controlled for (² = 0.249, p Â .05), but this relationship was attenuated by the inclusion of diabetes characteristics (² = 0.188, ns). Neither form of social support functioned as a moderator in these relationships.
Conclusion: This study lends support to previous research which has found an association between type 2 diabetes-related stigma and psychological wellbeing. This indicates the need for interventions to reduce type 2 diabetes-related stigma and to improve psychological wellbeing amongst individuals with the condition.
To compare the rate of falls between adults with and without cerebral palsy (CP).
We used primary care data on 1705 adults with CP and 5115 adults without CP matched for age, sex, and general practice attended. We compared odds of experiencing a fall between adults with and without CP using conditional logistic regression. We compared the rate of falls using a negative binomial model.
Participants were 3628 males (53%) and 3192 females (47%) (median age 29y, interquartile range 20?42y) at the start of follow?up. Follow?up was 14 617 person?years for adults with CP and 56 816 person?years for adults without CP. Of adults with CP, 15.3% experienced at least one fall compared to 5.7% of adults without CP. Adults with CP had 3.64 times (95% confidence interval [CI] 2.98?4.45) the odds of experiencing a fall compared to adults without CP. The rate of falls was 30.5 per 1000 person?years and 6.7 per 1000 person?years for adults with and without CP respectively (rate ratio 5.83, 95% CI 4.84?7.02)
Adults with CP are more likely to fall, and fall more often, than adults without CP. The causes and consequences of falls in adults with CP need examination.
Methods: Two data-sets were used. 7,848 participants from the Health Survey for England (HSE) 2016 (549 with T2DM) completed the General Health Questionnaire-12 (GHQ-12) and Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and reported average weekly alcohol consumption in units. Sixty-one UK participants with T2DM were recruited through diabetes peer-support websites to complete a survey, comprising the Alcohol Use Disorder Identification Test (AUDIT), WEMWBS, Diabetes Self-Management Questionnaire (DSMQ), and Diabetes Distress Scale (DDS). Spearman?s rank correlations, Chi-squared, Mann-Whitney U, and Kruskal-Wallis tests were used to explore the relationships between alcohol consumption and mental wellbeing (WEMWBS) in both samples, psychological distress (GHQ-12) from the HSE, and diabetes-related distress (DDS) and self-management (DSMQ) from the online survey.
Results: From HSE data, people with T2DM were more likely to be non-drinkers (OR=2.087) and to have poorer mental wellbeing (p Conclusions: Alcohol consumption is less prevalent among people with T2DM than the general population but may be associated with difficulties in some aspects of self-management. Drinking is associated with lower psychological distress than non-drinking among people with T2DM. Tentative clinical recommendations are made based on these findings and areas for further research are suggested.
Keywords: type 2 diabetes, alcohol, self-management, distress, wellbeing