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Investigating the lesser known symptoms of depression and anxiety

Researchers at the NCMH have been investigating how memory, concentration, and problem-solving skills are impacted by mental illness, and how the internet can be used to treat more people using an innovative digital assessment, the Cardiff ONline Cognitive Assessment (CONCA).

Many people who face mental health challenges report difficulties with their memory and concentration, this is also known as cognition. These difficulties can range from mild issues to severe difficulties impacting work and the ability to manage household and social relationships.

For some diagnoses such as psychosis, these challenges are well researched and the underlying causes are beginning to be understood.

However, for other diagnoses, we are only just starting to recognise these difficulties, and we know very little about the causes and extent of these challenges.

What is CONCA?

CONCA is an online assessment tool developed at the NCMH to assess the cognitive difficulties that are specifically associated with mental health diagnoses, such as psychosis and depression.

The assessment consists of five tasks, like games or puzzles, which measure things like the ability to remember information, recognise facial expressions, and solve problems.

Does everyone with a mental health diagnosis face cognitive challenges?

Since 2017, over 1200 people from the NCMH cohort have completed our memory and concentration assessment (CONCA) and provided information about their diagnoses, medication, symptoms, and day-to-day functioning.

The people we surveyed reported a range of diagnoses, including depression, anxiety, bipolar disorder, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), and schizophrenia. Over two-thirds of people who started the assessment were able to finish the full hour-long assessment.

We wanted to establish whether a history of mood disorders or psychosis were associated with cognitive difficulty, and found that people who reported a diagnosis of schizophrenia were most likely to show challenges with their cognition.

The extent of cognitive function varied from person to person, with some people showing no difficulties. But on average, people with a diagnosis of schizophrenia displayed clinically significant impairments in memory, concentration, and problem-solving skills.

People with a history of bipolar disorder or major depression also experienced difficulties with their cognition. However, these were less severe than those seen in people with schizophrenia.

Crucially, we looked at whether people facing cognitive challenges reported difficulties in their day to day lives, regardless of their mental health diagnosis.

What did we find out?

We found that people facing cognitive challenges were more likely to report difficulties in several areas of their life, including managing household responsibilities, work or school, dealing with people, and looking after themselves.

We wanted to see if we would find similar results in a larger sample of the Welsh population. To do this, in 2020 we teamed up with HealthWise Wales, a large online study of people living in Wales, and asked their participants to complete CONCA.

This helped us identify people who may be experiencing symptoms of mental illness but may not have sought help for them.

We found that people who experience symptoms of depression and anxiety had poorer cognition, even if they didn’t report having a diagnosis of these conditions.

This illustrates the wider impact that mental illness can have on memory and concentration problems. Additionally, just as our initial NCMH study indicated, these cognitive challenges resulted in day-to-day difficulties with functioning.

Cognition and disability

We also wanted to examine what factors might explain the relationship between cognition and reported disability across both samples.

We found that cognitive problems predicted difficulties with mobility, self-care, managing the household, social relationships and interacting with the community. This was partly (but not completely) explained by the fact that people with cognitive problems were more likely to be experiencing symptoms of depression and anxiety at the time of the assessment.

Lifestyle factors, such as activity levels, alcohol consumption and smoking, did not explain any of the relationship between cognition and disability.

What do these results tell us?

These results raise important implications for how patients are treated in clinics.

Currently, cognitive impairments are poorly recognised in health settings and treatment options are limited. Therefore, we are developing a tool that can help doctors and nurses to measure patients’ memory and concentration to help them better understand individual cognitive function and plan their care accordingly.

To do this, we are working with health professionals and people with lived experience to create a new programme that will provide a report for health professionals when someone is assessed in a clinic.

In addition to this, we’ve listened to participant suggestions and have added a feature on the CONCA website to provide feedback on individual task scores.

The new version of the website which will be released shortly includes a “My Profile” page, which gives information about personal scores, tracks changes in performance over time and gives more information about the tasks and what they measure.

Future plans for the CONCA programme also include looking at cognitive impairments in other diagnoses, such as anxiety disorders and post-traumatic stress disorder (PTSD).

Find out more about the Cardiff ONline Cognitive Assessment (CONCA)


NCMH leaflet | Schizophrenia

NCMH leaflet | Anxiety and panic attacks

MIND | What is psychosis?

Dr Amy Lynham

Dr Amy Lynham is a Research Associate at the NCMH with a focus on the relationship between mental health conditions and cognition.

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National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ

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