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Biomedical subjects

Andre Tylee

Publications and source records attributed to Andre Tylee.

16 recordsLinked to original sources
PubMed2006

District nursing staff and depression: a psychometric evaluation of Depression Attitude Questionnaire findings.

BACKGROUND: Mental health problems such as depression are common in primary care settings and patients with chronic medical problems are at an increased risk. This co-morbidity suggests that district nursing services are particularly likely to encounter psychological problems in their patients. Mental health problems are poorly recognised and inadequately treated in primary care. In part this may be due to stigmatising views of mental illness, which negatively influence help-seeking and user experiences. Likewise providers' attitudes are likely to play a significant part in the management of such problems. OBJECTIVES: The aims of this study were extend knowledge of district nursing staff attitudes to depression and explore the psychometric properties of a depression attitude measure used with this staff group. DESIGN AND SETTINGS: The Depression Attitude Questionnaire (DAQ) was used within a postal questionnaire survey of district nursing services in three areas, Jersey (Channel Islands), Lewisham, and Hertfordshire. PARTICIPANTS: All staff (community nurses, district nurses and home care staff) were contacted; 217 (66%) staff responded to the survey, and 189 (57%) completed the DAQ. RESULTS: Three factors were derived from the DAQ accounting for 47% of the variance. The factor solution appeared stable and provided meaningful dimensions, however the internal consistency of the measure and of its derived subscales was low (Cronbach's alpha between 0.59 and 0.64). The factors were labelled pessimism about depression and its treatment, tendency to defer to specialists, and professional ease in working with depressed patients. Staff responses revealed generally optimistic views concerning depression treatment, strongly rejecting deterministic attitudes to this condition. CONCLUSIONS: The DAQ has been widely employed to measure and compare attitudes of staff from various disciplines and specialisms. The current evaluation has provided a more detailed examination of its psychometric properties than previously available, but low internal consistency levels indicate further examination of this area is warranted.

Analysis of Variance↗
PubMed2006

Primary care professionals' perceptions of depression in older people: a qualitative study.

An understanding of patients' perspectives is crucial to improving engagement with health care services. For older people who may not wish to bother medical professionals with problems of living such as depression, such exploration becomes critical. General practitioners (GPs), nurses and counsellors working in 18 South London primary care teams were interviewed about their perceptions of depression in older people. All three professional groups shared a predominantly psychosocial model of the causes of depression. While presentation of somatic symptoms was seen as common in all age groups, identification of depression in older patients was complicated by co-existent physical illnesses. GPs reported that older patients rarely mentioned psychological difficulties, but practice nurses felt that older people were less inhibited in talking to them about "non-medical" problems. Many older people were perceived to regard symptoms of depression as a normal consequence of ageing and not to think it appropriate to mention non-physical problems in a medical consultation. Men were thought to be particularly reluctant to disclose emotional distress and were more vulnerable to severe depression and suicide. Some GPs had mixed feelings about offering medication to address what they believed to be the consequences of loneliness and social isolation. Participants thought that many older people regard depression as a "sign of weakness" and the perceived stigma of mental illness was widely recognised as a barrier to seeking help. Cultural variations in illness beliefs, especially the attribution of symptoms, were thought to profoundly influence the help-seeking behaviour of elders from minority ethnic groups. Families were identified as the main source of both support and distress; and as such their influence could be crucial to the identification and treatment of depression in older people.

Adult↗
PubMed2006

Concepts and causation of depression: a cross-cultural study of the beliefs of older adults.

PURPOSE: This U.K. study explored how older adults with depression (treated and untreated) and the general older population conceptualize depression. A multicultural approach was used that incorporated the perspectives of Black Caribbean, South Asian, and White British older adults. The study sought to explore and compare beliefs about the nature and causes of depression, and to suggest ways in which these beliefs act to facilitate or deter older people from accessing treatment. DESIGN AND METHODS: One hundred and ten in-depth separate interviews were conducted for 45 White British, 33 South Asian, and 32 Black Caribbean individuals. The interviews explored what the word depression meant to participants, and their beliefs regarding depression's causes. RESULTS: Depression was often viewed as an illness arising from adverse personal and social circumstances that accrue in old age. White British and Black Caribbean participants defined depression in terms of low mood and hopelessness; South Asian and Black Caribbean participants frequently defined depression in terms of worry. Those receiving antidepressants were more likely to acknowledge psychological symptoms of depression. Differences in attribution were found between the ethnic groups. IMPLICATIONS: A social model of depression is closer to the beliefs of older people than the traditional medical model. Culturally appropriate inquiries about recent life events could be used to facilitate discussion about depression. Our data suggest that many older adults would respond to probing by primary care physicians about their mood. Health and social care professionals need to be sensitive to the language of depression used by different ethnic groups.

Aged↗
PubMed2006

Identifying and managing depression in primary care in the United kingdom.

The Depression Guideline Panel for the National Institute for Clinical Excellence (NICE) in England has developed a stepped-care model for the recognition and treatment of depression in primary care. The first 3 steps of the model apply to primary care settings and were developed to help primary care professionals overcome barriers to recognizing depression. The somatic symptoms of depression present the most significant barrier to recognition because patients who somatize their symptoms will often lead their physician to think there is a physical reason for the symptoms. This preoccupation with physical illness often delays or prevents diagnosis. Step 1 of the care model focuses on recognizing depression by initially assessing patient mood and interest. Step 2 suggests nonpharmacologic therapies for patients who have mild depression, and step 3 suggests pharmacologic and nonpharmacologic therapies for patients who have moderate-to-severe depression. Improving awareness of the symptoms of depression and physician core skills through guideline-driven practice will hopefully increase the recognition rates for depression in England.

Antidepressive Agents↗
PubMed2006

Consensus statement and research needs: the role of dopamine and norepinephrine in depression and antidepressant treatment.

During a special session, the faculty identified several specific areas related to the role of dopamine and norepinephrine in depression and antidepressant treatment that either warrant the clinician's attention or are in need of more research. Areas of interest include fatigue and lethargy in depression, treatment strategies for treatment-resistant depression, the somatic presentation of depression, neurobiology of fatigue and its role in determining treatment, symptom rating scales, and sexual side effects. In addition, the faculty discussed the importance of patient psychoeducation and self-management as well as the ways in which disease models of depression affect treatment.

Antidepressive Agents↗
PubMed2004

Assessing the prevalence of depression in Punjabi and English primary care attenders: the role of culture, physical illness and somatic symptoms.

Previous studies exploring the prevalence of depression among South Asians reported inconsistent findings. Research artefacts due to sampling bias, measurements errors and a failure to include ethnographic methods may all explain this. We estimated the prevalence of depression, and variations of prevalence with culture, cultural adaptation, somatic symptoms and physical disability in a cross-sectional primary care survey of Punjabi and English attendees. We included a culture specific screening instrument, culturally adapted the instruments and offered bilingual interviews. We found that, compared with their English counterparts, depressive diagnoses were more common among Punjabis, Punjabi women, Punjabis with physical complaints and, contrary to expectation, even Punjabis with low scores for somatic symptoms.

Acculturation↗
PubMed2004

Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial.

BACKGROUND: Preliminary results have demonstrated the clinical efficacy of computerised cognitive-behavioural therapy (CBT) in the treatment of anxiety and depression in primary care. AIMS: To determine, in an expanded sample, the dependence of the efficacy of this therapy upon clinical and demographic variables. METHOD: A sample of 274 patients with anxiety and/or depression were randomly allocated to receive, with or without medication, computerised CBT or treatment as usual, with follow-up assessment at 6 months. RESULTS: The computerised therapy improved depression, negative attributional style, work and social adjustment, without interaction with drug treatment, duration of preexisting illness or severity of existing illness. For anxiety and positive attributional style, treatment interacted with severity such that computerised therapy did better than usual treatment for more disturbed patients. Computerised therapy also led to greater satisfaction with treatment. CONCLUSIONS: Computer-delivered CBT is a widely applicable treatment for anxiety and/or depression in general practice.

Adult↗
PubMed2004

Cost-effectiveness of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial.

BACKGROUND: Cognitive-behavioural therapy (CBT) is effective for treating anxiety and depression in primary care, but there is a shortage of therapists. Computer-delivered treatment may be a viable alternative. AIMS: To assess the cost-effectiveness of computer-delivered CBT. METHOD: A sample of people with depression or anxiety were randomised to usual care (n=128) or computer-delivered CBT (n=146). Costs were available for 123 and 138 participants, respectively. Costs and depression scores were combined using the net benefit approach. RESULTS: Service costs were 40 British pounds (90% CI - 28 British pounds to 148 British pounds) higher over 8 months for computer-delivered CBT. Lost-employment costs were 407 British pounds (90% CI 196 British pounds to 586 British pounds) less for this group. Valuing a 1-unit improvement on the Beck Depression Inventory at 40 British pounds, there is an 81% chance that computer-delivered CBT is cost-effective, and it revealed a highly competitive cost per quality-adjusted life year. CONCLUSIONS: Computer-delivered CBT has a high probability of being cost-effective, even if a modest value is placed on unit improvements in depression.

Adult↗
PubMed2004

Duloxetine Treatment of Stress Urinary Incontinence in Women Does Not Induce Mania or Hypomania.

BACKGROUND: Mania is a rare but unwelcome side effect of treating depressed patients with antidepressants. This research sought to determine the risk of treatment-emergent mania or hypomania in women with stress urinary incontinence treated with duloxetine, a balanced dual serotonin-norepinephrine reuptake inhibitor currently under investigation for the treatment of both stress urinary incontinence and major depressive disorder. METHOD: Data were obtained from 4 double-blind, randomized, placebo-controlled studies involving 1913 women aged 22 to 83 years and 4 ongoing uncontrolled longer-term studies involving 1877 women aged 20 to 87 years. In all studies, women had the predominant symptom of stress urinary incontinence; in the active treatment arms, all women received duloxetine 80 mg/day. Women receiving antidepressants for major depressive disorder were excluded. In the placebo-controlled studies, 1 woman reported a history of bipolar disorder and 74 women reported a history of depression. In the uncontrolled longer-term studies, 1 woman reported a history of bipolar disorder and 69 reported a history of depression. RESULTS: In the placebo-controlled trials, 1 woman treated with duloxetine reported euphoria, while 1 reported mania and 1 reported euphoria when on placebo. In the uncontrolled longer-term studies, 1 woman reported mania; 1, euphoria; and 4, elevated moods. No women discontinued the study due to treatment-emergent mood elevation. CONCLUSION: These data suggest that duloxetine does not induce mania or hypomania in women with stress urinary incontinence in this population, in which few women had a history of bipolar disorder or depression and women on antidepressants were excluded.

Journal Article↗
PubMed2002

A European perspective on depression in the community: the DEPRES study.

Depression is one of the most prevalent disorders in the general population, causing personal and social disability and impairment. Major studies assessing the diagnosis and management of depression have shown that it is often underdiagnosed and undertreated. A pan-European study aimed at assessing the extent and consequences of depression in six different countries is reported in this article. Different types of depressive profiles are analyzed and their respective management has been compared. The importance of improving diagnosis and treatment of depression is underlined. Appropriate management of depression depends on the recognition of depressive symptoms by patients, their possibility of seeking care, and the ability of the primary care physician to recognize the disorder and prescribe the appropriate medicines. Improvement in all of these fields is necessary.

Journal Article↗
PubMed2002

Knowledge, confidence and attitudes towards mental health of nurses working in NHS Direct and the effects of training.

BACKGROUND: NHS Direct, the United Kingdom's 24-hour nurse-led telephone advice service, was announced in December 1997. By November 2000 the service was available throughout England and Wales. Initial research had shown that people with mental health problems used the service and that, prior to its going live, this was one area about which nurses felt least confident. AIMS: The aim of the study was to measure confidence in dealing with mental health calls, knowledge of mental health issues, and attitudes to mental health before and after training. METHODS: A postal questionnaire was sent to all nurse advisers working in 17 NHS Direct sites in England before and after mental health training had been received. The questionnaire was designed to measure confidence, knowledge and attitudes. This was done through scenarios of real calls to NHS Direct, questions from the World Health Organization guide to Mental Health in Primary Care and the Depression Attitude Questionnaire. RESULTS: Confidence increased in nurses who received mental health training. Although there was no statistically significant increase in knowledge scores after training, those who had received training increased by on average one point. After training, attitudes towards depression had shifted in that nurses now felt more positive towards their role in treating depressed patients. CONCLUSIONS: Training in mental health can lead to increases in confidence and a change in attitudes and would be beneficial for all nurses working in NHS Direct and in other primary care fields. It would also be beneficial to repeat the study with a larger number of nurses and after a longer period of time to assess the long-term effects of training.

Adult↗
PubMedDate not supplied

'Antidepressants unlimited'. Are antidepressants the best option for treating depression in general practice? Debating session WONCA 2004.

Antidepressants are among the worlds' most prescribed drugs. However, there are several controversies around their extensive use in primary care, and doubts about their effects, especially in children and older people. Psychological interventions are probably at least as effective as antidepressants, and are preferred by many patients. These issues were discussed at the debating sessions at WONCA 2004 in Amsterdam.

Antidepressive Agents↗