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Biomedical subjects

C Dowrick

Publications and source records attributed to C Dowrick.

At least 19 recordsLinked to original sources
PubMed2006

Predictors of compliance with psychological interventions offered in the community.

BACKGROUND: This study sought to evaluate the acceptance of two brief psychological interventions for depressed individuals, contacted through a community survey, and to look for predictors of adherence at the patient level. METHOD: The authors used data from the Outcomes of Depression International Network (ODIN) study, which included a randomized controlled trial in which depressed individuals from five European countries, and nine geographical areas were assigned to one of three groups: individual problem-solving treatment, group psychoeducation, or control group. In this analysis, we included all of the individuals who had been assigned to one of the psychological interventions. Compliance with intervention was defined in two different ways. Multiple logistic regression was used to see which variables might predict an individual's compliance with psychological treatment. RESULTS: Psychological intervention was offered to 236 subjects. Treatment was completed by 128 subjects and not by 108 (compliance definition A). Three variables were found to have an effect on compliance A: the presence of a confidant, the use of antidepressant medication during the previous 6 months, and the previous use of any social or health services. On the other hand, 164 subjects had agreed to at least start the treatment, and 72 had not (compliance definition B). The three factors associated with compliance B were presence of a confidant, previous use of services, and the 'desire for change' score. CONCLUSIONS: Social support and previous use of services are the main predictors of compliance with a psychological treatment in depressed individuals from the community. Implications for clinical practice and community programs are discussed.

Adult↗
PubMed2006

Fatigue Intervention by Nurses Evaluation--the FINE Trial. A randomised controlled trial of nurse led self-help treatment for patients in primary care with chronic fatigue syndrome: study protocol. [ISRCTN74156610].

BACKGROUND: Chronic fatigue syndrome, also known as ME (CFS/ME), is a condition characterised primarily by severe, disabling fatigue, of unknown origin, which has a poor prognosis and serious personal and economic consequences. Evidence for the effectiveness of any treatment for CFS/ME in primary care, where most patients are seen, is sparse. Recently, a brief, pragmatic treatment for CFS/ME, based on a physiological dysregulation model of the condition, was shown to be successful in improving fatigue and physical functioning in patients in secondary care. The treatment involves providing patients with a readily understandable explanation of their symptoms, from which flows the rationale for a graded rehabilitative plan, developed collaboratively with the therapist. The present trial will test the effectiveness and cost-effectiveness of pragmatic rehabilitation when delivered by specially trained general nurses in primary care. We selected a client-centred counselling intervention, called supportive listening, as a comparison treatment. Counselling has been shown to be as effective as cognitive behaviour therapy for treating fatigue in primary care, is more readily available, and controls for supportive therapist contact time. Our control condition is treatment as usual by the general practitioner (GP). METHODS AND DESIGN: This study protocol describes the design of an ongoing, single-blind, pragmatic randomized controlled trial of a brief (18 week) self-help treatment, pragmatic rehabilitation, delivered by specially trained nurse-therapists in patients' homes, compared with nurse-therapist delivered supportive listening and treatment as usual by the GP. An economic evaluation, taking a societal viewpoint, is being carried out alongside the clinical trial. Three adult general nurses were trained over a six month period to deliver the two interventions. Patients aged over 18 and fulfilling the Oxford criteria for CFS are assessed at baseline, after the intervention, and again one year later. Primary outcomes are self-reported physical functioning and fatigue at one year, and will be analysed on an intention-to-treat basis. A qualitative study will examine the interventions' mechanisms of change, and also GPs' drivers and barriers towards referral.

Clinical Protocols↗
PubMed2004

A pragmatic cluster randomized controlled trial of an educational intervention for GPs in the assessment and management of depression.

BACKGROUND: General practitioners (GPs) can be provided with effective training in the skills to manage depression. However, it remains uncertain whether such training achieves health gain for their patients. METHOD: The study aimed to measure the health gain from training GPs in skills for the assessment and management of depression. The study design was a cluster randomized controlled trial. GP participants were assessed for recognition of psychological disorders, attitudes to depression, prescribing patterns and experience of psychiatry and communication skills training. They were then randomized to receive training at baseline or the end of the study. Patients selected by GPs were assessed at baseline, 3 and 12 months. The primary outcome was depression status, measured by HAM-D. Secondary outcomes were psychiatric symptoms (GHQ-12) quality of life (SF-36), satisfaction with consultations, and health service use and costs. RESULTS: Thirty-eight GPs were recruited and 36 (95%) completed the study. They selected 318 patients, of whom 189 (59%) were successfully recruited. At 3 months there were no significant differences between intervention and control patients on HAM-D, GHQ-12 or SF-36. At 12 months there was a positive training effect in two domains of the SF-36, but no differences in HAM-D, GHQ-12 or health care costs. Patients reported trained GPs as somewhat better at listening and understanding but not in the other aspects of satisfaction. CONCLUSIONS: Although training programmes may improve GPs' skills in managing depression, this does not appear to translate into health gain for depressed patients or the health service.

Adolescent↗
PubMed2003

Estimating psychological treatment effects from a randomised controlled trial with both non-compliance and loss to follow-up.

BACKGROUND: The Outcomes of Depression International Network (ODIN) trial evaluated the effect of two psychological interventions for the treatment of depression in primary care. Only about half of the patients in the treatment arm complied with the offer of treatment, prompting the question:'what was the effect of treatment in those patients who actually received it?' AIMS: To illustrate the estimation of the effect of receipt of treatment in a randomised controlled trial subject to non-compliance and loss to follow-up. METHOD: We estimated the complier average causal effect (CACE) of treatment. RESULTS: In the ODIN trial the effect of receipt of psychological intervention (an average of about 4 points on the Beck Depression Inventory) is about twice that of offering it. CONCLUSIONS: The statistical analysis of the results of a clinical trial subject to non-compliance to allocated treatment is now reasonably straightforward through estimation of a CACE and investigators should be encouraged to present the results of analyses of this type as a routine component of a trial report.

Data Interpretation, Statistical↗
PubMed2001

A preliminary communication on whether general dental practitioners have a role in identifying dental patients with mental health problems.

OBJECTIVE: To examine whether general dental practitioners regard themselves as having a role in identifying dental patients with mental health problems. METHOD: Telephone interviews were conducted with, and postal questionnaires were sent to, a random sample (n = 94) of general dental practitioners on Health Authority lists within the Mersey Region. A total of 84 general dental practitioners responded, resulting in an 89% response rate. RESULTS: The majority of general dental practitioners had encountered patients with mental health problems (78% of interviewees, 56% of questionnaire responders). However, nearly half of the interviewees (46%) do not refer patients with mental health problems. When referrals to dental specialists were made, they tended to be regarding a physical manifestation rather than a psychological one. The majority of interviewees and questionnaire responders (55% and 82% respectively) expressed a 'positive' response to the development of a referral role. Nevertheless, there were some reservations concerning the practicalities of its development and implementation. CONCLUSION: The majority of general dental practitioners consider a role in identifying patients with possible mental health problems. This role might include, being able to identify patients with undiagnosed mental health problems, and being aware of dental conditions which may be caused by mental health problems. To achieve this, inter-professional co-operation between general dental practitioners and other health professionals requires development.

Attitude of Health Personnel↗
PubMed2001

Developing mental health services in a primary care setting: Liverpool Primary Care Mental Health Project.

The Liverpool Primary Care Mental Health Project (PCMHP) was set up in 1996 to provide mental health services in a primary care setting. This study describes and evaluates an impact of a working model of a multi-disciplinary team in close association with five Liverpool practices. The data were collected on all patients who came in contact with the PCMHP team during a three-year period and compared with the data available for the five neighboring teams on waiting time between referral and assessment, clinical outcome, in-patient bed usage, GPs' and patients' satisfaction with services. The number of new referrals remained the same over three years. The usage of inpatient beds dropped by 38% in the same period. Waiting time between referral and assessment for new patients reduced from six weeks to one-two weeks. GP's were highly satisfied with access to CMH Nurses, overall communication with the team and overall delivery of the services. Over 80% of patients were satisfied with the services. Integrated mental health services with primary care proved to be effective and satisfactory to GPs as well as to patients. This approach did not increase the workload of the mental health team.

Community Mental Health Services↗
PubMed2001

Seasonal affective disorder: prevalence, detection and current treatment in North Wales.

BACKGROUND: There is a paucity of information concerning the prevalence and detection of seasonal affective disorder (SAD) in UK populations. AIMS: To determine the prevalence, detection and current treatment of SAD within a general population sample. METHOD: The study was conducted in conjunction with the Outcomes of Depression International Network (ODIN) project, a large European study of depression. At the North Wales arm of the project, 1999 adults were randomly selected from a health authority database and screened by post for SAD with the Seasonal Patterns Assessment Questionnaire (SPAQ). Those scoring above cut-off were offered diagnostic interview, after which diagnosis of SAD according to DSM-IV criteria could be made. RESULTS: The prevalence rate of SAD was calculated to be 2.4% (95% CII.4-1.3). The majority of identified cases had not previously received a diagnosis of SAD from their general practitioner, although over half had been diagnosed with other forms of depression and had been prescribed antidepressant medication. CONCLUSIONS: Although SAD was found to be common in this general population sample it appeared to be largely underdiagnosed and/or misdiagnosed.

Adolescent↗
PubMed2001

Depressive disorders in Europe: prevalence figures from the ODIN study.

BACKGROUND: This is the first report on the epidemiology of depressive disorders from the European Outcome of Depression International Network (ODIN) study. AIMS: To assess the prevalence of depressive disorders in randomly selected samples of the general population in five European countries. METHOD: The study was designed as a cross-sectional two-phase community study using the Beck Depression inventory during Phase 1, and the Schedule for Clinical Assessment in Neuropsychiatry during Phase 2. RESULTS: An analysis of the combined sample (n=8.764) gave an overall prevalence of depressive disorders of 8.56% (95% CI 7.05-10.37). The figures were 10.05% (95% CI 7.80-12.85) for women and 6.61% (95% CI 4.92-8.83) for men. The centres fall into three categories: high prevalence (urban Ireland and urban UK), low prevalence (urban Spain) and medium prevalence (the remaining sites). CONCLUSIONS: Depressive disorder is a highly prevalent condition in Europe. The major finding is the wide difference in the prevalence of depressive disorders found across the study sites.

Adolescent↗
PubMed2000

Problem solving treatment and group psychoeducation for depression: multicentre randomised controlled trial. Outcomes of Depression International Network (ODIN) Group.

OBJECTIVES: To determine the acceptability of two psychological interventions for depressed adults in the community and their effect on caseness, symptoms, and subjective function. DESIGN: A pragmatic multicentre randomised controlled trial, stratified by centre. SETTING: Nine urban and rural communities in Finland, Republic of Ireland, Norway, Spain, and the United Kingdom. PARTICIPANTS: 452 participants aged 18 to 65, identified through a community survey with depressive or adjustment disorders according to the international classification of diseases, 10th revision or Diagnostic and Statistical Manual of Mental Disorders, fourth edition. INTERVENTIONS: Six individual sessions of problem solving treatment (n=128), eight group sessions of the course on prevention of depression (n=108), and controls (n=189). MAIN OUTCOME MEASURES: Completion rates for each intervention, diagnosis of depression, and depressive symptoms and subjective function. RESULTS: 63% of participants assigned to problem solving and 44% assigned to prevention of depression completed their intervention. The proportion of problem solving participants depressed at six months was 17% less than that for controls, giving a number needed to treat of 6; the mean difference in Beck depression inventory score was -2. 63 (95% confidence interval -4.95 to -0.32), and there were significant improvements in SF-36 scores. For depression prevention, the difference in proportions of depressed participants was 14% (number needed to treat of 7); the mean difference in Beck depression inventory score was -1.50 (-4.16 to 1.17), and there were significant improvements in SF-36 scores. Such differences were not observed at 12 months. Neither specific diagnosis nor treatment with antidepressants affected outcome. CONCLUSIONS: When offered to adults with depressive disorders in the community, problem solving treatment was more acceptable than the course on prevention of depression. Both interventions reduced caseness and improved subjective function.

Adolescent↗
PubMed2000

Do general practitioners' attitudes towards depression predict their clinical behaviour?

BACKGROUND: GPs' attitudes towards depression vary, as do their abilities to detect and manage it effectively. Associations between attitudes and clinical behaviour have not yet been demonstrated directly. We tested two hypotheses: (1) that questionnaire measures of GPs' confidence in identifying depression predict their ability to identify depression in their patients; and (2) that GPs who prefer antidepressants prescribe more than those who prefer psychotherapy. METHODS: Forty GPs in Liverpool and Manchester completed the Depression Attitude Questionnaire (DAQ) and were asked for prescribing (PACT) information. Attender surveys using the General Health Questionnaire (GHQ-12), in combination with GP ratings of patients' psychological status, generated indices for GPs' case identification, bias and accuracy. We tested associations between these indices and the four DAQ components, in particular GPs' confidence in diagnosis, across a total of 1436 patients. We also compared the DAQ component on attitudes to treatment with relevant PACT data. RESULTS: The DAQ assessment of GPs' ability to identify cases of depression bore no relationship to their observed ability, as measured by accuracy, bias, or identification indices. However, there were significant associations between observed diagnostic ability and: preference for psychotherapy; ease in managing depression; and, belief in successful treatment. PACT data were available for 26 (65%) GPs. There was an association between preference for antidepressants and prescription of SSRIs (rs 0.3981, P < 0.044), but not for overall antidepressant or tricyclic prescribing, or for dose of dothiepin. CONCLUSIONS: The DAQ measure of ease of identification is not valid when compared to actual clinical practice. The ability of GPs to identify depression may not be an independent variable, but may rather reflect other beliefs, attitudes and skills. This has considerable implications for educational interventions in primary care.

Adolescent↗
PubMed2000

The educational challenge of mental health.

This paper poses a series of fundamental educational challenges about mental health. First, it questions whether 'mental health' is a valid concept, in the light of debates over mind/body dualism. If the concept is valid, should the absence of mental health be seen as an illness, an adaptive strategy or simply a statistical eccentricity? Fulford's concept of 'failure of intentional action' is commended as a philosophical basis for unravelling these issues. Secondly, the paper considers whether diagnosis is a simple or complex process, and whether it can be an objective activity or one which involves a strong subjective element. The current and potential value of multiaxial classification systems are discussed. Thirdly, themes concerning mental health treatment are introduced, covering problems with consent and patient preference, the evidential basis of interventions, and the range and limitations of possible treatments. Finally, the paper reviews the educational processes needed to meet these challenges effectively. It recommends the development of multifaceted educational programmes, nurturing a spirit of critical enquiry and personal awareness and, above all, the recognition and toleration of the uncertainty and complexity which lie at the heart of successful medical practice.

Education, Medical↗
PubMed2000

Homeopathy and general practice: an urban perspective.

Complementary medicine appears to be an increasingly popular option amongst both doctors and patients. General practitioners (GPs) in more affluent parts of Britain have showed considerable interest in its use. Our objectives were to ascertain the use of and attitudes towards homeopathy amongst GPs working in a socio-economically deprived urban area such as Liverpool. A postal questionnaire survey was carried out of all general practice principals in Liverpool, using freepost envelopes and one reminder after three weeks. With respect to eight common complementary therapies in general and homeopathy in particular, respondents were asked whether they treat with, refer to or endorse each therapy; and their views were questioned on NHS funding, effectiveness, adverse reactions, training needs and theoretical validity, for each therapy. The response rate was 131/252 (52%), and was higher amongst women and doctors aged under 40 y. During the previous week 37 (28%) GPs had been involved in homeopathy with their patients: 6.5% had treated directly, 18.5% had referred to, and 7% had endorsed homeopathy. 31% of GPs reported successful outcomes by homeopathic treatment compared with 14% reporting adverse effects. Respondents were generally uncertain about the validity of the theoretical basis of homeopathy; only 23% considered it to have a valid basis.

Adult↗
PubMed2000

Welfare to work: the role of general practice.

This paper considers the potential effects of the government's Welfare to Work policy on general practitioner (GP) working patterns, and aims to explore the relationship between unemployment, ill health, and GP sickness certification. Social security and employment policy initiatives are discussed in relation to the literature on the relationship between unemployment and ill health, sociological and psychological perspectives on work and unemployment, medicalisation of unemployment, adjudication of fitness for work, re-employment and health, and treatment of barriers to employment. The authors postulate that Welfare to Work policy may depend for its success on the crucial role of general practice in sickness certification.

Disability Evaluation↗
PubMed1999

Organizing ODIN: a case study in European academic co-operation. The ODIN Group.

The European Commission is an increasingly important source of funding for international research projects and is due to announce its Framework 5 program early in 1999. The Outcomes of Depression International Network (ODIN), funded from the current EC Biomed 2 program, is a case study in European academic co-operation. Its organization has three key elements. First, engaging the principal investigators: this has involved identifying potential partners, ensuring reciprocity of interests, effective co-ordination, 'dividing the spoils' in advance, and setting up good personal and electronic communication systems. Second, an esprit de corps has been created amongst the researchers, maintaining contact and consistency, and promoting higher degrees. Third, ongoing problems including difficulties in negotiations with the EC, divergence of detailed study methods, and isolation and demoralization amongst researchers, have been addressed. ODIN may provide a useful model for researchers wishing to set up international collaborative groups.

Academic Medical Centers↗
PubMed1999

Is care of the dying improving? The contribution of specialist and non-specialist to palliative care.

OBJECTIVES: To identify and synthesize evidence from studies examining the quality of care of dying patients in both specialist and general practitioner care. METHOD: Review of published research identified by online and manual searches. RESULTS: Three large, population-based surveys were identified, carried out between 1969 and 1990, and five randomized controlled trials of specialist palliative care programmes. There were, in addition, a small number of comparative studies and a large volume of descriptive, qualitative material. Some studies identified major methodological problems and the overall quality was poor. Most research concerned selected patients with neoplasms, particularly in settings where specialist palliative care teams are available. There was minimal information about the care of patients dying from non-neoplastic conditions. CONCLUSIONS: There is limited evidence of improvements in the care of selected cancer patients, and a dearth of evidence concerning patients dying from other, more common causes. The methods of research used to date are of limited current utility and new methods are required.

Adult↗
PubMed1998

Primary care. Associated benefits.

Results from an associate physician scheme for one region showed improved services for patients, benefits in organisation and management and high retention of doctors in inner cities. The scheme also caused early retirement of two poorly performing principals and uncovered instances of possible fraud. Success depended on the health authorities' commitment and support.

Benchmarking↗