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Biomedical subjects

C Dowrick

Publications and source records attributed to C Dowrick.

28 records · Page 2Linked to original sources
PubMed1998

Outcomes of Depression International Network (ODIN). Background, methods and field trials. ODIN Group.

BACKGROUND: ODIN aims (a) to provide data on the prevalence, risk factors and outcome of depressive disorders in rural and urban settings within the European Union (EU) based on an epidemiological sampling frame; and (b) to assess the impact of two psychological interventions on the outcome of depression and on service utilisation and costs. METHOD: Five centres across the EU are participating in ODIN. The centres are linked electronically and members meet regularly for training and strategic reviews. Urban and rural areas have been identified in each centre. The sampling frame is of adults aged 18-64, identified via primary care databases or electoral registers. Potential cases of depressive disorders are identified using the Beck Depression Inventory SCAN II and other validated measures are used to assign caseness against DSM-IV and ICD-10 criteria; assess comorbidity, disability, genetic/familial susceptibility, psychosocial stressors, personality traits and cognitive factors; and utilisation of local health care services. A randomised controlled trial of individual problem-solving treatment and a group educational programme is undertaken for respondents identified as cases of depressive disorder individuals are followed-up at six and 12 months. RESULTS AND CONCLUSIONS: ODIN has already stimulated the development of an effective international research partnership.

Adult↗
PubMed1996

Problems with recruitment in a randomized controlled trial of counselling in general practice: causes and implications.

OBJECTIVES: To evaluate the effectiveness of counselling in the management of minor psychiatric morbidity in general practice, and to explore the reasons for difficulties in recruiting patients to such an evaluation. METHODS: We attempted to conduct a randomized controlled trial of counselling in eight general practices in one NHS family health services authority area in England. Having experienced significant problems recruiting patients, we conducted semi-structured telephone interviews (n = 8) with participating GPs to explore the reasons for these difficulties. RESULTS: Five months after the start of the study only one patient had been recruited. The main reasons identified as contributing to the recruitment problems were: general practitioners' motivation for involvement in the study; their ethical doubts about the randomization process; the perceived lack of a viable non-counselling intervention; and their existing practical commitment to counselling. CONCLUSION: Although methodological modification might enhance the potential for success in future studies of this sort, more fundamental difficulties concerning general practitioners' attitudes to research and their professional responsibilities lie at the heart of our recruitment problems.

Attitude of Health Personnel↗
PubMed1996

The biopsychosocial model of general practice: rhetoric or reality?

BACKGROUND: For more than 20 years, general practitioners have been encouraged to adopt a 'biopsychosocial' model of health care, that is, encompassing physical, psychological and social aspects. AIM: A study was undertaken to explore the extent to which general practitioners' views about the acceptable boundaries of their work are consistent with a biopsychosocial model. METHOD: A semi-structured postal questionnaire was sent to all 494 members of the Royal College of General Practitioners in Mersey Region who were general practitioner principals. The general practitioners were asked to list up to three topics presented by patients that they considered to be appropriate, and up to three topics that they considered to be inappropriate, to a general practitioner's knowledge and skills. The general practitioners were asked to rate, on a five-point scale of appropriateness, each of a list of 12 topics about which patients might have problems and present. Responses were analysed by sex and age of respondents. RESULTS: The response rate was 42%. Acute physical problems were most often listed appropriate by respondents, followed by chronic physical and psychological problems. The topics most often considered inappropriate were bureaucracy and social issues. Among the list of 12 specified topics, respondents considered terminal care and hypertension to be more appropriate than housing issues, spiritual worries, welfare rights or political issues. The sex of respondents did not relate to differences in results. Respondents aged 35 years and over generally considered topics presented by their patients to be more appropriate than did their younger colleagues. CONCLUSION: The general practitioner respondents in this study appeared to hold the view that general practitioners should work to a bio(psycho) rather than a biopsychosocial model of health care.

Attitude of Health Personnel↗
PubMed1995

Twelve month outcome of depression in general practice: does detection or disclosure make a difference?

OBJECTIVES: To assess the extent to which the outcome of depression among primary care attenders may be affected by medical diagnosis or by feedback of questionnaire results in unrecognised cases. DESIGN: Prospective 12 month study including a randomised controlled trial of the effects of disclosure, with data on depression status and clinical management collected by questionnaire and interview. SETTING: Two group practices in north Liverpool. SUBJECTS: 1099/1444 (76%) consecutive adult attenders completed the Beck depression inventory, of whom 179 with scores of at least 14 were followed up. INTERVENTIONS: Disclosure of a random 45% (52/116) of depression scores to general practitioners for subjects whose depression was undetected. MAIN OUTCOME MEASURES: Depression status estimated by depression score at start of study and at six and 12 months, with subsample validation against ICD-10 criteria. RESULTS: Questionnaire response rates were 76% (136/179) at six months and 68% (122/179) at 12 months and were higher for women than men. The median depression score was 19 (interquartile range 15 to 22) initially, decreasing to 16 (11 to 23) at 12 months. The median depression score decreased significantly (two sided test, P = 0.019) in subjects whose depression was unrecognised at the index consultation but increased in those whose depression had been detected by their general practitioners. Disclosure of cases of unrecognised depression to general practitioners had no effect on outcome. Intention to treat was associated with a worse prognosis, although only a minority of subjects received adequate treatment. CONCLUSIONS: Disclosure of undetected depression did not improve prognosis. A diagnosis of depression in general practice should be considered simply as a marker of its severity.

Adolescent↗
PubMed1995

Does testing for depression influence diagnosis or management by general practitioners?

This study set out to assess the effects on diagnosis and management of providing general practitioners with feedback of patients' scores on a depression screening instrument. One hundred and sixteen general practice attenders aged 16-64 with undetected depression were identified using the Beck Depression Inventory (BDI). The BDI scores of a random 45% were disclosed to the general practitioners. Subjects and medical casenotes were reviewed over 12 months. Thirty-one (27%) of subjects were later diagnosed as depressed. Rates of diagnosis were higher in the disclosed group, but only after six months. Rates of intention to treat were low, but were marginally higher for the disclosed group; they were much higher for patients diagnosed by the doctors themselves. Feedback of screening questionnaire results appears to be of limited value in enhancing general practitioners' detection or management of depression.

Adolescent↗
PubMed1992

Why do the O'Sheas consult so often? An exploration of complex family illness behaviour.

Complex illness behaviour can be seen as a product of dysfunctional communication between doctors and patients. A methodology to understand such behaviour is described: it uses case record analysis and meetings with patients and health teams to create a set of family trees and graphs of consultation patterns; these are the basis on which to generate and test hypotheses. This model is used to explore the consultation rates of a family between the 1940s and 1988. Illness behaviours increased rapidly during the 1980s at a time when both the family and their general practitioners were undergoing rapid changes and losing significant members. Mutually unacknowledged depression may have been a key factor. Strategies for change are suggested.

Adult↗
PubMed1992

Mental health in the community.

Medical education needs to reflect the rapid development of community-based health care, particularly in the area of mental health. 'Mental health in the community' is a week-long collaborative course organized through the Department of General Practice at Liverpool University for first-year clinical medical students. It aims to introduce them to the range of mental health problems that exists in the community and the resources available to deal with them; to improve their counselling skills and to reduce their anxiety about mental health, both their own and other people's. The paper describes the wide variety of teaching methods and visits which are offered during the week. The course is evaluated using the method developed by Stake. Although there are some problems with student participation, 'Mental health in the community' has a significant positive overall effect on students' knowledge and anxiety levels with regard to mental health. It is making a contribution to the reorientation of medical education in Liverpool.

Anxiety↗
PubMed1992

Improving mental health through primary care.

The government white paper Health of the nation has highlighted mental health as a key issue for the next decade. Primary care is being encouraged to take a leading role in developing effective services for people with mental health problems. This paper reviews current research on key aspects of mental health in adults: the prevalence of mental health problems, improving detection and management of mental health problems, the role of counselling, and communication between primary and secondary care. Recommendations are made for initiatives in both research and service development.

Community Mental Health Services↗