Biomedical subjects

Chris Leach

Publications and source records attributed to Chris Leach.

7 recordsLinked to original sources

PubMed2006

Transforming between Beck Depression Inventory and CORE-OM scores in routine clinical practice.

OBJECTIVES: The Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) and the Beck Depression Inventory (BDI) are routinely used to assess emotional problems. It would be helpful to be able to compare scores when only one of the measures is available. We investigated the relationship between the measures and produced translation tables. METHODS: Level of agreement between CORE-OM and BDI-I was assessed for 2,234 clients who had completed both measures at referral for routine secondary care. Tables for predicting between the measures were constructed using several methods, including non-linear regression and non-parametric smoothing. Results were cross-validated on a separate sample of 326 clients. RESULTS: High correlations between the measures were obtained (r=.862 for female clients; r=.855 for male clients). Accuracy in predicting caseness is higher than predicting depression levels. CONCLUSIONS: CORE-OM and BDI can be compared in routine clinical settings with acceptable accuracy.

Adult↗

PubMed2006

Therapists' recall of early sudden gains in routine clinical practice.

This study followed up one by Stiles et al. (2003), which identified sudden gains -- large reductions from one session to the next on a short form of clinical outcomes in routine evaluation outcome measure (CORE-SF) -- by some clients in routine clinical practice. We interviewed the therapists who had treated sudden gain and non-sudden gain clients. Results showed that therapists could retrospectively identify which clients had or had not experienced sudden CORE-SF gains at substantially better than chance rates, although they identified only about half of the clients who had experienced such gains.

Adaptation, Psychological↗

PubMed2005

Predicting change for individual psychotherapy clients on the basis of their nearest neighbors.

This study extended client-focused research by using the nearest neighbor (NN) approach, a client-specific sampling and prediction strategy derived from research on alpine avalanches. Psychotherapy clients (N=203) seen in routine practice settings in the United Kingdom completed a battery of intake measures and then completed symptom intensity ratings before each session. Forecasts of each client's rate of change and session-by-session variability were computed on the basis of that client's NNs (n=10-50 in different comparisons). Alternative forecasts used linear or log-linear slopes and were compared with an alternative prediction strategy. Results showed that the NN approach was superior to the alternative model in predicting rate of change, though the advantage was less clear for predicting variability.

Adolescent↗

PubMed2005

Needs assessment in forensic learning disability.

This paper gives the results of a needs assessment of a group of learning-disabled forensic patients from two Strategic Health Authority areas in the north of England. The patients were found to be a heterogeneous group with wide-ranging psychiatric needs. The majority were cared for outside their geographical area of origin, either in specialist NHS facilities or the independent sector. Those with an additional diagnosis of mental illness were most likely to be detained in NHS facilities within the region: a diagnosis of personality disorder was associated with placement in either a high secure setting or the independent sector. Individuals with a clinical diagnosis of mental retardation were most likely to be detained in services provided by specialist learning disability/mental health trusts out of area. There was a small group of females who were all placed outside the region. Offending behaviour was most likely to consist of violence against the person, sexual offences and arson. The majority assessed were felt to have long term needs. The study raised important implications for future provision of forensic services in the area, particularly the need to offer services with treatment programmes tailored to the needs of the population under review.

Adolescent↗

PubMed2005

The relationship between social deprivation and unilateral termination (attrition) from psychotherapy at various stages of the health care pathway.

The relationship between social deprivation and attrition from psychotherapy was examined at various stages of the health care pathway. Data providing information on service users' discharge status gave a measure of attrition at different stages along this pathway. On the basis of their postcode, service users were allocated a Townsend deprivation score, which is a measure of social deprivation. Of the sample, 60% terminated therapy prior to agreed discharge at various pathway stages. Service users who failed to attend their first appointment had significantly higher social deprivation scores than those who completed therapy. Early terminators, who stopped attending before their fifth session, had a significantly higher level of social deprivation than the late terminators, and those who completed therapy. The late terminators did not significantly differ from completers on social deprivation. These results support earlier findings showing that socio-economic status influences attrition from therapy. However, socioeconomic status only affects two stages of the pathway - attendance at the first appointment, and the early stage of attending therapy. It does not affect earlier or later stages of the pathway. Applying the health action process approach (HAPA) model to the results, the action/maintenance stage can be represented by attendance for therapy. Socio-economic status influences this stage of the model, because social support and resources are important determinants for compliance. Earlier stages, characterized by HAPA as a decisional/motivation stage thought to be influenced by beliefs, was not affected by social deprivation. It is concluded that attrition from therapy should be studied separately for each pathway stage. Earlier conflicting findings on causes of attrition may have resulted from studying different combinations of pathway stages.

Adult↗

PubMed2003

Early sudden gains in psychotherapy under routine clinic conditions: practice-based evidence.

Sudden gains--large, enduring reductions in symptom intensity from one session to the next--were identified by T. Z. Tang and R. J. DeRubeis (1999b) on the basis of data from 2 manualized clinical trials of cognitive therapy for depression. The authors found similar sudden gains among clients with a variety of disorders treated with a variety of approaches in routine clinic settings. Clients (N = 135 who met inclusion criteria) completed short forms of the Clinical Outcomes in Routine Evaluation (CORE-SF) preceding 7 to 74 individual sessions. Those who experienced sudden gains within their first 16 sessions (n = 23) had significantly lower CORE-SF scores in their final 3 sessions than did the other clients.

Adult↗

PubMed2001

Personal constructs, childhood sexual abuse and revictimization.

Within the theoretical framework of Ryle's Procedural Sequence Object Relations Model and Kelly's Personal Construct Theory, this study investigates sex-role polarization of incest survivors and the centrality of abuse within survivors' constructs of men that may contribute to revictimization. Repertory grid methodology was used with 40 female survivors of childhood sexual abuse and 28 non-abused women. Grid measures and psychometric measures were compared between groups of women who had and had not experienced childhood sexual abuse, revictimized and non-revictimized survivors, and survivors who had and had not experienced incestuous abuse. Results showed significant differences between survivors and non-abused women, with survivors having higher levels of depression and perceived distress, lower self-esteem and higher self/ideal self discrepancy. Hypothesized differences in sex-role polarization were not found. There were few differences between revictimized and non-revictimized survivors, although revictimized survivors rated 'self now' as more powerful than non-revictimized survivors. No differences were found between survivors who had and had not experienced incestuous abuse. In addition to the value of exploring personal constructs, a range of models need to be considered in understanding revictimization and women's construal of men. The implications of using repertory grid methodology for research and clinical work are discussed.

Journal Article↗