PubMed Health⌕ Search

Biomedical subjects

Christopher Dowrick

Publications and source records attributed to Christopher Dowrick.

17 recordsLinked to original sources
PubMed2006

The role of personality disorder in 'difficult to reach' patients with depression: findings from the ODIN study.

Individuals with personality disorders (especially paranoid personality disorder) tend to be reluctant to engage in treatment. This paper aimed to elucidate the role of personality disorder in predicting engagement with psychological treatment for depression. The Outcomes of Depression International Network (ODIN) involves six urban and three rural study sites throughout Europe at which cases of depression were identified through a two-stage community survey. One patient in seven who was offered psychological treatment for depression had a comorbid diagnosis of personality disorder (most commonly paranoid personality disorder). Forty-five percent of patients who were offered psychological treatment for depression did not complete treatment. The odds of completion were higher for patients with a comorbid diagnosis of personality disorder, especially paranoid, anxious or dependent personality disorder. The relatively low number of cases with some specific personality disorders (e.g. schizoid personality disorder) limited the study's power to reach conclusions about these specific disorders. This study focused on a community-based sample which may lead to apparently lower rates of engagement when compared to studies based on treatment-seeking populations. Episodes of depression in the context of personality disorder may represent a valuable opportunity to engage with patients who might otherwise resist engagement.

Adolescent↗
PubMed2006

Negative life events, social support and gender difference in depression: a multinational community survey with data from the ODIN study.

OBJECTIVE: To explore if differences in negative life events, vulnerability and social support may explain the gender difference in depression. METHODS: Cross-sectional, multinational, community survey from five European countries (n = 8,787). Depression is measured by Beck Depression Inventory, whereas negative life events and social support are measured by various questionnaires. RESULTS: Women report slightly more negative life events than men do, mainly related to the social network, but more social support in general and in connection with reported life events. This trend is the same in all participating countries except Spain, where there is no gender difference in the reported support. In general, women are not more vulnerable to negative life events than men are. However, women with no social support, who are exposed to life events, are more vulnerable than men without support. CONCLUSION: The higher rate of depression in women is not explained by gender differences in negative life events, social support or vulnerability.

Adult↗
PubMed2006

Can adjustment disorder and depressive episode be distinguished? Results from ODIN.

BACKGROUND: No large-scale epidemiological study has included adjustment disorders (AD) for consideration yet it is considered to be a common psychiatric diagnosis. METHODS: Using a two stage screening method, those above a threshold score for possible caseness on the Beck Depression Inventory (BDI), were interviewed using SCAN to identify those with depressive episode and AD. Variables that might distinguish AD from depressive episode were examined. RESULTS: The prevalence of AD was extremely low with one centre having no cases. Finland, the country with the highest prevalence, only achieved a frequency of 0.8% and 1%, respectively, for urban and rural sites. Logistic regression failed to identify any variables that independently differentiated AD from depressive episode. Findings relating to severity of symptoms using BDI were robust. LIMITATIONS: The small sample size might have contributed to a failure to identify distinguishing features between AD and other disorders. CONCLUSIONS: Reasons for the failure of even robust results, such as BDI severity, to distinguish AD from depressive episode are considered of which problems in conceptualising AD are the most likely. Further studies are required.

Adjustment Disorders↗
PubMed2006

Painful symptoms in depression: under-recognised and under-treated?

Current diagnostic systems maintain an artificial division between 'physical'and 'psychological'disorders. This is exemplified by the way in which pain symptoms are dealt with in the context of depressive illness. The consequences of this are discussed, and ways to enhance the clinical care of patients with depression and pain are suggested.

Depressive Disorder↗
PubMed2006

Health service use by adults with depression: community survey in five European countries. Evidence from the ODIN study.

BACKGROUND: Little is known about patterns of healthcare use by people with depression in Europe. AIMS: To examine the use and cost of services by adults with depressive or adjustment disorders in five European countries, and predictive factors. METHOD: People aged 18-65 years with depressive or adjustment disorders (n=427) in Ireland, Finland, Norway, Spain and the UK provided information on predisposition (demographics, social support), enablement (country, urban/rural, social function) and need (symptom severity, perceived health status) for services. Outcome measures were self-reported use Client Services Receipt Interview and costs of general practice, generic, psychiatric or social services in the past 6 months. RESULTS: Less frequent use was made of generic services in Norway and psychiatric services in the UK. Severity of depression, perceived health status, social functioning and level of social support were significant predictors of use; the number of people able to provide support was positively associated with greater health service use. CONCLUSIONS: Individual participant factors provided greater explanatory power than national differences in healthcare delivery. The association between social support and service use suggests that interventions may be needed for those who lack social support.

Adolescent↗
PubMed2006

Factors associated with suicidal ideation in the general population: five-centre analysis from the ODIN study.

BACKGROUND: Very few studies have examined the cross-national prevalence of suicidal ideation in the general population or variables associated with it. AIMS: To examine the risk factors for suicidal ideas in the general population. METHOD: As part of a five-country two stage epidemiological study of depressive disorder (the ODIN study) a random sample of over 12 000 people were screened using the Beck Depression Inventory (BDI). There followed detailed analysis of item 9 of the BDI, which measured the severity of suicidal ideation. RESULTS: Age, marriage, concern by others and severity of depressed mood independently increased or decreased the odds of suicidal ideation overall. An interaction between life events and social supports was identified, although this differed between men and women. Only concern by others and severity of depression were independently associated with serious suicidal ideation. The study does not allow for interpretation of the direction of the association. CONCLUSIONS: A number of social, clinical and demographic variables were independently associated with all suicidal ideation and with serious suicidal ideation. Longitudinal studies are required to confirm whether these are risk factors for or the result of suicidal ideation or have some other relationship.

Adolescent↗
PubMed2005

The estimated incidence of depressive disorder and its determinants in the Finnish ODIN sample.

BACKGROUND: In contrast to the huge number of prevalence studies, there are relatively few incidence studies of depressive disorders. Furthermore, estimates of incidence vary remarkably between existing studies. The aim of this paper is to add knowledge about the incidence and determinants of depressive disorder, based on the Finnish sub-sample of the European Outcomes of Depression International Network study. METHOD: The random population sample in the Finnish sub-study consisted of 2,999 subjects, aged 18-64, selected from one urban and one rural area. In the baseline survey, potential cases of depressive disorder were identified using the Beck Depression Inventory. SCAN-2 interview was used to assign caseness against ICD-10 criteria. Findings from the 1-year follow-up survey with those who responded in the baseline survey (N=1,939), using the same case-finding instruments, were used to estimate the incidence rate of depressive disorder. RESULTS: The estimated annual incidence rate for all depressive disorders, including both first-time and recurrent episodes, was 28.5 per 1,000; for first-time episodes it was 20.5 per 1,000. Significant predictors for experiencing a depressive episode were: suffering from self-perceived long-term illness or handicap, experiencing little or no concern from friends, low sense of coherence, low self-confidence, uncertainty about one's future and reporting two or more threatening life events during the preceding 6 months. CONCLUSIONS: About 3% of the working-age population experience an episode of depressive disorder each year. Due to recall problems, the estimate of first-time incidence may be too high.

Adolescent↗
PubMed2004

Do patients with unexplained physical symptoms pressurise general practitioners for somatic treatment? A qualitative study.

OBJECTIVES: To identify the ways in which patients with medically unexplained symptoms present their problems and needs to general practitioners and to identify the forms of presentation that might lead general practitioners to feel pressurised to deliver somatic interventions. DESIGN: Qualitative analysis of audiorecorded consultations between patients and general practitioners. SETTING: 7 general practices in Merseyside, England. PARTICIPANTS: 36 patients selected consecutively from 21 general practices, in whom doctors considered that patients' symptoms were medically unexplained. MAIN OUTCOME MEASURES: Inductive qualitative analysis of ways in which patients presented their symptoms to general practitioners. RESULTS: Although 34 patients received somatic interventions (27 received drug prescriptions, 12 underwent investigations, and four were referred), only 10 requested them. However, patients presented in other ways that had the potential to pressurise general practitioners, including: graphic and emotional language; complex patterns of symptoms that resisted explanation; description of emotional and social effects of symptoms; reference to other individuals as authority for the severity of symptoms; and biomedical explanations. CONCLUSIONS: Most patients with unexplained symptoms received somatic interventions from their general practitioners but had not requested them. Though such patients apparently seek to engage the general practitioner by conveying the reality of their suffering, general practitioners respond symptomatically.

Adult↗
PubMed2004

Depression in men attending a rural general practice: factors associated with prevalence of depressive symptoms and diagnosis.

BACKGROUND: Doctors are less likely to diagnose depression in men than in women. Little research has been conducted to explore the underlying reasons for this in rural settings, or to compare primary care doctors' and male patients' ratings of perceived depression. AIMS: To identify symptomatic and socio-demographic correlates of depression in men attending a rural practice, and to compare and contrast general practitioners' and patients' assessments of depression. METHOD: All male patients of working age attending a rural general practice over a 12-month period were invited to participate. RESULTS: Men reporting recent "chest pain" or "feeling tired/little energy", expressing low job enjoyment or with a previous diagnosis of depression were more likely to be scored above threshold on the Hospital Anxiety and Depression Scale-Depression sub-scale. There was little agreement between the doctors and their male patients about the degree of perceived depression. CONCLUSIONS: Educational interventions aimed at addressing the diagnosis of depression in men should take greater account of factors within a particular social setting.

Adult↗
PubMed2003

Urban-rural differences in the occurrence of female depressive disorder in Europe--evidence from the ODIN study.

BACKGROUND: In an earlier paper of the European multi-centre ODIN study (Ayuso-Mateos et al. 2001) we found remarkable urban preponderance in comparison to the corresponding rural site in the female prevalence of depressive disorder in the UK and Ireland. The aim of this paper is to analyse the possible reasons for this finding. METHOD: A representative sample of 12,702 people aged between 18 and 64 residing in specified urban and rural areas were screened by the Beck Depression Inventory (BDI) for depressive disorder in four European countries (Finland, Ireland, Norway and the UK). Those over cut-off (BDI score < 12) and a 5 % random sample of those under cut-off underwent diagnostic interview including the SCAN version 2.0, and completed a battery of additional research instruments. RESULTS: The estimated 1-month prevalence of depressive disorder according to ICD-10 was 9 % in the total ODIN sample. A large between-country variation was found in female urban prevalence, with Ireland (Dublin) and the UK (Liverpool) having a remarkably high rate. The women in these same countries showed a significant urban/rural difference, whereas in men and in the total sample this difference was non-significant. Logistic regression analysis including some selected risk factors of depression showed still higher risk of depressive disorder both in Dublin and Liverpool compared with the Finnish urban site (Turku), which had the lowest urban prevalence. In addition, also such factors as lack of confidant and having difficulties in getting practical help from neighbours were important predictors of depressive disorder. Similarly, when analysing the different countries separately, the significance of the urban/rural difference in women remained for Ireland and the UK, indicating that the other risk factors studied could not totally explain the difference. CONCLUSIONS: ODIN is the first European study on occurrence of depressive disorder in both urban and rural settings allowing closer analysis of the urban/rural differences. The most striking result was the large urban/rural difference in women in the two countries from the British Isles which could not be totally explained by the socio-demographic factors included in this study.

Adolescent↗
PubMedDate not supplied

Turning theory into practice: rationale, feasibility and external validity of an exploratory randomized controlled trial of training family practitioners in reattribution to manage patients with medically unexplained symptoms (the MUST).

BACKGROUND: The evidence for the effectiveness of reattribution training are limited, and optimal service delivery is not yet established. OBJECTIVES: The objectives of this study were to establish the feasibility and to optimize the service delivery and design of a definitive randomized controlled trial (RCT) of reattribution training for patients with medically unexplained symptoms (MUSs) in routine primary care. METHODOLOGY: The study was of a cluster RCT design with the practice as the unit of randomization. Health facilitator (HF)-delivered reattribution training was compared with no reattribution training. The primary outcome measure used is doctor-patient communication in the consultation. Quantitative and qualitative methods identify barriers to effectiveness. The acceptability and feasibility of the intervention were established by attendance rates and postal survey after completion of training. RESULTS: Sixteen practices and 70 family practitioners (FPs) were recruited with representative practice and FP characteristics. Six hours of HF reattribution training to FPs in the workplace proved feasible and acceptable with all 35 FPs completing the training. Feedback from 27 (77%) FPs who received training indicated that 25 (93%) FPs believed that specific and relevant learning achievements were made, 22 (82%) felt more confident and 21 (77%) thought the training was useful. CONCLUSION: HF-delivered reattribution training to whole practices is feasible and acceptable, and its effectiveness is measurable in routine primary care.

Adult↗
PubMedDate not supplied

Stories from frequent attenders: a qualitative study in primary care.

PURPOSE: Patients who make frequent office visits (frequent attenders) in primary care are often considered a major burden on resources, yet we know little about their perceptions and expectations. We wanted to explore how these patients viewed their rates of consultation, what they expected from the consultation, and how they perceived their relationship with the primary health care team. METHODS: Using a qualitative study design, we undertook in-depth semi-structured interviews with frequent attenders at 4 primary care practices of the Mersey Primary Care R&D Consortium in the North West of England. Participants were identified on the basis of office visits at least twice the mean standardized rate for 1 year and a medical assessment that these visits had no important clinical outcome. Interviews with 30 patients aged 24 to 81 years (18 men) were audiotaped and transcribed, and the text was methodically coded; data were analyzed by generating common themes. RESULTS: Participants were unable or unwilling to quantify their consultation rates. Despite the assertion by many participants that family doctors are caring, authority figures, there was an underlying tension between such perceptions and the apparent medical mismanagement of symptoms. Their expectations of the consultation were complex and included the presentation of old and new symptoms implicitly embedded within an illness framework. Gaining access to family doctors was generally perceived as problematic. CONCLUSION: The criteria held by family doctors and researchers regarding the appropriate rate of consultations in primary care may not be shared by patients who attend frequently. Such patients require family doctors to acknowledge their symptoms and to provide reassurance.

Adult↗
PubMedDate not supplied

Pain symptoms in depression: definition and clinical significance.

This article presents the findings of a focused literature review and consensus meetings on the definition and clinical significance of painful symptoms in patients with depression. About 50% of depressed patients report pain, and many types of pain occur more frequently in people with depression than in those without. There is some evidence that pain in depressed patients is associated with a poor response to treatment. Pain and depression may share common pathways and may both respond to treatment with certain antidepressants. Doctors need to be alert to pain in depressed patients and be prepared to treat it.

Antidepressive Agents↗