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Biomedical subjects

D Gath

Publications and source records attributed to D Gath.

At least 19 recordsLinked to original sources
PubMed1998

The assessment of depression in peri-menopausal women.

This paper reviews research methods for detecting and assessing depressive symptoms in peri-menopausal women. The paper is written from the standpoint of clinical psychiatrists and clinical psychologists. Problems of method arise in two main areas: (i) the selection of population samples; (ii) the choice of methods for defining, detecting and measuring depression. An important distinction should be made between depressed mood and depressive disorder. Depressed mood is familiar sadness, low spirits, or despondency. Depressive disorder is a syndrome which is much more serious. The failure to make this distinction can detract from research findings. Standardised measures should always be used. These measures may be either self-rated or interviewer-rated. It is emphasised that the choice of these measures should be based on four characteristics: criterion overlap, sensitivity, test-retest reliability, and utility. The scales already available can be valuable provided that they are chosen carefully and with particular regard to these four qualities.

Depression↗
PubMed1998

Cognitive therapy for premenstrual syndrome: a controlled trial.

The aim of this study was to evaluate the effectiveness of cognitive therapy (CT) as a psychological treatment for premenstrual syndrome (PMS), by comparison with a waitlist control group. Women meeting selection criteria for PMS were randomly allocated to one of two treatment groups: (i) an immediate treatment group, who received 12 weekly sessions of individual CT; or (ii) a waiting list group who recorded symptoms of PMS for a length of time equivalent to the duration of an individual treatment in the immediate treatment group. General practitioners and gynecologists referred women who were complaining of distressing and disabling emotional and physical symptoms in the second half of the menstrual cycle, as verified by 2 months of prospective diary recording. Assessments of the women's psychological and social functioning were made on entry to the study, 2 months later, and at the end of the treatment period. This design allows evaluation of the efficacy of CT relative to any spontaneous remission that may have occurred as a consequence of the passage of time, the keeping of menstrual diaries, interview, and self-rated assessments. Results indicated that CT was significantly more effective than assignment to the waitlist group. Diary measures and self-report questionnaires indicated an almost complete remission of psychological and somatic symptoms and of impairment of functioning. It is concluded that CT for PMS is associated with substantial improvements that cannot be attributed to the passage of time or the completion of the diary and other assessments.

Adult↗
PubMed1997

Predictors of treatment outcome for major depression in primary care.

BACKGROUND: A randomized controlled clinical trial compared three treatments for major depression in primary care. Ninety-one patients were randomized to receive either problem-solving, or amitriptyline with standard clinical management, or drug placebo with standard clinical management. This paper examines the possible predictive value of a range of demographic clinical and personality variables in determining outcome. METHODS: To examine the interaction between treatment group and predictor variables, analyses of co-variants were carried out for two outcome measures: the Hamilton Rating Scale for Depression and the Beck Depression Inventory. Predictor variables were also entered into a stepwise forward logistic regression in which patients were categorized as recovered or not recovered. RESULTS: None of the predictor variables examined interacted with treatment to predict outcome. Patients with a longer duration of illness, chronic social difficulties, or definite, as opposed to probable, major depression had a poorer outcome at the end of treatment, irrespective of treatment group. CONCLUSIONS: The findings in this study do not enable clear guidelines to be given as to which patients with major depression in primary care might benefit from either a psychological or pharmacological treatment.

Adult↗
PubMed1997

The psychological effects of laparoscopy on women with chronic pelvic pain.

BACKGROUND: Many women who undergo diagnostic laparoscopy for chronic pelvic pain do not have pelvic pathology. This has led to an interest in psychological factors that might contribute to their experience of pain. This study was designed to evaluate the effects of diagnostic laparoscopy on women with chronic pelvic pain and to explore possible psychological mechanisms. METHODS: Seventy-one women undergoing laparoscopy for chronic pelvic pain were randomly allocated to one of two groups waiting different lengths of time for laparoscopy. Women were interviewed before laparoscopy and were followed up 1 week, 3 months and 6 months afterwards. Pain was assessed with an interview measure, diaries and visual analogue scales. RESULTS: Pain reductions were observed from before to after diagnostic laparoscopy. Regression analysis was used to identify factors which predicted improvements in pain. The hypothesis that psychological factors would predict improvements in pain was confirmed. Pain improvements after laparoscopy were predicted by beliefs about pain and the change in each woman's evaluation of the seriousness of her condition. Other than baseline pain, these psychological variables were the only ones to emerge as predictors of pain change despite exploratory analysis of over 40 other variables. CONCLUSIONS: Diagnostic laparoscopy can have beneficial effects in women with chronic pelvic pain. These effects appear to be the result of psychological mechanisms. Further investigation of these mechanisms could help in the understanding and treatment of women with chronic pelvic pain.

Adolescent↗
PubMed1997

A randomised controlled trial and cost analysis of problem-solving treatment for emotional disorders given by community nurses in primary care.

BACKGROUND: We set out to investigate whether community nurses could be trained in problem-solving therapy and, once trained, how effective they would be in treating emotional disorders in primary care. METHOD: Seventy patients with an emotional disorder in primary care were randomly allocated to receive either problem-solving therapy from a trained community nurse or treatment as usual from their general practitioner. Interview and self-rated assessments of clinical and economic outcome were made pretreatment, at eight weeks and at 26 weeks after treatment. RESULTS: There was no difference in clinical outcome between patients who received problem-solving treatment and patients who received the general practitioner's usual treatment. However, patients who received problem-solving treatment had fewer disability days and fewer days off work. The health care cost of problem-solving was greater than that of the general practitioner's usual treatment but this was more than offset by savings in the cost of days off work. CONCLUSIONS: Problem-solving treatment can be given by trained community nurses. The clinical effectiveness and cost-benefit of the treatment will depend on the selection of appropriate patients.

Absenteeism↗
PubMed1995

Social services case-management for long-term mental disorders: a randomised controlled trial.

Case management arose in the USA as a solution to the difficulties of providing community care to people with severe mental disorders. The basic principle of the approach is that a case manager takes responsibility for a client; arranges an assessment of need, a comprehensive service plan, delivery of suitable services, and monitoring and assessment of services delivered. The case-management approach has been widely accepted, to the extent that recent legislation has made case-management the cornerstone of community care in the UK. We did a randomised controlled trial to evaluate a social services case-management team for people with long-term mental disorders. Subjects were referred from hostels for the homeless, night shelters, a general-practitioner clinic for the homeless, the Oxford City Council homelessness unit, and local voluntary-sector group homes. Of 103 subjects referred, 80 consented to be randomised to treatment or control groups. At 14-month follow-up, as assessed by standardised interviews, there were no significant differences between groups in number of needs, quality of life, employment status, quality of accommodation, social behaviour, or severity of psychiatric symptoms. In the case-management group there was a significant reduction in deviant behaviour on a standardised behaviour rating scale (REHAB) (mean = 0.79; 95% CI 0.26-1.32). It is unfortunate, in view of the limited effectiveness we have shown, that social services case-management was not evaluated in randomised controlled trials before its implementation in the UK.

Adult↗
PubMed1995

Why do so few patients appeal against detention under Section 2 of the Mental Health Act?

OBJECTIVE: To determine why most patients do not exercise their right of appeal against detention under section 2 of the Mental Health Act 1983. DESIGN: Part one--retrospective analysis of the clinical notes of patients detained under section 2 of the Mental Health Act. Part two-interviews with patients on the penultimate day before the deadline for lodging an appeal. SETTING: In part one, five districts in the Oxfordshire Regional Health Authority. In part two, six hospitals from three districts in the region. SUBJECTS: In part one all patients detained under section 2 in the five districts in 1993 (n = 418). In part two interviews with 40 patients detained under section 2 in the six hospitals. RESULTS: Patients were more likely to appeal if they were educated to A level standard (odds = 2.26; P = 0.0014) or had had a previous admission (2.19, P = 0.0029). Patients with a diagnosis of depression (0.31; P = 0.0.15) or dementia (0.0003, P = 0.0001) were less likely to appeal. Compared with those who appealed (n = 12) those who did not (n = 28) showed less understanding of their rights (P = 0.034) and poorer comprehension of sentences from the booklet describing patients' rights (P = 0.057). The main reasons given for not appealing were not being aware of the appeals process and being deterred by having to appeal in writing. After they received a full explanation of their rights 12 of those who did not appeal said that they wished to appeal and four did so within the time remaining before the deadline. Of 40 patients, 39 said there should be an automatic right of appeal. CONCLUSIONS: The appeals procedure against detention under section 2 of the Mental Health Act is not a satisfactory way of protecting the civil liberties of patients. If patients were fully informed of their rights they would probably be much more likely to appeal.

Adult↗
PubMed1995

Hysterectomy and psychiatric disorder: are the levels of psychiatric morbidity falling?

This paper compares the findings of three studies carried out at intervals over the years 1975-1990. The three studies were concerned with different issues, but each study examined psychiatric morbidity among women undergoing hysterectomy for menorrhagia of benign origin. In all three studies levels of psychiatric morbidity were measured before the operation and 6 months after the operation. Psychiatric morbidity was measured with the Present State Examination (PSE) (Wing et al. 1974), and with established self-report questionnaires. Levels of psychiatric morbidity fell significantly across the three studies. In Study 1, the proportions of psychiatric cases were 58% before hysterectomy and 26% after; in Study 2, 28% before and 7% after; and in Study 3, 9% before and 4% after. The decline in psychiatric morbidity was not associated with demographic and social characteristics, previous psychiatric history, family psychiatric history, the nature of the women's menstrual complaints, or the women's understanding and expectations of the operation. In Study 3 anti-menorrhagic drugs were prescribed twice as frequently as in the two previous studies; while the prescribing of psychotropic medication was significantly higher in Study 1 than in Study 2 or Study 3. The implications of these findings are discussed.

Adaptation, Psychological↗
PubMed1994

Sexual function in a community sample of middle-aged women with partners: effects of age, marital, socioeconomic, psychiatric, gynecological, and menopausal factors.

A randomly selected community sample of 436 women with partners was studied with regard to frequency of sexual intercourse and orgasm with their partners and to attitudes to their sexual relationships. Associations were examined between these factors and demographic, psychiatric, marital, gynecological, and menopausal status. Frequency of sexual intercourse, orgasm, and enjoyment of sexual activity with the partner were most closely associated with younger age and better general marital adjustment, with the partners' ages also appearing to influence frequency of sexual intercourse and the duration of the relationships to affect enjoyment of sexual activity. Women's satisfaction with their sexual relationships was most closely associated with marital adjustment and bore no relation to age. Weak positive associations were found between higher socioeconomic status and frequency of orgasm and enjoyment of sexual activity. Psychiatric factors (psychiatric disorder and neuroticism) made little contribution to differences in frequency of sexual activity although they were associated with attitudes towards it. Sexual behavior was largely unrelated to gynecological symptoms. Little difference was found between age-matched subgroups of pre- and postmenopausal women in frequency of sexual behavior and attitudes towards their sexual relationships.

Adaptation, Psychological↗
PubMed1993

Psychiatric outcome of termination of pregnancy for foetal abnormality.

Termination of pregnancy for foetal abnormality has become frequent with the increasing sophistication of techniques of antenatal diagnosis. The aim of this study was to obtain quantitative and qualitative information about psychiatric morbidity in women after termination of pregnancy for foetal abnormality. Two samples of women were compared. The first consisted of 71 women who had had a termination of pregnancy for foetal abnormality (FA group). The second consisted of 26 women who had experienced so-called missed abortion (MA group). Both groups had lost a pregnancy in the mid-trimester of pregnancy, but the MA group had no element of choice. Standardized psychiatric and social measures were used to assess both groups on three occasions after the termination. In both groups, 4 weeks after the termination psychiatric morbidity was high (four to five times higher than in the general population of women), and social adjustment was impaired. Six months and 12 months after the abortion, levels of psychiatric morbidity were near normal. Semi-structured interviewing was used to obtain information about the experience of grief after mid-trimester termination. For many women, symptoms of grief persisted throughout the year. These symptoms included typical features of grief as well as grief symptoms specific to pregnancy loss. The findings have implications for the counselling of women after termination for foetal abnormality or after missed abortion.

Abortion, Eugenic↗
PubMed1992

What happens to homeless mentally ill people? Follow up of residents of Oxford hostels for the homeless.

OBJECTIVES: To follow up severely mentally ill residents of hostels for the homeless to determine their social and psychiatric outcome. DESIGN: Follow up at 18 months of hostel residents previously assessed with psychiatric and behavioural measures. SETTING: Two Oxford hostels for the homeless. SUBJECTS: 48 hostel residents previously identified as disabled by mental illness. MAIN OUTCOME MEASURES: Current housing, admissions to psychiatric hospital, violent or antisocial behaviour, and score on standardised behavioural rating. RESULTS: 45 of the 48 residents were traced. 27 had remained in the hostels; only 10 had been rehoused, mainly in bedsits or with their families. 16 had a poor outcome as judged by death (four subjects), lengthy hospital readmission (two), marked deterioration in behaviour (six), sleeping rough (one), or disappearance (three). CONCLUSION: More effort is needed to provide suitable housing for homeless mentally ill people.

Adult↗
PubMed1989

Psychological problems and uterine bleeding.

Gynaecological complaints are often associated with psychiatric disorder. Women with psychiatric disorder are more likely to complain of excessive uterine bleeding than women without psychiatric disorder. When a woman complains of menorrhagia, yet also has a psychiatric disorder, it is important to establish which is the primary problem. If menorrhagia is primary, then any associated psychiatric disorder may be secondary to distress and fear caused by excessive menstruation. If the psychiatric disorder is primary, then psychological distress may lead a women to complain about her usual menstrual pattern or minor changes in it. If the complaint of excessive menstruation is secondary to psychiatric disorder, surgical or medical treatment of this complaint may not be justified. If the gynaecologist is to make the important distinction between complaints of menorrhagia which are primary and those which are secondary to psychiatric disorder, then he/she needs to be able to detect and assess psychiatric disorder in women who present with complaints of excessive uterine bleeding. Recent research has provided information about the relationship between the surgical treatment of menorrhagia and psychiatric disorder. Hysterectomy for menorrhagia seems to alleviate psychiatric disorder in many women who had psychiatric disorder before operation. The operation rarely induces psychiatric disorder in women who are psychiatrically well before surgery. There is no association between psychiatric disorder either before or after hysterectomy for menorrhagia and the presence of absence of demonstrable pelvic pathology. There is no evidence that those women who overestimate their menstrual blood loss have an increased likelihood of being psychiatrically disturbed after hysterectomy. However, an important determinant of psychiatric outcome after hysterectomy for menorrhagia is preoperative psychiatric status--for example, mental state before surgery, previous psychiatric history and neuroticism.

Female↗
PubMed1989

The psychiatric consequences of spontaneous abortion.

Sixty-seven women were interviewed four weeks after spontaneous abortion. As determined by the Present State Examination, 32 of these women were psychiatric cases. This rate is four times higher than in the general population of women. In each case the diagnosis was depressive disorder, a finding confirmed by scores on three depression rating scales. Many women showed typical features of grief. Depressive symptoms were significantly associated with a history of previous spontaneous abortion, and less so with childlessness.

Abortion, Spontaneous↗
PubMed1989

Maternity blues. I. Detection and measurement by questionnaire.

The studies reported had two purposes: (a) to identify psychological symptoms commonly experienced by mothers in the first few days after childbirth; (b) to use psychometric methods to develop a questionnaire for detecting and measuring these symptoms. A draft 49-item questionnaire was derived by asking 100 newly delivered mothers to volunteer suitable items. The number of items was systematically reduced to 28 while testing the questionnaire on two further samples of newly delivered mothers (n = 100 and n = 50). Cluster analysis of the 28 items yielded seven clusters, the robustness of which was established in a further sample of 87 newly delivered mothers. The validity of the 28-item questionnaire was established. The questionnaire was quick and easy to administer, suitable for repeated administration on consecutive days, and well accepted by mothers.

Female↗
PubMed1989

Maternity blues. II. A comparison between post-operative women and post-natal women.

A new scale for the detection and assessment of maternity blues was completed by 56 women daily for ten days after elective gynaecological surgery. When their responses were compared with those of 87 post-natal women, they differed significantly in frequencies of different symptoms at different times. The findings suggest that post-natal mood changes ('maternity blues') are characteristic of the puerperium and not simply non-specific reactions to physical and emotional stress.

Adolescent↗
PubMed1989

Maternity blues. III. Associations with obstetric, psychological, and psychiatric factors.

One hundred and six women were assessed psychiatrically in the 14-16th and 36-38th weeks of pregnancy and the 12th week after childbirth. They also completed a maternity blues questionnaire daily in the ten days after delivery. Blues scores were significantly associated with: neuroticism; anxiety and depressed mood during pregnancy; fear of labour; poor social adjustment; and retrospective severity of pre-menstrual tension. Blues scores were not associated with obstetric factors, with previous history of psychiatric disorder, or with case status on the PSE in pregnancy or 12 weeks after delivery.

Adolescent↗