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F Creed

Publications and source records attributed to F Creed.

At least 55 records · Page 3Linked to original sources
PubMed1999

General hospital services for deliberate self-poisoning: an expensive road to nowhere?

This study was designed to investigate the clinical and economic aspects of deliberate self-poisoning services in four teaching hospitals in Leeds, Leicester, Manchester and Nottingham. We investigated the management of the current self-harm episode, including direct in-hospital costs, in 456 individuals who presented to hospital on a total of 477 occasions with deliberate self-poisoning during a 4-week period in 1996. Fewer than half of the patients received specialist psychosocial assessment or follow-up. Patients were more likely to receive an assessment if they were already in contact with psychiatric services, had a history of previous overdoses, if they presented during working hours, or if they lived near the hospital. Patients who were admitted were nearly twice as likely to receive specialist assessment, and those who received a specialist assessment were nearly three times as likely to be offered follow-up. In-patient days and days on the intensive care unit accounted for 47% and 8% of the total costs, respectively. This study suggests that general hospital services are disorganised, with evidence of inequitable access to specialist assessment and after-care. This state of affairs cannot be justified on financial or clinical grounds.

Analysis of Variance↗
PubMed1999

Costs of antidepressant overdose: a preliminary study.

There is ongoing debate regarding the relative cost effectiveness of different classes of antidepressants. Although factors such as tolerability and discontinuation rates have been taken into account, there has been little consideration of the cost of overdose. In the current study we examined the cost of antidepressant overdose at four teaching hospitals over a four-week period and found that the cost of selective serotonin reuptake inhibitor overdose was less than half that of tricyclic anti-depressant overdose. The cost of overdose is often ignored and should be considered in future analyses of the cost effectiveness of different antidepressant prescribing policies in primary care.

Adult↗
PubMed1998

Mental health in the north west region of England: associations with deprivation.

Minor psychiatric morbidity is known to be associated with social disadvantage, but few studies have explored this association at the population level. This study reports data from a postal survey across 19 health districts in one region, with a total sample of 38,000 respondents. The percentage scoring above the General Health Questionnaire (GHQ) threshold for each health district was correlated with measures of deprivation derived from the 1991 census and standardised mortality ratios. Highly significant correlations were seen between the percentage above the GHQ threshold and the Underprivileged Area (UPA) score (r = 0.84), under 65 Standardised Mortality Ratio (SMR; r = 0.80), lack of amenities (r = 0.56), overcrowding (r = 0.54), lone-parent families (r = 0.84), unemployment (r = 0.87), unskilled workers (r = 0.77), ethnic minority composition (r = 0.58) and social mobility (r = 0.85). However, the three most deprived districts had the lowest response rates and when these were excluded from the analysis, only the correlations with under 65 SMR (r = 0.57, P < 0.05), UPA score (r = 0.52, P < 0.05) and unskilled workers (r = 0.60, P < 0.05) remained significant. There may be a threshold effect for the impact of social disadvantage on mental health, with much higher rates of psychological morbidity among markedly disadvantaged populations.

Adult↗
PubMed1998

Severity of psychiatric disorder in day hospital and in-patient admissions.

This study assessed whether severity of psychiatric disorder varies across day hospital and in-patient units according to local need, and whether severity of disorder predicts length of stay and therefore costs. Data were collected for a consecutive series of 2230 in-patients and 712 day patients using the Social Behaviour Scale (data completed by nurses) and diagnosis and Clinical Global Impression (CGI) (completed by doctors). Severity of illness of subjects admitted to in-patient units, but not to day hospitals, was associated with under-privileged area score (UPA). Length of in-patient stay is most accurately predicted by Clinical Global Impression and six other variables relating to diagnosis, demographic status and individual hospital. Improved resource allocation for mental health services could be achieved if severity of disorder was routinely collected.

Adult↗
PubMed1998

The different uses of day hospitals.

A 1-day census was performed on 341 patients at 10 day hospitals in a UK Region to compare day hospitals and to predict length of stay. Only 13% of day hospital places were used as an alternative to in-patient admission. The majority of places were used for 'rehabilitation', but nearly half of the patients with psychotic disorders were only receiving general support--such patients could have their needs served in a day centre. In total, 40.2% of the variation in length of stay could be explained on multiple regression. Even when age, diagnosis and source of referral were accounted for, there remained significant variation in length of stay reflecting the stated policy of each hospital. These findings are in contrast to similar analyses of in-patient data. If psychiatric day hospitals are to be used as a cost-effective alternative to in-patient admission, many of them would need to change their policy.

Adolescent↗
PubMed1998

Psychological stress and burnout in medical students: a five-year prospective longitudinal study.

The aim of this study was to assess psychological morbidity and symptoms of burnout in medical students during their undergraduate training, and to identify baseline factors that predict psychological morbidity in students in the final year of the course. It was a 5-year prospective longitudinal cohort study. Students were assessed in years 1, 4 and 5 of their medical undergraduate training by means of the GHQ-12 and the Maslach Burnout Inventory. 172 (84.3%), 157 (77.0%) and 155 (75.9%) students out of an original group of 204 completed assessments in years 1, 4 and 5, respectively. 18 students were above threshold on the GHQ-12 on all three occasions, 25 on two occasions and 43 on one occasion; 69 students were never a 'case'. Students who were cases on two or more occasions were more likely to find the medical course stressful during the first year, but not subsequent years. There was no significant difference between the percentages of men and women who scored as cases on the GHQ-12 in any of the years. The best predictor of psychological morbidity in the final year of the course was the GHQ-12 score in year 1. This study suggests that a small group of students repeatedly experience psychological distress during their medical training.

Alcohol Drinking↗
PubMed1997

Cost effectiveness of day and inpatient psychiatric treatment: results of a randomised controlled trial.

OBJECTIVE: To compare direct and indirect costs of day and inpatient treatment of acute psychiatric illness. DESIGN: Randomised controlled trial with outcome and costs assessed over 12 months after the date of admission. SETTING: Teaching hospital in an inner city area. SUBJECTS: 179 patients with acute psychiatric illness referred for admission who were suitable for random allocation to day hospital or inpatient treatment. 77 (43%) patients had schizophrenia. INTERVENTIONS: Routine inpatient or day hospital treatment. MAIN OUTCOME MEASURES: Direct and indirect costs over 12 months, clinical symptoms, social functioning, and burden on relatives over the follow up period. RESULTS: Clinical and social outcomes were similar at 12 months, except that inpatients improved significantly faster than day patients and burden on relatives was significantly less in the day hospital group at one year. Median direct costs to the hospital were 1923 pounds (95% confidence interval 750 pounds to 3174 pounds) per patient less for day hospital treatment than inpatient treatment. Indirect costs were greater for day patients; when these were included, overall day hospital treatment was 2165 pounds cheaper than inpatient treatment (95% confidence interval of median difference 737 pounds to 3593 pounds). Including costs to informants when appropriate meant that day hospital treatment was 1994 pounds per patient cheaper (95% confidence interval 600 pounds to 3543 pounds). CONCLUSIONS: Day patient treatment is cheaper for the 30-40% of potential admissions that can be treated in this way. Carers of day hospital patients may bear additional costs. Carers of all patients with acute psychiatric illness are often themselves severely distressed at the time of admission, but day hospital treatment leads to less burden on carers in the long term.

Adolescent↗
PubMed1997

[The reason for medical consultations in patients with psychiatric diseases: somatization phenomena and suicide attempts].

BACKGROUND: The objectives of the study are to document the frequency of use of the general medical services by psychiatric patients, to measure how many consultations are due to somatization and suicide attempts and to know the existence of possible differences between psychiatric inpatients and outpatients in relation to the reason of medical consultation. MATERIAL AND METHODS DESIGN: retrospective study. Site: Manchester Royal Infirmary, a university third level hospital in Manchester (United Kingdom). PATIENTS: patients from the psychiatric department seen during the period from July 1st to December 31st in 1992 (n = 1,012 patients). RESULTS: The percentage of patients that consults a medical/surgical department in one year is 27.5%, 25.2% of outpatients and 36.3% of inpatients. Non-medical reasons are 42.3% of these consultations: 30.4% somatization phenomena and 10.8% suicide attempts. The frequency of somatization in psychiatric patients (30.4%) is similar to that described in non-psychiatric patients. The psychiatric inpatients that are referred to a medical department as inpatients show a significant lower rate of somatization (2.2%) and a higher rate of suicide (35.5%). CONCLUSIONS: On fourth of psychiatric patients consult a medical department in one year and more than 40% of these consultations are not due to somatic diseases. The frequency of somatization in psychiatric patients is similar to the observed in other patients. Psychiatric inpatients that are also medical inpatients in one year constitute a specific high risk group.

Adult↗
PubMed1997

Predicting length of stay in psychiatry.

BACKGROUND: Diagnostic Related Groups (DRGs) and Healthcare Resource Groups (HRGs) do not predict accurately length of stay or resources needed for treatment in psychiatry. This preliminary study assessed the relative contribution of severity of illness, in combination with other variables, in predicting length of stay. METHOD: Data were analysed on 115 consecutive admissions to a district psychiatric in-patient unit to assess the variables which most accurately predict length of stay. The variables included demographic data, diagnosis, clinical, social and behavioural measures. RESULTS: For initial admission, diagnosis of neurosis predicted shortest stay, but diagnosis alone accounted for only 14.6% of the variation in length of stay. Addition of Social Behaviour Scale score, living alone and specific psychiatric symptoms significantly increased the predictive value (adjusted R2 = 36.6%). Addition of variables available at discharge (use of ECT, major tranquillizers and antidepressants) significantly increased the adjusted R2 to 49.0%. Prediction of total length of hospitalization over a 12-month period, from the date of initial admission, indicated that mania predicted the longest stay and addition of other variables meant that only 18.9% of length of stay was predicted. CONCLUSION: If these results are borne out in a large study, they indicate that diagnostic or health related groups (DRGs) are only likely to be useful in psychiatry if they include more detailed social, clinical and behavioural variables.

Analysis of Variance↗
PubMed1997

Relation between psychiatric disorder and abnormal illness behaviour in patients undergoing operations for cervical discectomy.

OBJECTIVE: To test the hypothesis that depression in patients being considered for cervical disc surgery is associated with severe organic pathology. Secondly, to test whether depression and abnormal illness attitudes recorded preoperatively would predict poorer recovery. METHODS: Seventy four patients with pain and disability from cervical arthrosis were examined during investigations before potential cervical surgery. The prevalence of psychiatric disorder was assessed using the SCAN, and attitude to illness using the illness attitude scale. RESULTS: There was a rate of depressive disorder in the sample of 37%. The depressed patients did not have more severe organic pathology, more neurological symptoms or signs, or more disablement. They reported more pain and displayed more abnormal illness behaviour. Fifty patients went on to cervical surgery. Outcome four to eight months postoperatively was not related to the presence of psychiatric disorder or illness attitude recorded preoperatively. CONCLUSION: Depressive disorder is not secondary to severe pathology; the outcome of surgery is predominantly determined by physical factors.

Adult↗
PubMed1997

Evaluating models of working at the interface between mental health services and primary care.

BACKGROUND: This paper examines the feasibility of evaluating innovative models of working at the interface between primary care and secondary mental health services. METHOD: Methodological problems relevant to evaluation of innovative models of working at the interface are discussed. RESULTS: Although there is some evidence that neurotic disorders can be more cost-effectively treated in primary care, many general practitioners (GPs), and possibly some patients, prefer referral to community mental health teams and community psychiatric nurses, which are provided by the secondary health care services. Since the latter are provided with the intention of improving serious mental illness their involvement in the care of neurotic illness can lead to tensions between GPs, local health authorities and service providers. There is little evidence to suggest that psychiatrists working in health centres using the 'shifted out-patient' model have eased this problem. By contrast the 'consultation-liaison' (C-L) model has a number of theoretical advantages; referrals to secondary care should be limited to those most in need of this level of expertise and GP management skills should improve, so leading to better quality of care for patients who are not referred. CONCLUSION: Studies comparing the different models of service delivery are required to address the tensions that have arisen following changes in government policy. Further work is also needed to develop the necessary research tools.

Ambulatory Care↗
PubMed1997

Outcome of anxiety and depressive disorders in primary care.

BACKGROUND: Factors related to the outcome of depression and anxiety in primary care are not fully understood. METHOD: Adult patients in general practice with depressive, anxiety or panic disorder (n = 148; DSM-III-R criteria) were studied prospectively for six months to determine the factors most closely associated with outcome. The Psychiatric Assessment Schedule, Hamilton Depression Rating Scale, Clinical Anxiety Scale and Life Events and Difficulties Schedule interviews were performed at index consultations and repeated six months later. Variables associated with outcome were assessed by multiple regression analysis. RESULTS: Good outcome was predicted by mild depression at initial assessment, high educational level, and being in employment. At follow-up the most important predictor of improvement was reduction in marked difficulties over the six months. Recognition and management by the GP was most frequent in patients with severe disorder; such patients were least likely to improve because of the severity of their depression and marked social difficulties. CONCLUSIONS: This naturalistic study helps to provide a framework for further studies with more precisely defined groups of people with depression. An effective treatment strategy for people with marked depression and ongoing social difficulties is especially needed.

Adolescent↗
PubMed1997

Adverse social circumstances and depression in people of Pakistani origin in the UK.

BACKGROUND: The social origins of depression in people of Pakistani origin in the UK are not fully understood; they may not be the same as for the indigenous White population. METHOD: Patients attending a GP's surgery were screened with the Personal Health Questionnaire to detect depressive illness, which was confirmed using the Psychiatric Assessment Schedule; the estimated prevalence of major depression was 42%. Forty-four people with depression and 33 non-depressed comparison subjects were successfully interviewed using the Life Event and Difficulty Schedule, either in Urdu or English. RESULTS: Seventy-five per cent of the sample were Pakistani born; 57% of cases and 33% of non-cases spoke English with difficulty. Seventy-five per cent of the cases and 36% of the non-cases had experienced an independent severe event and/or a major difficulty (P = 0.0015). Difficulties associated with depression were most commonly in the marital, health and housing categories; overt racial harassment and discrimination were rare. CONCLUSIONS: This is a preliminary study because of the small sample of GP attenders. The somatic presentation of depression in this population is clear. Acceptable forms of social support and help with marital, housing and employment problems will be needed to help relieve the depression in this population.

Adult↗
PubMed1996

The relationship of current psychiatric disorder to functional disability and distress in patients with inflammatory bowel disease.

Although prior theories about psychiatric disorders causing inflammatory bowel disease (IBD) have largely been discredited, these same disorders have at times been associated with functional gastrointestinal symptoms such as those found in irritable bowel syndrome. Since functional gastrointestinal symptoms can also occur in patients with organic pathology, we hypothesized that a current psychiatric disorder might amplify or produce additional gastrointestinal symptoms in patients with organic gastrointestinal diseases such as IBD, leading to additive functional disability and decreased quality of life. This pilot study evaluated a sequential sample of 40 IBD patients using the NIMH Diagnostic Interview Schedule, structured interviews for functional gastrointestinal symptoms, and prior episodes of emotional, physical, and sexual abuse as well as self-report measures of personality and disability. We compared IBD patients with and without a current psychiatric disorder while controlling for disease severity. Eight patients with major depression were treated with antidepressants. Patients with a current psychiatric disorder had significantly higher 1) mean number of lifetime psychiatric diagnoses, 2) prevalence rates of prior sexual and physical victimization, and, 3) mean numbers of both gastrointestinal and other medically unexplained symptoms despite no differences in severity of IBD. Significant and trend level differences were apparent on several measures of functional disability. A regression analysis showed that number of psychiatric diagnoses, number of functional gastrointestinal symptoms, and dissociation scale scores significantly discriminated the groups. Treatment of current major depression decreased functional disability despite no objective changes in gastrointestinal disease severity. It was concluded that the presence of a current psychiatric disorder appears to alter the perception of disease severity in patients with IBD. Nonrecognition of the psychiatric disorder may lead to unnecessary and aggressive interventions for IBD patients such as medication changes, invasive testing, or surgery. The presence of a current psychiatric illness also appears to be associated with increased functional disability. Psychiatric evaluation and treatment, therefore, have an important role in the ongoing management of IBD patients with distressing gastrointestinal symptoms not directly attributable to their IBD.

Activities of Daily Living↗
PubMed1996

Referral of Asian patients to a GI clinic.

This study compared gastrointestinal (GI) symptoms and psychiatric morbidity in consecutive new out-patients presenting to a district general hospital. In a 6-month period 36 patients of South Asian origin were referred to the clinic. They were compared in terms of GI symptoms and psychiatric morbidity with white European controls, both with a large sample of clinic attenders, and with a subsample of 36 matched for age, gender, and diagnosis. A total of 72% (26 of 36) of Asian patients had functional GI disorders compared to 48% (42 of 88) of white patients (p < 0.05). However, comparisons of matched patients showed that Asian patients with functional GI disorders had less severe GI symptoms than the matched white patients, and fewer had psychiatric disorder (23% of Asians and 42% of white Europeans). These results suggest that the threshold for referral for Asian patients with functional GI disorders to hospital clinics is lower than for white patients. Detection and management of somatization in Asian patients in primary care need to be improved, and referral patterns of general practitioners need to be explored in future research.

Adolescent↗
PubMed1995

Coronary risk factors in people from the Indian subcontinent living in west London and their siblings in India.

Several reports have shown that migrants from southeast Asia tend to have an increased risk of coronary heart disease when settled in their new country. We compared coronary risk factors in a randomly selected group of 247 migrants from the Indian subcontinent of Punjabi origin living in West London and 117 of their siblings living in the Punjab in India. The West London cohort had a greater body mass index (p < 0.001), systolic blood pressure (p = 0.0087), serum cholesterol (p < 0.001), apolipoprotein B (p < 0.001), lower high-density lipoprotein cholesterol (p < 0.05) and higher fasting blood glucose (p < 0.05) than their siblings in the Punjab. Insulin sensitivity, derived from the homoeostatic assessment mathematical model, was lower in men in West London than in their counterparts in India (p < 0.05). Indians in West London had lower beta cell function than those in the Punjab (p < 0.001). Serum lipoprotein (a) concentrations were similar in both the West London and Punjab population, but were significantly higher (p = 0.01) than those of white European populations in the UK. Increases in serum cholesterol after migration from India lead to increased coronary risk conferred by high serum lipoprotein (a) concentrations and greater insulin resistance. Such between-country comparisons are an important means of establishing the importance of coronary risk factors.

Adult↗