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Biomedical subjects

Francis Creed

Publications and source records attributed to Francis Creed.

At least 19 recordsLinked to original sources
PubMed2006

Outcome of prenatal depression and risk factors associated with persistence in the first postnatal year: prospective study from Rawalpindi, Pakistan.

BACKGROUND: Rates of prenatal and postnatal depression in developing countries are high. Prolonged depression during the postnatal period is associated with impaired infant growth and development. Little is known about the factors predicting the persistence of prenatal depression beyond the first few postnatal months. METHODS: From a sample of 701 women in a rural sub-district of Pakistan, the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was used to identify those with ICD-10 depressive disorder in the third trimester of pregnancy (n=160). Depressed women were re-assessed at 3, 6 and 12 months postnatal. Persistently depressed women (depressed at all time points) were compared with the remainder. Psychiatric symptoms, disability and life events were measured using the Self-Reporting Questionnaire (SRQ), Brief Disability Questionnaire (BDQ), and a modified Life Events Checklist. RESULTS: Of 129 mothers who completed follow-up, 73 (56%) were depressed at all points of assessment. These persistently depressed mothers had higher SRQ and BDQ scores prenatally and had experienced more life events in the year preceding the third pregnancy trimester than the mothers whose depressive disorder resolved (none received treatment). Persistent depression was significantly associated also with poverty, having 5 or more children, an uneducated husband and lack of a confidant or friend. On multivariate analysis, higher SRQ score and poverty during pregnancy predicted persistent depression. LIMITATIONS: The sample was from one rural sub-district only. We did not assess the women for physical conditions such as anaemia and thyroid-deficiency. CONCLUSION: Women who are poor and have more psychological symptoms during pregnancy are more likely to remain depressed one year after giving birth. This study highlights the need for developing mechanisms of early identification and suitable psychosocial interventions to minimise the damaging effects of persistent postnatal depression in poor communities.

Adult↗
PubMed2006

Number of bodily symptoms predicts outcome more accurately than health anxiety in patients attending neurology, cardiology, and gastroenterology clinics.

BACKGROUND: In consecutive new outpatients, we aimed to assess whether somatization and health anxiety predicted health care use and quality of life 6 months later in all patients or in those without demonstrable abnormalities. METHOD: On the first clinic visit, participants completed the Illness Perception Questionnaire (IPQ), the Health Anxiety Questionnaire (HAQ), and the Hospital Anxiety and Depression Scale (HADS). Outcome was assessed as: (a) the number of medical consultations over the subsequent 6 months, extracted from medical records, and (b) Short-Form Health Survey 36 (SF36) physical component score 6 months after index clinic visit. RESULTS: A total of 295 patients were recruited (77% response rate), and medical consultation data were available for 275. The number of bodily symptoms was associated with both outcomes in linear fashion (P<.001), and this was independent of anxiety and depression. Similar associations were found in people with or without symptoms due to demonstrable structural abnormalities. Health anxiety was associated only with health-related quality of life in patients with symptoms explained by demonstrable abnormalities. CONCLUSION: The number of bodily symptoms and degree of health anxiety have different patterns of association with outcome, and these need to be considered in revising the diagnoses of somatization and hypochondriasis.

Ambulatory Care↗
PubMed2006

Can DSM-V facilitate productive research into the somatoform disorders?

OBJECTIVE: To highlight key research issues relevant to the diagnostic classification of somatoform disorders and assess whether DSM-V can facilitate research. METHODS: A selective review of recent research findings in relation to the diagnostic categories of somatization disorder and hypochondriasis. RESULTS: The DSM-IV criteria have been ignored by researchers as they were either too restrictive or too broad to study the associated features of somatization and hypochondriasis. In view of the linear relationship between number of bodily symptoms and impairment, the appropriate cutoff point has yet to be established. Ongoing research highlights the perceptual and cognitive aspects of these disorders, which need to be researched further in order to improve management. CONCLUSION: DSM-IV did not facilitate research. Its successor should enable longitudinal studies to further elucidate the causes and perpetuating factors of somatization and illness worry rather than limit such studies by producing artificial criteria that may not be supported by subsequent research.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed2006

Psychosocial aspects of the functional gastrointestinal disorders.

This report reviews recent research on the psychosocial aspects of the functional gastrointestinal disorders (FGIDs). A review and evaluation of existing literature was conducted by a multidisciplinary committee of experts in this field. This report is a synopsis of a chapter published in the Rome III book. The committee reached consensus in finding considerable evidence supporting the association between psychological distress, childhood trauma and recent environmental stress, and several of the FGIDs but noted that this association is not specific to FGIDs. There is also considerable evidence that psychosocial variables are important determinants of the outcomes of global well-being, health-related quality of life, and health care seeking. In line with these descriptive findings, there is now increasing evidence that a number of psychological treatments and antidepressants are helpful in reducing symptoms and other consequences of the FGIDs in children and adults. The FGIDs are a result of complex interactions between biological, psychological, and social factors, and they can only be treated satisfactorily when all these factors are considered and addressed. Therefore, knowledge about the psychosocial aspects of FGIDs is fundamental and critical to the understanding, assessment, and treatment of these disorders. More extensive physician training is needed if these aspects of treatment are to be used effectively and widely in clinical practice.

Anti-Anxiety Agents↗
PubMed2006

Violence in women with psychosis in the community: prospective study.

BACKGROUND: Little is known about the determinants of violence in women with psychosis. AIMS: To identify predictors of violence in a community sample of women with chronic psychosis. METHOD: The 2-year prevalence of physical assault was estimated for a sample of 304 women with psychosis. Baseline socio-demographic and clinical factors were used to identify predictors of assault. RESULTS: The 2-year prevalence of assault in the sample was 17%. Assaultive behaviour was associated with previous violence (OR=5.87,95% CI 2.42-14.25), non-violent convictions (OR=2.63,95% CI 1.17-5.93), victimization (OR=2.46, 95% CI1.02-5.93), African-Caribbean ethnicity (OR=2.24,95% CI1.02-4.77), cluster B personality disorder (OR=2.66, 95% CI1.11-6.38) and high levels of unmet need (OR=1.17,95% CI1.01-1.35). An interaction between African-Caribbean ethnicity and cluster B personality disorder was identified in relation to violent outcome. Violent women were found to be more costly to services. CONCLUSIONS: Nearly a fifth of community-dwelling women with chronic psychosis committed assault over a period of 2 years. Six independent risk factors were found to predict violence.

Adult↗
PubMed2006

Comparison of the Personal Health Questionnaire and the Self Reporting Questionnaire in rural Pakistan.

OBJECTIVE: To apply ROC analysis to select the best threshold scores for the PHQ and SRQ; to compare the sensitivity and specificity of the PHQ and SRQ against a criterion diagnosis of depressive disorder in a community sample in rural Pakistan, and to examine the influence of socio-demographic factors on misclassification. METHODS: The study used a two-stage design. Receiver Operating Characteristic (ROC) analysis was used to estimate the optimal threshold score and to compare the ability of the Self Reporting Questionnaire (SRQ) and the Personal Health Questionnaire (PHQ) to discriminate between cases of depressive disorder and non-cases. RESULTS: The results of the ROC analysis suggest that the SRQ is superior to the PHQ, and at the threshold of 5/6, the SRQ has superior sensitivity, negative predictive value and percentage agreement compared with the PHQ. When the SRQ threshold is raised it gains specificity, and at a cut-off threshold of 7/8 it is superior to the PHQ (5/6) in all validity coefficients and percentage agreement. Only gender and the presence of a confidant had a significant effect on misclassification using the SRQ among the cases. Both questionnaires performed better for females based on comparison of the areas under the ROC curves. CONCLUSION: This study has demonstrated that the Urdu translations of both the PHQ and SRQ can be used as screening tests for depressive disorder in the Pakistani population. People with little or no education answer both somatic and psychological items with equal ease. Inconclusion, the PHQ does not appear to have any advantage over the SRQ.

Adolescent↗
PubMed2006

Should general psychiatry ignore somatization and hypochondriasis?

This paper examines the tendency for general psychiatry to ignore somatization and hypochondriasis. These disorders are rarely included in national surveys of mental health and are not usually regarded as a concern of general psychiatrists; yet primary care doctors and other physicians often feel let down by psychiatry's failure to offer help in this area of medical practice. Many psychiatrists are unaware of the suffering, impaired function and high costs that can result from these disorders, because these occur mainly within primary care and secondary medical services. Difficulties in diagnosis and a tendency to regard them as purely secondary phenomena of depression, anxiety and related disorders mean that general psychiatry may continue to ignore somatization and hypochondriasis. If general psychiatry embraced these disorders more fully, however, it might lead to better prevention and treatment of depression as well as helping to prevent the severe disability that may arise in association with these disorders.

Journal Article↗
PubMed2005

Does psychological treatment help only those patients with severe irritable bowel syndrome who also have a concurrent psychiatric disorder?

OBJECTIVE: We have previously reported improved health-related quality of life in patients with severe irritable bowel syndrome (IBS) following psychological treatments. In this paper, we examine whether this improvement was associated with improvement in psychological symptoms and was confined to those patients who had concurrent psychiatric disorder. METHOD: Two hundred and fifty-seven patients with severe IBS entering a psychological treatment trial were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. At entry to the trial and 15 months later, patients were also assessed using the Hamilton Depression Rating Scale, Symptom Cheecklist-90 (SCL-90) and Short Form-36 (SF36) physical component summary score as the main outcome measure. Partial correlation was used to compare changes in SF36 score and changes in psychological scores while controlling for possible confounders, treatment group and baseline scores. Multiple regression analysis was used to examine whether changes in psychological scores, changes in pain and a history of abuse could account for most of the variance of change in SF36 physical component score. RESULTS: Of 257 patients with severe IBS, 107 (42%) had a depressive, panic or generalized anxiety disorder at trial entry. There were moderate but significant correlations (0.21-0.47) between change in the psychological scores and the change in SF36 physical component scores. The correlation coefficients were similar in the groups with and without psychiatric disorder. The superiority of psychotherapy and antidepressant groups over treatment as usual was similar in those with and without psychiatric disorder. Multiple regression found significant independent effects of change in depression, anxiety, somatization and abdominal pain but there was still variance explained by treatment group. CONCLUSIONS: In severe IBS improvement in health-related quality of life following psychotherapy or antidepressants is correlated with, but not explained fully by reduction of psychological scores. A more complete understanding of how these treatments help patients with medically unexplained symptoms will enable us to refine them further.

Adult↗
PubMed2005

Outcome in severe irritable bowel syndrome with and without accompanying depressive, panic and neurasthenic disorders.

BACKGROUND: Irritable bowel syndrome often leads to impaired functioning. AIMS: To assess the contribution of psychiatric disorders to impaired outcome in severe irritable bowel syndrome. METHOD: Patients with severe irritable bowel syndrome entering a psychological treatment trial (n=257) were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. Outcomes were number of days of restricted activity, role limitation (physical) score of the Short Form Health Survey and costs. RESULTS: At baseline, depressive disorder (29% of patients), panic (12%) and neurasthenia (35%) were associated with impairment; number of psychiatric disorders was associated in a dose-response fashion (P=0.005). At follow-up, depressive disorder and neurasthenia were associated with role limitation score. Improved depression was associated with improved role functioning. CONCLUSIONS: Depressive, panic and neurasthenic disorders contribute to poor outcomes in severe irritable bowel syndrome, and appropriate treatment should be available to these patients.

Activities of Daily Living↗
PubMed2005

Primary care consultation predictors in men and women: a cohort study.

BACKGROUND: Women visit their doctors more than men, but comparatively few studies have explored gender differences in consultation in detail. AIMS: To identify the factors that predicted the number of primary care consultations in men and women over a 5-year period. DESIGN OF STUDY: Prospective cohort study with three waves of data collection by postal questionnaire. SETTING: A single suburban general practice in Greater Manchester, UK. METHOD: Consultation data were sought from primary care records on a random sample of 800 adults. The main outcome measure was the number of consultations over the 5 years of the study. Questionnaire measures included the 12-item version of the General Health Questionnaire, the Illness Attitude Scales, a somatic symptom scale, a fatigue scale, and a functional assessment of disability. RESULTS: Consultation data were obtained on 738 patients (445 women, 293 men, 92% of selected subjects). Longitudinal models of consultation over 5 years showed that changes in psychological distress were more strongly associated with consultation in women than in men, whereas cognitive factors (negative illness attitudes) were more strongly associated with the consultation rate in men than women. CONCLUSION: The predictors of consultation in primary care may be different for men and women. A fuller understanding of the reasons for consultation may enable primary care doctors to better help individual patients, as well as perhaps contributing more generally to the development of gender specific interventions for those who consult unusually frequently.

Adolescent↗
PubMed2004

Predicting violence in schizophrenia: a prospective study.

BACKGROUND: People with schizophrenia are more violent than the general population, but this increased risk is attributable to the actions of a small subgroup. Identifying those at risk has become an essential part of clinical practice. AIMS: To estimate the risk factors for assault in patients with schizophrenia. METHODS: Two hundred seventy-one patients with schizophrenia were interviewed using an extensive battery of instruments. Assault was measured from multiple data sources over the next 2 years and criminal records were obtained. Multiple sociodemographic and clinical variables measured at baseline were examined as possible predictors of assault during follow-up. RESULTS: Sixty-nine (25%) patients committed assault during the 2-year follow-up. The model that best predicted assault included a history of recent assault (OR 2.33, 95% CI 1.17-4.61), a previous violent conviction (OR 2.02, 95% CI 1.04-3.87), having received special education (OR 2.76, 95% CI 1.22-6.26) and alcohol abuse (OR 3.55, 95% CI 1.24-10.2). CONCLUSIONS: Previously established risk factors including a history of violence and alcohol abuse are replicated in this study. Although low premorbid IQ did not predict violence, a need for special education did.

Adolescent↗
PubMed2004

Social factors associated with chronic depression among a population-based sample of women in rural Pakistan.

OBJECTIVE: Previous studies have reported a high prevalence of depression in women in Pakistan. This paper investigates whether risk factors for chronic depression established in studies performed in Western countries can explain this high prevalence. METHOD: A two-phase survey using the self-rating questionnaire (SRQ) for common mental disorders and the Psychiatric Assessment Schedule was performed on a general population sample in rural Pakistan. Demographic data and results of the Life Events and Difficulties Schedule were analysed in relation to SRQ score and psychiatric disorder. RESULTS: A total of 145 women were screened. High SRQ score was associated with low educational status, not having a confidant, having four or more children, being older, not being married and living in a house with more than three people per room. Regression analysis demonstrated that the first three of these independently contributed to SRQ score. In the interviewed sample (74 women), only educational level independently contributed to the presence of depression. In addition, the least educated group experienced the greatest number of marked difficulties: 67% of them had experienced both marked housing and financial difficulties compared to 28% and 25% of the other educational groups (p = 0.005). Experiencing both housing and financial difficulties was a significant risk factor for depression in women with secondary education, but not for those without secondary education. CONCLUSIONS: This study suggests that high levels of social adversity and low levels of education are strongly associated with depression in women in Pakistan. The other vulnerability factors found in the West (such as lack of a confidant, the presence of three or more young children at home, or loss of mother during childhood) may be of lesser importance in this population.

Adolescent↗
PubMed2004

Distinct psychosocial differences between women with coronary heart disease and cardiac syndrome X.

AIMS: To compare the impact of oestrogen, gynaecological history, social support, life events and family history of CHD on psychosocial morbidity in syndrome X, CHD patients and healthy controls. METHODS AND RESULTS: 100 female syndrome X (60 +/- 9 years), 100 female CHD (65 +/- 9 years) and 100 healthy female volunteers (61 +/- 10 years) completed the hospital anxiety and depression scale (HADS), health anxiety questionnaire (HAQ), a demographic information scale, life events scale, family history of CHD, menopausal, menstrual and gynaecological history. A 17beta-oestradiol sample was taken. Syndrome X patients had higher levels of life interference (p < 0.05) and HADS anxiety (p < 0.05) than CHD patients, and higher levels of all HADS and HAQ scales than controls (p < 0.01). Syndrome X patients with a large social network had lower HADS anxiety (p < 0.05), health worry (p < 0.05), life interference (p < 0.01) and total HAQ (p < 0.01). Social network (p = 0.003), divorced/separated or widowed status (p = 0.005), HRT (p = 0.008) and HADS anxiety score (p < 0.001) accounted for 41.9% of the variance in HAQ scores in syndrome X. Oestrogen was unrelated to the HADS or HAQ for any group. CONCLUSION: Syndrome X patients suffered higher levels of psychological morbidity in comparison to CHD patients and controls. Life events and social network size were related to health anxiety, general anxiety and depression in women with syndrome X.

Anxiety↗
PubMed2004

The relationship between vital exhaustion, depression and comorbid illnesses in patients following first myocardial infarction.

OBJECTIVE: Vital exhaustion and depression are both independent risk factors for cardiovascular disease, yet the relationship between these highly similar dimensions remains unclear. We have examined the association between depression and vital exhaustion and investigated the extent to which any association is the result of comorbid illnesses. METHODS: Three hundred and five consecutive patients were examined on average 3.6 days following hospital admission with first myocardial infarction (MI). The Maastricht Questionnaire (MQ; vital exhaustion) was administered together with the Hospital Anxiety and Depression Scale (HADS), and details of comorbid physical illness were recorded. The factor structure of the MQ was explored using factor analysis. RESULTS: Depression and vital exhaustion were highly correlated (r=.61, P<.01). This correlation did not diminish on controlling for age, sex, and comorbidity (r=.59, P<.01). Factor analysis of MQ score gave a four-factor solution: fatigue (18.2% of variance), depression (17.9%), lack of concentration (9.5%), and sleep difficulties (8.1%). The fatigue dimension of the MQ remained highly associated with HADS depression score (r=.50, P<.01), controlling for age, sex, and comorbidity. CONCLUSIONS: Depression and fatigue are highly correlated and their association is not attributable to comorbid physical illnesses or the tendency of the MQ to measure depression. Future studies should investigate fatigue instead of vital exhaustion as a potential risk factor for poor cardiac prognosis independent of the influence of depression.

Anxiety↗
PubMed2004

A systematic review of the epidemiology of somatisation disorder and hypochondriasis.

BACKGROUND: This paper reviews current knowledge regarding the prevalence and associated features of somatisation disorder and hypochondriasis in population-based and primary care samples. METHOD: A systematic review of the literature, which used a standardised definition of somatisation disorder or hypochondriasis and which examined the characteristics and associated features of these disorders in population-based samples or primary care settings. RESULTS: In population-based studies the prevalence of somatisation disorder and hypochondriasis was too low to examine associated features reliably. In studies using abridged criteria, a clear female predominance was not found in either disorder; there was a consistent relationship with few years of education. There was a close relationship with anxiety and depressive disorders, with a linear relationship between numbers of somatic and other symptoms of distress in several studies, including longitudinal studies. No studies showed that these symptom clusters fulfil the criteria of characteristic onset, course and prognosis required to merit the status of discrete psychiatric disorders. CONCLUSIONS: On existing evidence, somatisation disorder and hypochondriasis cannot be regarded as definite psychiatric disorders. There is some evidence that numerous somatic symptoms or illness worry may be associated with impairment and high health care utilisation in a way that cannot be solely explained by concurrent anxiety and depression, but further research using population-based samples is required.

Culture↗