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Biomedical subjects

Glyn Lewis

Publications and source records attributed to Glyn Lewis.

At least 37 records · Page 2Linked to original sources
PubMed2005

Phenotypic variation between parent-offspring trios and non-trios in genetic studies of schizophrenia.

BACKGROUND: Phenotypic differences between parent-offspring trios and non-trios have been reported for various psychiatric disorders, and it has been suggested that this may make comparisons of case-control and family-based results for gene-disease association studies inappropriate. AIMS: To compare phenotypes between trios and non-trios with schizophrenia, and explore possible reasons for differences observed. METHOD: Phenotypes were compared between trios (n=75) and non-trios (n=424) collected as part of a case-control study. RESULTS: Differences were observed for most phenotypes investigated, although all were eliminated after adjusting for confounding. CONCLUSIONS: Confounding, genetic heterogeneity or selection bias could result in differences in case-control and family-based results. However as we discuss, where adequately designed case-control studies are used, gene-disease association results would be incomparable between family-based and case-control studies only if genetic heterogeneity was present. These results do not support the presence of such genetic heterogeneity in schizophrenia.

Adolescent↗
PubMed2005

Investigating the effect of demographic and socioeconomic variables on misclassification by the SRQ-20 compared with a psychiatric interview.

BACKGROUND: Previous research among primary care attenders in Latin America has noted that females and those with less education may over-report psychiatric complaints on the SRQ-20, compared with responses to a standardized psychiatric interview administered by a clinician. In this paper, the association between demographic and socioeconomic variables and misclassification by the SRQ-20 were investigated and the size of misclassification estimated in a population-based survey. METHOD: A cross-sectional survey of a random sample of private households included 683 adults aged 15 years and over living in Olinda, Recife Metropolitan Region, Pernambuco, Brazil. The SRQ-20 results were compared with an interview administered by a psychiatrist. The effect of demographic and socioeconomic variables on misclassification by the SRQ-20 was assessed by calculating the odds ratio (OR) for being a case on the SRQ-20 after adjustment for being a case on the psychiatric interview. Logistic regression was used to investigate the size of misclassification, adjusting the association between common mental disorders, defined by the SRQ-20,and different variables for the psychiatric interview results. RESULTS: In the univariate analysis, females, the elderly, the less educated, manual workers, housewives and migrants did tend to over-report complaints in the absence of symptoms. However, the apparent influence of age, education, occupation and migration on misclassification by the SRQ-20 was markedly reduced and became statistically non-significant after adjustment for sex and for the other variables in the table. In contrast, the gender effect was not altered after adjustment. CONCLUSIONS: Our results suggest that misclassification on the SRQ-20 was mostly related to being female, though this did not entirely explain the increased prevalence of CMD in women in the sample. Further research is needed to understand why different ways of measuring CMD can lead to different results.

Adolescent↗
PubMed2005

Factors associated with being a false positive on the General Health Questionnaire.

BACKGROUND: The General Health Questionnaire (GHQ) has been used extensively in community and primary care research as an alternative to longer, time-consuming and more expensive assessments of the common mental disorders of depression and anxiety. The sensitivity and specificity of the GHQ compared with longer more detailed assessments is between 70 and 80%. Though satisfactory, this raises the concern about the possibility of bias in relation to longer assessments. We studied socio-demographic factors that were associated with being a false positive on the GHQ in order to investigate any ascertainment bias in relation to more detailed assessments. METHOD: A total of 7,357 consecutive patients aged 16 and over, in five general practices in Cardiff, Bristol and Pontypridd, were invited to complete the 12-item GHQ. Of these, 1,154 patients scored 3 or more, our case definition on the GHQ, and completed a computerised version of the Revised Clinical Interview Schedule (CIS-R) together with a short socio-demographic questionnaire. RESULTS: Of the 1,154 subjects who were cases on the GHQ, 344 (30 %) (95% CI 27%-32%) were false positive and were not cases on the CIS-R. After adjustment for the other variables, including GHQ score, false positive subjects were more likely to be employed [odds ratio (OR) 2.7, 95% CI 1.4-5.3], owner-occupiers (OR 1.6, 95% CI 1.0-2.4) and to have a close friend or relative to talk to about personal problems (OR 2.2, 95 % CI 1.4-3.5). CONCLUSION: Our results suggest that in this study there was an ascertainment bias on the GHQ in relation to the CIS-R. Studies that use the GHQ to study the relationship between socio-economic status and common mental disorder could lead to biased estimates of association compared to studies that use the CIS-R. It is likely that the GHQ will lead to a higher estimate of prevalence than the CIS-R in subjects who are better off financially and who have better social support.

Adolescent↗
PubMed2005

Comparing sex inequalities in common affective disorders across countries: Great Britain and Chile.

Most studies throughout the world have found that women report more psychological symptoms than men. Much less is known about possible variation between countries in the magnitude of these sex differences or the factors contributing to the increase of risk among women in countries with different levels of development. This study aimed to compare sex differences for common affective disorders (CAD) between Great Britain and Chile based on two large urban cross-sectional psychiatric household surveys that used similar methodology. Women in both countries reported more CAD than men but Chilean women had an increased risk in comparison to their British counterparts, a difference that became larger as symptom severity increased. Of all the main explanatory variables included in the analysis--education, employment status, children at home, marital status, and social support--the only statistically significant interaction that could account for this increased risk was education, with an increasingly larger risk for women with lower levels of educational attainments in Chile compared to Britain. Education is a powerful socio-economic indicator that is difficult to revert later in life, especially in countries where opportunities for women are less forthcoming, and it might act as powerful reminder of social entrapment.

Adolescent↗
PubMed2005

Psychiatric and social aspects of suicidal behaviour in prisons.

BACKGROUND: Suicidal behaviour and completed suicide are serious problems within British prisons, leading to significant morbidity and mortality, and are the focus of major efforts towards their prevention. AIM: To explore the demographic, social and psychiatric correlates of suicidal behaviour in prisons in England and Wales and their relationship with health service use; and to develop a combined psychosocial model of risk. METHOD: This report analyses the prevalence of suicidal ideation and suicide attempts in the ONS National Prison Survey, and their association with the presence of psychiatric disorders, personality disorder, substance abuse and social risk factors. These data were compared with data from the second national survey of psychiatric morbidity in adults living at home. In both surveys, a two-phase interviewing procedure was used, covering general health, health service use, assessment of psychiatric disorders, life events, social supports, suicidal behaviour, activities of daily living, sociodemographic data, substance abuse and intelligence. RESULTS: Suicidal thoughts and suicide attempts were commoner in prisons than in the general population and these were significantly associated with higher rates of psychosis, neurosis and personality disorder in prisons. In addition, demographic and factors such as being young, single, white, leaving school early and experiencing poor social support and significant social adversity were important risk factors for suicidal thoughts. Crucially, there was no separate category of people at suicidal risk who did not have psychiatric disorders. CONCLUSIONS: The high rates of suicidal behaviour in prisons cannot be addressed without adequate attention to the high rates of psychiatric disorder and vulnerability factors in prisoners.

Adolescent↗
PubMed2005

Primary group size, social support, gender and future mental health status in a prospective study of people living in private households throughout Great Britain.

BACKGROUND: Structural characteristics of social networks such as primary group size have received less attention than measures of perceived social support. Previous research suggests that associations between social network size and later common mental disorder status may differ according to sex and initial mental state. METHOD: Adults participating in the 2000 British National Household Survey of psychiatric morbidity were randomly selected for follow-up 18 months later. The revised Clinical Interview Schedule (CIS-R) and the Interview Measure of Social Relations (IMSR) were administered at baseline and follow-up. Primary group size was defined as the total number of close relatives and friends. A four-level scale of common mental disorder was modelled with ordinal logistic regression, based on weighted data (n=2413). FINDINGS: After adjusting for confounders, a primary group size of three or less at time 1 predicted worse mental health at time 2. This effect was greatest in men who were initially non-cases at baseline (averaged odds 4.5) and in women who were initially cases at baseline (average odds 2.9). Primary group size at time 2 was significantly predicted by level of common mental disorder at time 1 in women but not in men. Thus, confounding by baseline disorder does not explain risk of developing poor mental health in socially isolated men. CONCLUSION: This study replicates the strong effects of primary group size on future mental health that emerge when men and women are studied separately and when subjects are categorized according to baseline mental health status.

Adolescent↗
PubMed2005

Psychosis in the community and in prisons: a report from the British National Survey of psychiatric morbidity.

OBJECTIVE: Reports of increased rates of psychosis in prisons could be due to sampling and ascertainment differences. The authors compared two samples of subjects 16-64 years of age: those from the general population of residents in Great Britain and prisoners in England and Wales. METHOD: A random sample of remanded and sentenced male and female prisoners (N=3,142) and a two-phase, cross-sectional random sample of household residents (N=10,108) were assessed with structured questionnaires and the semistructured Schedules for Clinical Assessment in Neuropsychiatry. RESULTS: The weighted prevalence of probable functional psychosis in the past year was 4.5 per thousand (95% CI=3.1 to 5.8) in the household survey. In the prison survey, the weighted prevalence was over 10 times greater: 52 per thousand (95% CI=45 to 60). One in four prisoners with a psychotic disorder had psychotic symptoms attributed to toxic or withdrawal effects of psychoactive substances. The proportion of subjects with specific types of hallucinations or delusions did not differ between prison and household psychosis cases. CONCLUSIONS: This large study using standardized comparisons showed that the prevalence of psychosis in prisons is substantially higher than in the community and is deserving of greater attention to treatment and prevention. Apart from a minority of prisoners with symptoms attributable to psychoactive substances, the clinical symptom profile of psychosis is the same in both settings. Longitudinal research is needed to better understand these prevalence differences.

Adolescent↗
PubMed2005

Social adversity in childhood and the risk of developing psychosis: a national cohort study.

OBJECTIVE: There is conflicting evidence concerning the association of social childhood factors and subsequent psychosis. Previous studies have had inadequate designs. The aim of the present study was to describe a broad range of social factors during childhood and the risk of developing psychosis later in life in a national cohort. METHOD: The study population consisted of all children born in Sweden in 1963-1983-2.1 million persons-in family households participating in the national census of 1970, 1980, 1985, or 1990. Hazard ratios were estimated for five different indicators of socioeconomic position (living in rented apartments, low socioeconomic status, single-parent households, unemployment, and households receiving social welfare benefits) from hospital admissions for schizophrenia and other psychoses during 1987-2002. RESULTS: Increased age- and sex-adjusted hazard ratios for schizophrenia and other psychoses were found for all childhood socioeconomic indicators, ranking from lowest to highest hazard ratio: rented apartments, low socioeconomic status, single-parent households, unemployment, and households receiving social welfare benefits. Hazard ratios increased with an increasing number of adverse social factors present. Those with four measures of adversity had a 2.7-fold higher risk of schizophrenia than those with none. CONCLUSIONS: The results indicate that social adversity in childhood and fetal life is independently associated with the risk of developing schizophrenia and other psychoses later in life. The risks increased with an increasing number of exposures, suggesting a dose-response relationship.

Adult↗
PubMed2005

Negative self-schemas and the onset of depression in women: longitudinal study.

BACKGROUND: Beck's cognitive theory of depression has received little empirical support. AIMS: To test whether those with negative self-schemas were at risk of onset of depression. METHOD: Data were collected by postal questionnaire from 12,003 women recruited during early pregnancy; questionnaires included measures of depressive symptoms and negative self-schemas. Regular questionnaires were sent during pregnancy and following childbirth. RESULTS: Of 8540 women not depressed when recruited, 8.6% (95% CI 8.0-9.2) became depressed 14 weeks later. Those in the highest tertile for negative self-schema score were more likely to become depressed than those in the lowest tertile (odds ratio 3.04, 95% CI 2.48-3.73). The association remained after adjustment for baseline depressive symptoms and previous depression (OR 1.6, 95% CI 1.27-2.02) and was of similar magnitude for onset 3 years later. CONCLUSIONS: Holding a negative self-schema is an independent risk factor for the onset of depression in women. This finding supports a key element of Beck's cognitive theory. Understanding more about how negative self-schemas arise should help inform preventive policies.

Adolescent↗
PubMed2005

Mental health inequalities in Wales, UK: multi-level investigation of the effect of area deprivation.

BACKGROUND: Geographical variation in the prevalence of common mental disorders has not been explained adequately. AIMS: To investigate whether regional mental health differences in Wales would persist after having taken into account the characteristics of individuals and regional social deprivation. METHOD: Data from the 1998 Welsh Health Survey were used. Common mental disorders were assessed with the mental health index included in the Short-Form 36 health survey (SF-36). The data were analysed using a multi-level linear regression model. RESULTS: Of the total variance in the mental health index, 1.47% occurred at regional level (95% CI 0.56-2.38). Adjustment for individual characteristics did not explain the between-region variation. A higher area deprivation score was associated with a higher score on the mental health index. CONCLUSIONS: Mental health differences in Wales are partly explained by the level of regional social deprivation.

Adolescent↗
PubMed2005

Birth weight and psychological distress at age 45-51 years: results from the Aberdeen Children of the 1950s cohort study.

BACKGROUND: It is unclear whether the effect of low birth weight on common affective disorders in later life is direct or mediated through childhood factors. AIMS: To determine whether birth weight has a direct effect on psychological distress in adulthood not mediated by childhood IQ or behavioural problems. METHOD: Participants (n=5572) of the Aberdeen Children of the 1950s study had data on birth weight for gestational age and adult psychological distress. Logistic regression was used to examine the association between these factors, with adjustment for confounders and potential childhood mediators. RESULTS: Children born full term but weighing less than 5.5 lb had increased odds of psychological distress in later life after adjustment for potential confounders (OR=1.49, 95% CI 1.01-2.20). Further adjustment for childhood IQ and behaviour did not attenuate the association. A 1 s.d. decrease in birth weight for gestational age was associated with a 4% increased odds of psychological distress in adulthood (OR=1.04, 95% CI 0.97-1.12). CONCLUSIONS: Low birth weight for gestational age, particularly at term, was associated with adult psychological distress. This was not mediated by childhood factors, suggesting a direct effect of early life factors on adult mental health. A neurodevelopmental pathway may therefore be implicated.

Birth Weight↗
PubMed2005

Geographical variation in rates of common mental disorders in Britain: prospective cohort study.

BACKGROUND: There is little geographical variation in the prevalence of the common mental disorders. However, there is little longitudinal research. AIMS: To estimate variance in rates of common mental disorders at individual, household and electoral ward levels prospectively. METHOD: A 12-month cohort study of 7659 adults aged 16-74 years in 4338 private households, in 626 electoral wards. Data were collected as part of the British Household Panel Survey. Common mental disorders were assessed using the 12-item General Health Questionnaire (GHQ). Ward-level socio-economic deprivation was measured using the Carstairs index. RESULTS: Less than 1% of total variance, in onset and maintenance of common mental disorders and change in GHQ score between waves, occurred at ward level. However, 12% of variance, which is a statistically significant difference, was found at household level (a much smaller geographical unit) and this difference remained after further analyses. CONCLUSIONS: Ward level socio-economic deprivation does not influence the onset and maintenance of common mental disorders in Britain but local factors at the household level do. Reasons for this remain unclear.

Adolescent↗
PubMed2005

Alcohol consumption as a risk factor for anxiety and depression: results from the longitudinal follow-up of the National Psychiatric Morbidity Survey.

BACKGROUND: Longitudinal studies have been in conclusive in identifying alcohol as a risk factor for anxiety and depression. AIMS: To examine whether excessive alcohol consumption is a risk factor for anxiety and depression in the general population, and whether anxiety and depression are risk factors for excessive alcohol consumption. METHOD: Data were analysed from the 18-month follow-up of the Psychiatric Morbidity Among Adults Living in Private Households, 2000 survey. RESULTS: Hazardous and dependent drinking were not associated with onset of anxiety and depression at follow-up. Binge-drinking was non-significantly associated with incident anxiety and depression (adjusted OR=1.36, 95% CI 0.74-2.50). Abstainers were less likely to have new-onset anxiety and depression at follow-up. Anxiety and depression or sub-threshold symptoms at baseline were not associated with incident hazardous or binge-drinking at follow-up, but there was weak evidence linking sub-threshold symptoms with onset of alcohol dependence (adjusted OR=2.04, 95% CI 0.84-4.97). CONCLUSIONS: Excessive alcohol consumption was not associated with the onset of anxiety and depression but abstinence was associated with a lower risk. Sub-threshold symptoms were weakly associated with new-onset alcohol dependence.

Adolescent↗
PubMed2005

Self-help books for depression: how can practitioners and patients make the right choice?

BACKGROUND: Depression is a common and important public health problem most often treated by GPs. A self-help approach is popular with patients, yet little is known about its effectiveness. AIM: Our primary aim was to review and update the evidence for the clinical effectiveness of bibliotherapy in the treatment of depression. Our secondary aim was to identify which of these self-help materials are generally available to buy and to examine the evidence specific to these publications. METHOD: Medline, CINAHL, EMBASE, PsycINFO, CCTR, PsiTri and the National Research Register were searched for randomised trials that evaluated self-help books for depression which included participants aged over 16 years with a diagnosis or symptoms of depression. Clinical symptoms, quality of life, costs or acceptability to users were the required outcome measures. Papers were obtained and data extracted independently by two researchers. A meta-analysis using a random effects model was carried out using the mean score and standard deviation of the Hamilton Rating Scale for Depression at the endpoint of the trial. RESULTS: Eleven randomised controlled trials were identified. None fulfilled CONSORT guidelines and all were small, with the largest trial having 40 patients per group. Nine of these evaluated two current publications, Managing Anxiety and Depression (UK) and Feeling Good (US). A meta-analysis of 6 trials evaluating Feeling Good found a large treatment effect compared to delayed treatment (standardised mean difference = -1.36; 95% confidence interval [CI] = -1.76 to -0.96). Five self-help books were identified as being available and commonly bought by members of the public in addition to the two books that had been evaluated in trials. CONCLUSION: There are a number of self-help books for the treatment of depression readily available. For the majority, there is little direct evidence for their effectiveness. There is weak evidence that suggests that bibliotherapy, based on a cognitive behavioural therapy approach is useful for some people when they are given some additional guidance. More work is required in primary care to investigate the cost-effectiveness of self-help and the most suitable format and presentation of materials.

Adolescent↗
PubMed2005

A qualitative study exploring how GPs decide to prescribe antidepressants.

BACKGROUND: To influence GPs' prescribing policies and practices it is necessary to have an understanding of how they make decisions. The limited evidence available suggests that not only do GPs find making decisions about diagnosing and prescribing for depression problematic, but that decisions are severely constrained by lack of resources. As a result, it might be thought that GPs, in line with current guidelines, will inevitably prescribe antidepressants for patients presenting with symptoms of anxiety and depression. This study examines the accuracy of this view. AIM: To explore how GPs decide to prescribe antidepressants. DESIGN: Focus groups with self-selected GPs. SETTING: Bristol and the surrounding district. METHOD: Qualitative study of five focus groups with 27 GPs. RESULTS: GPs' decisions about whether an antidepressant would be an appropriate form of management are shaped by a set of rules based on 'clinical' and 'social' criteria. The preferred strategy is to 'wait and see', but antidepressants are prescribed earlier when symptoms are perceived to be persistent, unresolving, severe and 'classic'. Decisions to prescribe are also shaped by organisational constraints of time, lack of accessible alternative management options, cost of prescribing and perceived patient attitude. CONCLUSION: The evidence from this study provides little support for the view that GPs take the easy option of prescribing antidepressants in the face of uncertainty. Evidence suggests that the GPs' prescribing was cautious, which indicates that GPs would support the initiative of recent draft guidelines regarding watchful waiting. This guidance, however, needs to be clear about what constitutes mild depression and address the question of prescribing to patients who are experiencing social adversity. Furthermore, alternatives to antidepressants such as counselling would need to be readily and equitably accessible. In addition, GPs need to be convinced that alternatives to antidepressants are at least as effective for patients with so-called 'mild depression'.

Antidepressive Agents↗
PubMed2005

Deciding who gets treatment for depression and anxiety: a study of consecutive GP attenders.

BACKGROUND: Most research has focused on recognition by GPs of the common mental disorders: depression and anxiety. However, less is known about the factors that determine whether patients with those disorders that are recognised receive any active treatment. AIM: To investigate factors associated with receiving active treatment among consecutive attenders identified by GPs as having a common mental disorder. SETTING: Data were collected as part of a cluster randomised controlled trial in 30 general practices in the south of Bristol, UK, on the impact of mental health guidelines in primary care. METHOD: We studied 439 consecutive general practice attenders aged 16-64 years who were given a diagnosis of depression, anxiety, or chronic mixed anxiety and depression by their GP. The main outcome measure was the provision of any active treatment, whether pharmacological or psychological, for these disorders. Patient, GP, and practice level data, including sociodemographic, clinical, and administrative data were explored as predictors in a logistic regression model. Huber White variance estimates were used to account for hierarchical clustering. RESULTS: Of those patients identified as having a common mental disorder by the GP, 54% were offered active treatment. Higher symptom score, as measured by the General Health Questionnaire (GHQ) (odds ratio [OR] = 1.09; 95% confidence interval [CI] = 1.06 to 1.13; P<0.001) and being male (OR = 1.54; 95% CI = 1.13 to 2.09; P = 0.006), were both associated with an increased likelihood of being offered active treatment. Patients with anxiety (OR = 0.24; 95% = CI 0.14 to 0.41; P<0.001), or chronic mixed anxiety/depression (OR = 0.41; 95% CI = 0.23 to 0.73; P = 0.003) were less likely to be offered active treatment than those considered to have depression. CONCLUSION: When deciding to offer active treatment for common mental disorders, GPs appear to be influenced by the severity of symptoms rather than their 'understandability' in relation to recent life stresses or the social context of distress. Further research is needed to investigate why men are more likely and those with an anxiety disorder less likely, to be offered active treatment.

Adolescent↗
PubMed2004

Paternal age and schizophrenia: a population based cohort study.

OBJECTIVE: To investigate the association of paternal age at conception with the risk of offspring developing schizophrenia. DESIGN: A population based cohort study. SETTING: Sweden. SUBJECTS: 754,330 people born in Sweden between 1973 and 1980 and still alive and resident in Sweden at age 16 years. MAIN OUTCOME MEASURES: Hospital admission with schizophrenia or non-schizophrenic, non-affective psychosis. RESULTS: After adjustment for birth related exposures, socioeconomic factors, family history of psychosis, and early parental death the overall hazard ratio for each 10 year increase in paternal age was 1.47 (95% confidence interval 1.23 to 1.76) for schizophrenia and 1.12 (0.98 to 1.29) for non-schizophrenic non-affective psychosis. This association between paternal age and schizophrenia was present in those with no family history of the disorder (hazard ratio for each 10 year increase in paternal age 1.60, 1.32 to 1.92), but not in those with a family history (0.91, 0.44 to 1.89) (P = 0.04 for interaction). CONCLUSIONS: Advancing paternal age is an important independent risk factor for schizophrenia. The stronger association between paternal age and schizophrenia in people without a family history provides further evidence that accumulation of de novo mutations in paternal sperm contributes to the overall risk of schizophrenia.

Adolescent↗