Detection of depression and anxiety in primary care: follow up study.
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Antidepressive Agents↗
Biomedical subjects
Glyn Lewis
Publications and source records attributed to Glyn Lewis.
A cross-sectional study of the prevalence of psychopathology in adults with congenital heart disease.
OBJECTIVE: Several studies have suggested high levels of psychopathology in children and adolescents with congenital heart disease (CHD). However, little information is published relating to psychopathology in adults with CHD. We wanted to estimate the prevalence of psychopathology in adults with CHD. DESIGN: A cross-sectional study of attenders at an adult CHD clinic compared with orthopaedic outpatients of the same hospital. SETTING: A tertiary CHD clinic in South Wales, the comparison group being recruited from the orthopaedic outpatient clinic in the same teaching hospital. PARTICIPANTS: One hundred and one individuals attending the CHD clinic were identified, 87 successfully completed questionnaires. Forty-five from 80 randomly selected orthopaedic outpatients completed questionnaires. MAIN OUTCOME MEASURES: The General Health Questionnaire 30 (GHQ30) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: We found a statistically significant difference in the mean GHQ 30 score between the CHD and comparison groups, the CHD group having lower scores. The difference remained after adjustment for age and sex. The mean HADS scores differed in the same direction, and were of borderline statistical significance. CONCLUSIONS: In this study, adult subjects with CHD had a lower prevalence of psychopathology. Possible explanations for this finding are discussed.
Adaptation, Psychological↗
Patients' opinions of the use of psychiatric case-finding questionnaires in general practice.
BACKGROUND: The common mental disorders of depression and anxiety often remain undetected in general practice. Psychiatric screening instruments have been recommended to assist detection. AIM: To assess patients' attitudes towards the use of psychiatric screening questionnaires for common mental disorders within general practice. DESIGN: Twenty focus groups comprising 127 patients were conducted in Wales, UK. The groups were distinguished by age, sex and locality. RESULTS: The majority of respondents felt that the use of a screening questionnaire was acceptable and would be willing to complete one within a general practice setting. However, a number of individuals expressed concern about the validity of the kinds of questions asked and the usefulness of the instrument in practice. Respondents also discussed their concerns relating to issues of confidentiality and the doctor's response to the assessment. CONCLUSION: The study indicates that lay beliefs towards mental illness, particularly relating to perceived stigma, will continue to pose problems for the routine use of psychiatric case-finding questionnaires within general practice.
Adolescent↗
Non-psychotic, non-major affective psychiatric disorders in adolescent boys were associated with greater schizophrenia risk.
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Comment↗
The National Survey of Psychiatric Morbidity among prisoners and the future of prison healthcare.
It has long been known that psychiatric disorders are highly prevalent among prisoners (Coid, 1984; Gunn et al., 1991; Maden et al., 1995; Joukamaa, 1995; Bland et al., 1998; Lamb and Weinberger, 1998). However, the Survey of Psychiatric Morbidity Among Prisoners in England and Wales (Singleton et al., 1998) represents a considerable advance on earlier surveys. By using the same standardized psychiatric assessment procedures, and similar questions on medication, service use and social functioning, its findings can be compared with previous national surveys of adults living in private households (Meltzer et al., 1995), residents in institutions (Meltzer et al., 1996), homeless persons (Gill et al., 1996), and with the forthcoming household survey in England, Wales and Scotland. It should also inform the future organisation of healthcare for prisoners, following recent recommendations from a joint Home Office/Department of Health Working Party that Health Authorities must work with prisons in their catchment areas to carry out joint health needs assessments, agree prison healthcare improvement strategies and jointly plan and commission services (HM Prison Service and NHS Executive 1999). The ultimate test of the survey will be whether it provides a benchmark to evaluate the future effectiveness of the new policy changes.
England↗
Randomised controlled trials investigating pharmacological and psychological interventions for treatment-refractory depression. Systematic review.
BACKGROUND: About 30% of people with depression do not respond to an antidepressant at the recommended dose and can be described as having treatment-refractory depression. AIMS: To summarise the findings from all randomised controlled trials (RCTs) that have assessed the efficacy of a pharmacological or psychological intervention for treatment-refractory depression. METHOD: We used a systematic search strategy to identify RCTs that included adults aged 18-75 years with a diagnosis of unipolar depression that had not responded to a 4-week course of a recommended dose of an antidepressant. RESULTS: We identified 16 RCTs. None of the included trials assessed the efficacy of psychotherapy. All the trials were too small to detect an important clinical response. We found only two trials on lithium augmentation, which randomised 50 subjects in total. CONCLUSIONS: There is little evidence to guide the management of depression that has not responded to a course of antidepressants. Treatment-refractory depression is an important public health problem and large pragmatic trials are needed to inform clinical practice.
Antidepressive Agents↗
Ethnic differences in prisoners. 1: criminality and psychiatric morbidity.
BACKGROUND: In England and Wales, persons of African-Caribbean origin are more likely to be both imprisoned and admitted to secure hospitals. AIMS: To estimate population-based rates of imprisonment in different ethnic groups, and compare criminal behaviour and psychiatric morbidity. METHOD: We examined Home Office data on all persons in prison, and carried out a two-stage cross-sectional survey of 3142 remanded and sentenced, male and female, prisoners in all penal establishments in England and Wales in 1997. RESULTS: We confirmed high rates of imprisonment for Black people and lower rates for South Asians. Different patterns of offending and lower prevalence of psychiatric morbidity were observed in Black prisoners. CONCLUSIONS: Despite increased risks of imprisonment, African-Caribbeans show less psychiatric morbidity than White prisoners. This contrasts with the excess of African-Caribbeans in secure hospitals, an inconsistency possibly in part due to the effects of ethnic groups on admission procedures.
Adult↗
Ethnic differences in prisoners. 2: risk factors and psychiatric service use.
BACKGROUND: The high rates of psychiatric morbidity in prisoners vary between ethnic groups. AIMS: To compare early environmental risks, stressful daily living experiences and reported use of psychiatric services in prisoners from different ethnic groups. METHOD: Cross-sectional survey of 3142 prisoners in all penal establishments in England and Wales in 1997. RESULTS: Fewer Black and South Asian male prisoners reported childhood traumas and conduct disorder, and fewer Black prisoners experienced stressful prison experiences, than White prisoners. Fewer Black women had received previous psychiatric treatment, and fewer Black men had their psychiatric problems identified in prison. Black prisoners were less likely to have received psychiatric treatment than Whites. CONCLUSIONS: The lower prevalence of psychiatric morbidity observed in Black prisoners corresponds with reduced exposure to risk factors. Higher rates of imprisonment might be explained by higher rates of conduct disorder, adolescent-onset criminality and disadvantage within the criminal justice system.
Adolescent↗
Predictors of mental health service utilization in the 12 months before imprisonment: analysis of results from a national prisons survey.
OBJECTIVE: To describe the self-reported history of health service utilization and help-seeking to those who are drug-dependent in the period of time prior to imprisonment. METHOD: A cross-section survey of 3142 sentenced or remand prisoners in English prisons completed private, face-to-face interviews with trained Office for National Statistics staff covering a full structured psychiatric assessment interview. Specific questions about service utilization prior to imprisonment were included, as were questions on patterns of drug use and dependence prior to imprisonment. RESULTS: Receipt of any form of help was demographically most strongly associated with being older, white and female. Women were about twice as likely as men to report having received help for mental or emotional problems. Older age was also consistently associated with greater levels of reporting having received help, for both genders but only for use of general practitioners. Being black was strongly associated with reduced likelihood of receiving help and this was maintained after adjusting for other sociodemographic variables. Opioid dependence alone or opioid dependence with stimulant dependence, psychiatric disorder alone and probable psychosis were all most predictive of service use in the 12 months prior to imprisonment. CONCLUSIONS: In the year prior to imprisonment, the majority of mental health needs of these individual prisoners were not able to access help prior to imprisonment. Future strategies should aim for better health access before, during and after imprisonment.
Adolescent↗
Temporal relations between unexplained fatigue and depression: longitudinal data from an international study in primary care.
OBJECTIVE: Unexplained fatigue syndromes, such as chronic fatigue syndrome and neurasthenia, are strongly associated with depression, but the temporal nature of this association is not clear. METHODS: The authors examined this issue by using data from the World Health Organization collaborative study of psychological problems in general health care. Three thousand two hundred one subjects from 15 primary care centers in 14 countries were followed up for 12 months. The Composite International Diagnostic Interview was the main instrument used. Odds ratios and their 95% confidence intervals (CI) were calculated using logistic regression models adjusted for sociodemographic variables, physical morbidity and intercenter variability. RESULTS: Cases of depression were found to have an increased risk of developing a new episode of unexplained fatigue at follow-up with an adjusted odds ratio of 4.15 (95% CI = 2.64-6.54). Similarly, cases of unexplained fatigue were found to have an increased risk of developing a new episode of depression at follow-up with an adjusted odds ratio of 2.76 (95% CI = 1.32-5.78). Further adjustment for subthreshold symptoms at baseline weakened the reported associations, especially between fatigue and development of a new episode of depression, but these remained significant. CONCLUSIONS: The findings support the view that unexplained fatigue and depression might act as independent risk factors for each other.
Adult↗