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Biomedical subjects

Kate Davidson

Publications and source records attributed to Kate Davidson.

10 recordsLinked to original sources

Comparison of alternative methods of collection of service use data for the economic evaluation of health care interventions.

Economic evaluation of health care interventions usually requires the collection of service use data to estimate the total cost of participants in an evaluation. There are a number of methods available to measure the quantity of services used but little is known about the relative accuracy of alternative methods. In a multicentre randomised controlled trial of interventions for the treatment of adults with recurrent episodes of deliberate self-harm (the POPMACT trial), health service data were collected by patient self-report after six and twelve months and also from GP records by independent investigators. Agreement for overall costs was relatively high. However, this hides substantial variation in agreement between the two sources of information for different services. The results suggest that GP records provide more accurate data on the use of general practice-based contacts than patient report, but less reliable information on contacts with other health services. Thus reliance on GP records for data on hospital services and other community health services based outside of general practice surgeries is not recommended. Future research should explore the level of agreement between patient report and other providing sector records, such as hospital records.

Adult↗

A randomized controlled trial of cognitive behavior therapy for borderline personality disorder: rationale for trial, method, and description of sample.

This paper describes the rationale for a randomized controlled trial, comparing cognitive behavior therapy in addition to treatment as usual with treatment as usual alone, for borderline personality disorder. Previous pioneering randomized controlled trials of psychotherapies have suffered from methodological weaknesses and have not always been reported clearly to allow adequate evaluation of either the individual study or comparisons across studies to be undertaken. We report on the recruitment and randomization, design, and conduct of an ongoing randomized controlled trial of one hundred and six patients with borderline personality disorder. Primary and secondary hypotheses and their planned analyses are stated. The baseline characteristics of 106 patients meeting diagnostic criteria for borderline personality disorder are described.

Adult↗

The effectiveness of cognitive behavior therapy for borderline personality disorder: results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial.

The outcome of a randomized controlled trial of cognitive behavior therapy in addition to treatment as usual (CBT plus TAU) compared with TAU alone (TAU) in one hundred and six participants meeting diagnostic criteria for borderline personality disorder is described. We anticipated that CBT plus TAU would decrease the number of participants with in-patient psychiatric hospitalizations or accident and emergency room contact or suicidal acts over twelve months treatment and twelve months follow-up, compared with TAU. We also anticipated that CBT plus TAU would lead to improvement in a range of secondary outcomes of mental health and social functioning compared to TAU. Of the 106 participants randomized, follow-up data on 102 (96%) was obtained at two years. Those randomized to CBT were offered an average of 27 sessions over 12 months and attended on average 16 (range 0 to 35). We found that the global odds ratio of a participant in the CBT plus TAU group compared with the TAU alone group having any of the outcomes of a suicidal act, in-patient hospitalization, or accident and emergency contact in the 24 months following randomization was 0.86 (95% confidence interval [CI] 0.45 to 1.66, p = 0.66). The corresponding global odds ratio, excluding accident and emergency room contact, was 0.75 (95% CI 0.37 to 1.54, p = 0.44). In terms of the number of suicidal acts, there was a significant reduction over the two years in favor of CBT plus TAU over TAU, with a mean difference of -0.91 (95% CI -1.67 to -0.15, p = 0.020). Across both treatment arms there was gradual and sustained improvement in both primary and secondary outcomes, with evidence of benefit for the addition of CBT on the positive symptom distress index at one year, and on state anxiety, dysfunctional beliefs and the quantity of suicidal acts at two year follow-up. CBT can deliver clinically important changes in relatively few clinical sessions in real clinical settings.

Adult↗

The cost-effectiveness of cognitive behavior therapy for borderline personality disorder: results from the BOSCOT trial.

Borderline personality disorder places a significant burden on healthcare providers and other agencies. This study evaluated the cost-effectiveness of cognitive behavior therapy plus treatment as usual compared to treatment as usual alone for patients with borderline personality disorder. The economic analysis was conducted alongside a multi-center, randomized controlled trial. The costs of primary and secondary healthcare utilization, alongside the wider economic costs, were estimated from medical records and patient self-report. The primary outcome measure used was the quality-adjusted life year (QALY), assessed using EuroQol. On average, total costs per patient in the cognitive behavior therapy group were lower than patients receiving usual care alone (-689 pounds sterling), although this group also reported a lower quality of life (-0.11 QALYs). These differences were small and did not approach conventional levels of statistical significance. The use of cognitive therapy for borderline personality disorder does not appear to demonstrate any significant cost-effective advantage based on the results of this study.

Adult↗

Hopelessness and positive and negative future thinking in parasuicide.

OBJECTIVES: Hopelessness about the future is a key element in suicidal behaviour. The aim of the present study was to examine possible components of hopelessness, in particular, to contrast positive and negative future thinking and to examine separately number, expectancy, and value of anticipated positive and negative future experiences. DESIGN: A correlational design. METHOD: Repeat parasuicide patients (N = 441) were administered the Beck Hopelessness Scale, the Hospital Anxiety and Depression Scale and the future thinking task, a measure of future positive and negative thinking that assesses number, perceived likelihood, and perceived value of anticipated future positive and negative events. RESULTS: Consistent with predictions, hopelessness correlated more strongly with lack of positive thoughts about the future than it did with presence of negative thoughts. Both positive and negative future thinking showed a relationship to hopelessness over and above their relationships to depression (positive future thinking) and anxiety (negative future thinking). Number and likelihood of positive events and likelihood and value of negative events showed both simple and partial relationships to hopelessness. Number of negative events related to hopelessness but only after the other future thinking variables had been controlled for and value of positive events no longer related to hopelessness after controlling for the other variables. CONCLUSIONS: Hopelessness about the future in suicidal individuals is a multi-faceted construct but lack of positive future thinking is more important than presence of negative future thinking.

Adolescent↗

Differential effects of manual assisted cognitive behavior therapy in the treatment of recurrent deliberate self-harm and personality disturbance: the POPMACT study.

A total of 480 patients were treated in a large, multicenter randomized trial of a brief form of cognitive therapy, manual-assisted cognitive behavior therapy (MACT) versus treatment as usual (TAU) for recurrent deliberate self-harm. Each patient was randomized after a self-harm episode assessed at an accident and emergency center and followed up over 1 year. The main hypothesis tested was that those allocated to MACT would have a lower proportion of self-harm episodes in the succeeding year. A total of 60% of those allocated to MACT had face-to-face treatment and 430 (90%) of all patients had self-harm data recorded after 1 year. Although the results showed no significant difference between those repeating self-harm in the MACT group (39%) compared with the TAU group (46%) (P = 0.20), the treatment was cost effective (10% cheaper than TAU) and the frequency of self-harm episodes was fewer (50%) in the MACT group. A total of nine of 10 patients had some personality disturbance (42% of these with disorder), and for those where information on parasuicide events was collected, the proportion having a repeat episode ranged from 33% to 63% for different personality disorders. Those with BPD were most likely to repeat episodes quickly (mean 89 days for 25% to repeat) with dissocial personality disorder (equivalent mean 384 days) the slowest to repeat. Total costs were significantly greater in those with personality disorder and were reduced in those allocated to MACT; this saving was reversed in those with borderline disorder. On average, MACT appeared to increase the cost of those patients with BPD (BPD) and reduce the cost of those with other personality disorders. It is concluded that MACT has value in preventing self-harm cost effectively but this appears to be confined mainly to those who do not have BPD.

Adult↗

Personality disorder and future-directed thinking in parasuicide.

Parasuicide patients have been found to lack positive expectations for the future. The aim of the present study was to look at variations in this lack of positive future-thinking as a function of personality status. A sample (N = 442) of repeat parasuicide patients was assessed on positive and negative future-thinking and the presence of personality disorder or personality difficulty. Those with a Cluster B personality disorder (borderline or dissocial) were significantly lower in positive future-thinking than those with no Cluster B symptoms or those with Cluster B personality difficulty. Neither Cluster A nor Cluster C symptomatology was related to positive future-thinking. Negative future-thinking was not significantly related to any type of personality disorder or difficulty. The results are interpreted as evidence of the importance of personality status in influencing positive future-thinking and gives some indications of why those with Cluster B personality disorder have such high rates of recurrent self-harm.

Adult↗

Service variation in baseline variables and prediction of risk in a randomised controlled trial of psychological treatment in repeated parasuicide: the POPMACT Study.

The treatment protocol and baseline characteristics of 480 subjects with a history of repeated parasuicide recruited in five centres to a randomised therapeutic trial of manual assisted cognitive-behaviour therapy (MACT) and treatment as usual (TAU) are described. Most patients had significant anxiety and depressive disturbance with 42% having a personality disorder. Variation in service policies influenced recruitment, with earlier assessment centres seeing people with more frequent episodes of self-harm and greater parasuicide risk than later ones. Parasuicide risk was also significantly greater in those with their first parasuicide episode at an earlier age and in those with a more recent latest episode.

Adult↗

Intratracheal administration of glucocorticoids using surfactant as a vehicle.

1. Glucocorticoids are an effective treatment in the amelioration of chronic lung disease in neonates. However, systemic administration of glucocorticoids to neonates is associated with significant side-effects that preclude them as an early intervention to prevent onset of the condition. Conversely, local intratracheal administration of glucocorticoids may prevent inflammatory insult to the lungs without the development of systemic side-effects. We therefore investigated whether local intratracheal delivery of corticosteroids could be facilitated using surfactant as a vehicle. 2. Addition of dexamethasone to either diluted or commercial artificial surfactant, Survanta (Abbott Industries, Sydney, NSW, Australia), did not alter the surface properties of the surfactant. 3. After intratracheal instillation to rats, radiolabelled dexamethasone in Survanta was well distributed throughout all four lobes of the lungs. A concentration gradient of the steroid was observed between the root and the peripheral sections of all lobes. 4. Our results suggest that surfactant is an effective vehicle for intratracheal delivery of glucocorticoids. Moreover, we propose that prophylactic intratracheal administration of glucocorticoids administered shortly after birth may prevent inflammatory insult to the lungs and thereby reduce the likelihood of chronic lung disease developing.

Animals↗

Parasuicidal behaviour and interpersonal problem solving performance in older adults.

OBJECTIVES: To test the hypothesis that interpersonal problem-solving performance in older adults with a recent episode of parasuicide is poorer than that of depressed patients and community controls. DESIGN: A cross-sectional design was used to assess differences between older parasuicidal patients, depressed patients, and community controls in interpersonal problem solving performance. METHOD: An existing outcome measure of interpersonal problem-solving, the Means End Problem-Solving (MEPS) procedure, was modified in order to make it more suitable for older adults. It was then administered to 18 older adults with an episode of parasuicide in the previous 14 days, 18 older adults who were being treated for clinical depression, and 22 older adults attending community groups. Comparisons between the groups in terms of performance on the MEPS were made. RESULTS: When level of depression was controlled for, parasuicidal patients were poorer at generating relevant means of reaching given outcomes to interpersonal problems than community controls. There was no difference between the parasuicidal and depressed groups in terms of relevancy scores. There were no significant differences between groups in terms of other MEPS outcome variables. CONCLUSIONS: Parasuicide in older adults is related to a deficit in interpersonal problem solving performance that cannot be completely explained in terms of depression. Further investigation of interpersonal problem-solving in relation to parasuicide and depression in older adults is required, perhaps using process measures of interpersonal problem solving to clarify the nature of the difficulties. The modified MEPS is acceptable to older adults and can be easily administered.

Aged↗