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Biomedical subjects

Sube Banerjee

Publications and source records attributed to Sube Banerjee.

13 recordsLinked to original sources
PubMed2007

Treatment and prevention of depression after surgery for hip fracture in older people: randomized, controlled trials.

OBJECTIVES: To evaluate the effect of a psychiatric intervention in treating depression (treatment study) and the effect of a psychological treatment in preventing depression (prevention study) after hip fracture in older people. DESIGN: Two linked randomized, controlled trials. SETTING: Orthopedic units in Manchester, England. PARTICIPANTS: Two hundred ninety-three older people who had undergone surgery for a fractured hip: 121 in the treatment study and 172 in the prevention study. MEASUREMENTS: The Geriatric Depression Scale and Hospital Anxiety and Depression Scale for mood, functional tests for mobility and pain measures. RESULTS: There was a slight reduction in depressive symptoms in the active arm of the treatment study. In the prevention study, there was no significant difference in incident depression between the psychological intervention and treatment as usual. There were no differences in the functional and pain outcomes. CONCLUSION: The results from these two randomized, controlled trials show that, after hip fracture surgery, no statistically significant benefits can be achieved from a psychiatric intervention in people who are depressed or a psychological intervention to prevent the onset of depression.

Aged, 80 and over↗
PubMed2006

The impact of mental illness on quality of life: A comparison of severe mental illness, common mental disorder and healthy population samples.

Patient-centred outcomes such as quality of life (QOL) are valued and used extensively in mental healthcare evaluations, but concerns remain about their practical application due to perceived measurement issues, including responsiveness and relationships with objective indicators and depression. Evidence from general population studies challenge some assumptions, suggesting that measurement difficulties might relate to the characteristics of mental health samples, rather than measurement itself. This paper assesses the impact of mental illness on QOL and its measurement, examining whether the life-conditions, opportunities and QOL of different mental health-status groups vary, and if explanatory models of domain-specific and global QOL differ. Objective life-conditions, access to life-opportunities and subjective QOL were assessed over 2 years, using the same methodology in severe mental illness (SMI; n = 149 (baseline)/n = 126 (follow-up)), common mental disorder (CMD; n = 794/354) and no disorder (n = 1119/583) groups. Objective life-conditions were worse in the SMI group than in mentally healthy population and CMD groups, but the opportunities available to the SMI group were no more restricted than the CMD group. Subjective QOL ratings reflected this; SMI group scores were lower than the healthy population and in some life-domains the CMD group. Models of QOL suggested that life-quality was explained differently in the three groups. QOL studies combining mental health samples should control for health-status group, and domain-specific and global indicators of lifestyle and opportunity.

Adult↗
PubMed2006

Fear of falling more important than pain and depression for functional recovery after surgery for hip fracture in older people.

BACKGROUND: Depression and cognitive functioning have a negative impact on functional recovery after hip fracture surgery in older people, and the same has been suggested for pain and fear of falling. These variables, however, have never been studied together, nor has the timing of psychiatric assessment been taken into account. METHOD: Two parallel, randomized controlled trials were undertaken aiming to prevent and treat depression after hip fracture surgery in older people. Multiple logistic regression analyses corrected for age and pre-morbid level of functioning were performed to evaluate the effect of depressive symptoms (15-item Geriatric Depression Scale, GDS), pain (Wong-Baker pain scale), cognitive functioning (Mini-mental State Examination, MMSE) and fear of falling (Modified Falls Efficacy Scale, MFES) within 2 weeks after surgery and 6 weeks later on functional recovery at 6 months. Main outcome measures were performance-based measures (up-and-go test, gait test, functional reach) and the self-report Sickness Impact Profile (SIP) questionnaire to assess the impact of the hip fracture on activities of daily living (ADL). RESULTS: Two hundred and ninety-one patients participated and outcome measures for 187 (64%) patients were available at 6 months. All mental health variables interfered with functional recovery. However, in the final multivariate model, cognitive functioning and fear of falling assessed 6 weeks after surgery consistently predicted functional recovery, whereas pain and depressive symptoms were no longer significant. CONCLUSION: Fear of falling and cognitive functioning may be more important than pain and depression to predict functional recovery after hip fracture surgery. Rehabilitation strategies should take this into account.

Accidental Falls↗
PubMed2006

Coping with depression in later life: a qualitative study of help-seeking in three ethnic groups.

BACKGROUND: Research suggests high levels of depression and low levels of service use among older adults from UK minority ethnic groups. This study aimed to explore older adults' attitudes and beliefs regarding what would help someone with depression, and to consider how these may facilitate or deter older people from accessing treatment. METHOD: In-depth individual qualitative interviews were conducted with older adults with depression (treated and untreated) and the non-depressed older population. A multi-cultural approach was used that incorporated the perspectives of 32 black Caribbean, 33 South Asian and 45 white British older adults. RESULTS: Participants felt that the responsibility for combating depression was an internal and individual task with support considered secondary. However, the majority expressed a willingness and desire to discuss psychosocial problems. Within the black Caribbean group, conversing with God through prayer was seen as an effective means of overcoming depression, while a large proportion of South Asian and white British participants identified families as an important source of help. There was wide variation in how older adults construed the role of the general practitioner (GP) and many expressed acute awareness of the demands on GPs' time. CONCLUSIONS: Efforts to socialize and remain active may provide a useful and acceptable adjunct to clinical interventions. However, there is a need to communicate that depression often necessitates formal help, and that it is acceptable to voice concerns regarding emotional states in a GP consultation. The findings suggest that older adults would welcome the opportunity to discuss their feelings with health-care professionals.

Adaptation, Psychological↗
PubMed2006

Primary care professionals' perceptions of depression in older people: a qualitative study.

An understanding of patients' perspectives is crucial to improving engagement with health care services. For older people who may not wish to bother medical professionals with problems of living such as depression, such exploration becomes critical. General practitioners (GPs), nurses and counsellors working in 18 South London primary care teams were interviewed about their perceptions of depression in older people. All three professional groups shared a predominantly psychosocial model of the causes of depression. While presentation of somatic symptoms was seen as common in all age groups, identification of depression in older patients was complicated by co-existent physical illnesses. GPs reported that older patients rarely mentioned psychological difficulties, but practice nurses felt that older people were less inhibited in talking to them about "non-medical" problems. Many older people were perceived to regard symptoms of depression as a normal consequence of ageing and not to think it appropriate to mention non-physical problems in a medical consultation. Men were thought to be particularly reluctant to disclose emotional distress and were more vulnerable to severe depression and suicide. Some GPs had mixed feelings about offering medication to address what they believed to be the consequences of loneliness and social isolation. Participants thought that many older people regard depression as a "sign of weakness" and the perceived stigma of mental illness was widely recognised as a barrier to seeking help. Cultural variations in illness beliefs, especially the attribution of symptoms, were thought to profoundly influence the help-seeking behaviour of elders from minority ethnic groups. Families were identified as the main source of both support and distress; and as such their influence could be crucial to the identification and treatment of depression in older people.

Adult↗
PubMed2006

Concepts and causation of depression: a cross-cultural study of the beliefs of older adults.

PURPOSE: This U.K. study explored how older adults with depression (treated and untreated) and the general older population conceptualize depression. A multicultural approach was used that incorporated the perspectives of Black Caribbean, South Asian, and White British older adults. The study sought to explore and compare beliefs about the nature and causes of depression, and to suggest ways in which these beliefs act to facilitate or deter older people from accessing treatment. DESIGN AND METHODS: One hundred and ten in-depth separate interviews were conducted for 45 White British, 33 South Asian, and 32 Black Caribbean individuals. The interviews explored what the word depression meant to participants, and their beliefs regarding depression's causes. RESULTS: Depression was often viewed as an illness arising from adverse personal and social circumstances that accrue in old age. White British and Black Caribbean participants defined depression in terms of low mood and hopelessness; South Asian and Black Caribbean participants frequently defined depression in terms of worry. Those receiving antidepressants were more likely to acknowledge psychological symptoms of depression. Differences in attribution were found between the ethnic groups. IMPLICATIONS: A social model of depression is closer to the beliefs of older people than the traditional medical model. Culturally appropriate inquiries about recent life events could be used to facilitate discussion about depression. Our data suggest that many older adults would respond to probing by primary care physicians about their mood. Health and social care professionals need to be sensitive to the language of depression used by different ethnic groups.

Aged↗
PubMed2005

What constitutes health-related quality of life in dementia? Development of a conceptual framework for people with dementia and their carers.

BACKGROUND: The evaluation of multi-dimensional outcomes such as health-related quality of life (HRQL) is particularly relevant in dementia where the disease can compromise all areas of functioning. The nature of dementia can make self-report difficult, yet the subjective nature of HRQL makes the value of proxy reports limited. Previous work suggests that there are domains of HRQL that are unique to dementia. We aimed to develop a conceptual framework of HRQL in dementia from the perspective of people with dementia and their carers and to examine differences in the reports of the HRQL of these two groups. METHODS: We combined existing literature and new qualitative data to develop the conceptual framework and analysed qualitative data using content analysis. RESULTS: We identified five domains: daily activities and looking after yourself, health and well-being, cognitive functioning, social relationships and self-concept, and each was defined by specific descriptive components. There were differences between people with dementia and carers in the way they described these domains. CONCLUSIONS: We have developed a conceptual framework of HRQL in dementia that incorporates the views of people with dementia and their carers. This provides the basis for the development of a new measure of HRQL in dementia (DEMQOL).

Activities of Daily Living↗
PubMed2005

Assessment of quality of life in later life: development and validation of the QuiLL.

The aim was to develop a quality of life (QOL) instrument, informed by older people, carers and professionals in older peoples' services, for use by community care staff as part of their assessment, care-planning and outcome monitoring procedures. The multi-phase development project involved: qualitative interviews to generate the item pool; pre-testing; preliminary field-testing; and final testing in a community survey and in health and social care settings. The process was informed by over 100 interviews with older people, carers, professionals, academics and policy-makers. Two products emerged following data-reduction: a research instrument (64 items), and a shorter assessment tool suitable for routine use in clinical, therapeutic or case-management practice (27 items, taking 7-15 min to complete). A community survey using the research instrument achieved a 71% response rate (n = 249). Ninety six percent of people found the domain content of the assessment tool relevant, and 80% considered the items covered were important. Both instruments have good internal consistency (alpha = 0.85). Inter-rater reliability was good for research staff, but poor between them and operational staff. Little objective change took place during the 3-month follow-up study, but where it did the direction was consistent with subjective change. The instrument needs to be applied in different contexts to assess interventions of known impact. Together with daily living and health status measures it can form part of a comprehensive assessment for older people.

Activities of Daily Living↗
PubMed2003

Distribution and characteristics of in-patient child and adolescent mental health services in England and Wales.

BACKGROUND: Little is known about the current state of provision of child and adolescent mental health service in-patient units in the UK. AIMS: To describe the full number, distribution and key characteristics of child and adolescent psychiatric in-patient units in England and Wales. METHOD: Following identification of units, data were collected by a postal general survey with telephone follow-up. RESULTS: Eighty units were identified; these provided 900 beds, of which 244 (27%) were managed by the independent sector. Units are unevenly distributed, with a concentration of beds in London and the south-east of England. The independent sector, which manages a high proportion of specialist services and eating disorder units in particular, accentuates this uneven distribution. Nearly two-thirds of units reported that they would not accept emergency admissions. CONCLUSIONS: A national approach is needed to the planning and commissioning of this specialist service.

Adolescent↗
PubMed2002

Attributions of physical symptoms in patients of an old age psychiatry service.

BACKGROUND: Somatization is a phenomenon found across all medical specialities and in all types of care. There has been little in the way of systematic investigation of the phenomenon in older people. OBJECTIVES: The objective was to establish whether treatment for psychiatric illness would be accompanied by a fall in somatic attributions. METHOD: Patients' attributions of physical symptoms were studied in a consecutive group of older people with functional disorders (mostly depression) referred to an old age psychiatry service. Depression, anxiety, physical illness and attributional style were measured soon after referral and seven months later. RESULTS: 41 subjects were interviewed in the first leg. Anxiety was the chief association of abnormal attributional style. At follow up (n = 29) mean depression and anxiety scale scores and somatic attributions of symptoms had fallen significantly. CONCLUSION: Abnormal focus on physical symptoms in depressed elderly patients may resolve with treatment.

Aged↗
PubMed2002

Obsessive compulsive behaviour and depressive symptoms in young people with Tourette syndrome. A controlled study.

Tourette syndrome (TS) is characterised by multiple motor and one or more vocal tics. There have been no controlled studies using standardised instruments of depressive symptoms and obsessive compulsive symptomatology (OCS) in young people with TS. We completed a study of phenomenology and psychopathology in children with TS, including a controlled evaluation of the association between depressive symptoms, OCS, and TS. 57 people aged 15 or under with TS were recruited. Phenomenology and psychopathology were assessed using standardised instruments. The association between TS, depressive symptoms and obsessionality was investigated using 75 age- and gender-matched controls. There were high levels of depressive symptomatology and OCS in the TS group. Twenty-three (40 %) had carried out self-injurious behaviours and 34 (60 %) met criteria for Attention Deficit Hyperactivity Disorder (ADHD). Depressive symptoms and obsessionality were higher in the TS cohort compared with the control group; this excess persisted after adjustment for the effects of age, gender and comorbidity between depression and obsessionality. This study demonstrates high levels of psychopathology in children with TS, including ADHD, OCS and depressive symptoms. The findings illustrate the potentially complex, challenging combination of difficulties encountered by children with TS and those who care for them.

Adolescent↗
PubMed1998

Obsessive-compulsive disorder in the elderly.

Four cases of obsessive-compulsive disorder arising in late life in association with a presumed organic aetiology are described. Three of the four had brief episodes of OCD earlier in their lives. Neuropsychological assessment demonstrated impairments in verbal fluency and visuo-spatial tasks. No case exhibited global intellectual impairment. The two patients who complied with appropriate treatment became asymptomatic after 4-6 months.

Journal Article↗