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Ying Y, Ji Y, Kong F, Wang M, Chen Q, Wang L, Hou Y, Yu L, Zhu L, Miao P, Zhou J, Zhang L, Yang Y, Wang G, Chen R, Liu D, Huang W, Lv Y, Lou Z, Ruan L. Efficacy of an internet-based cognitive behavioral therapy for subthreshold depression among Chinese adults: a randomized controlled trial. Psychol Med 2023; 53:3932-3942. [PMID: 35388776 PMCID: PMC10317808 DOI: 10.1017/s0033291722000599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Subthreshold depression (sD) negatively impacts well-being and psychosocial function and is more prevalent compared with major depressive disorder (MDD). However, as adults with sD are less likely to seek face-to-face intervention, internet-based cognitive-behavioral therapy (ICBT) may overcome barriers of accessibility to psychotherapy. Although several trials explored the efficacy of ICBT for sD, the results remain inconsistent. This study evaluated whether ICBT is effective in reducing depressive symptoms among Chinese adults with sD. METHODS A randomized controlled trial was performed. The participants were randomly assigned to 5 weeks of ICBT, group-based face-to-face cognitive-behavioral therapy (CBT), or a waiting list (WL). Assessments were conducted at baseline, post-intervention and at a 6-month follow-up. The primary outcome measured depressive symptoms using the Center for Epidemiological Studies Depression Scale (CES-D). Outcomes were analyzed using a mixed-effects model to assess the effects of ICBT. RESULTS ICBT participants reported greater reductions on all the outcomes compared to the WL group at post-intervention. The ICBT group showed larger improvement on the Patient Health Questionnaire-9 (PHQ-9) at post-intervention (d = 0.12) and at follow-up (d = 0.10), and with CES-D at post-intervention (d = 0.06), compared to the CBT group. CONCLUSIONS ICBT is effective in reducing depressive symptoms among Chinese adults with sD, and improvements in outcomes were sustained at a 6-month follow-up. Considering the low rates of face-to-face psychotherapy, our findings highlight the considerable potential and implications for the Chinese government to promote the use of ICBT for sD in China.
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Affiliation(s)
- Yuchen Ying
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, People's Republic of China
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, People's Republic of China
| | - Yunxin Ji
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, People's Republic of China
| | - Fanqian Kong
- Department of Medical Record and Statistics, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Minyao Wang
- School of Medicine, Ningbo University, Ningbo, Zhejiang, People's Republic of China
| | - Qiqi Chen
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, People's Republic of China
| | - Li Wang
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, People's Republic of China
| | - Yanbin Hou
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, People's Republic of China
| | - Libo Yu
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, People's Republic of China
| | - Lijie Zhu
- Department of Statistics and Programming, Jiangsu Hengrui Pharmaceuticals Co. Ltd, Shanghai, People's Republic of China
| | - Pingping Miao
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, People's Republic of China
| | - Jing Zhou
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, People's Republic of China
| | - Li Zhang
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, People's Republic of China
| | - Yiling Yang
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, People's Republic of China
| | - Guanjun Wang
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, People's Republic of China
| | - Ruijia Chen
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, People's Republic of China
| | - Denong Liu
- School of Medicine, Ningbo University, Ningbo, Zhejiang, People's Republic of China
| | - Wenjun Huang
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, People's Republic of China
| | - Yueer Lv
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, People's Republic of China
| | - Zhongze Lou
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, People's Republic of China
- Central Laboratory of the Medical Research Center, Ningbo First Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Liemin Ruan
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, People's Republic of China
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Napoli G, Autuori S, Ephraim KS. Attitudes of Italian mental health nurses towards mental illness and recovery: a cross-sectional study. AIMS Public Health 2023; 10:333-347. [PMID: 37304595 PMCID: PMC10251057 DOI: 10.3934/publichealth.2023025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/22/2023] [Accepted: 04/23/2023] [Indexed: 06/13/2023] Open
Abstract
Background Mental health nurses' (MHNs) stigma and discrimination against people with mental illnesses are obstacles to recovery and the development of effective care and treatment. Although many authors have been interested in exploring stigma among general health professionals, paradoxically, less and non-generalizable evidence is available on this phenomenon among MHNs. Understanding the factors associated with stigma and its relationship to recovery attitudes among MHNs could allow for more accurate interventions and improve patient care outcomes. Objective This study conducted on a sample of Italian psychiatric nurses had the objective of analyzing the aptitude for recovery and the tendency towards stigma of these professionals towards mental illness. Methodology A cross-sectional web survey was conducted on a sample of Italian MHNs, who were administered two validated tools, the RAQ-7 (assessment of recovery aptitude) and the WHO-HC-15 (assessment of stigma) respectively. Results A total of 204 MHNs were interviewed. The analysis showed positive overall scores (high recovery aptitude and low stigma levels) among participating MHNs. The attitude to recovery appeared to be directly related to a lower tendency to stigma towards mental illness. It has been observed that MHNs with advanced levels of education appear to be more predisposed to recovery, as well as generally less stigmatizing. There is evidence that the setting in which care is provided, marital status and age can play a significant role in the tendency to stigmatization. Conclusion Our manuscript could assist nursing executives, leaders or educators in making decisions about managing and preventing stigma among MHNs.
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Affiliation(s)
- Giovanni Napoli
- Dipartimento di Salute Mentale, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Simone Autuori
- UOC Psichiatria 2, Azienda Ospedale-Università Padova (AOUP), Padova, Italy
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Timimi S. Commentary on 'Depression: why drugs and electricity are not the answer': We have created a public health disaster. Psychol Med 2022; 52:1421-1422. [PMID: 35506421 DOI: 10.1017/s0033291722001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Sami Timimi
- Consultant Child and Adolescent Psychiatrist, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
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Harper DJ. Framing, Filtering and Hermeneutical Injustice in the Public Conversation about Mental Health. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2020. [DOI: 10.1080/10720537.2020.1773360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Community stigma studies may neglect clinically relevant experience and views of stigma that are important features of mental health problems. After attempting suicide, patients in a hospital emergency ward in Mumbai, India, were assessed for stigma referring to underlying prior problems motivating their deliberate self-harm (DSH) event, the DSH event itself and serious mental illness generally based on both anticipated community views and distinctive personal views. In this cultural epidemiological study of 196 patients, assessment items and four corresponding indexes were analysed and compared on a four-point scale, 0 to 3, for prominence of indicated stigma. Narratives from patients with high, low and discordant levels of stigma for prior problems and DSH events were analysed and compared. Disclosure, critical opinions of others and problems to marry were greater concerns for DSH events than prior problems. Problem drinking, unemployment, and sexual or financial victimization were common features of prior problems. Impulsivity of the DSH event and externalizing blame were features of lower levels of stigma. Ideas about most people's views of serious mental illness were regarded as more stigmatizing than patients' prior problems and DSH event; patients' personal views of serious mental illness were least stigmatizing. Findings suggest linking suicidality and stigmatized mental illness may discourage help seeking. Suicide prevention strategies should therefore emphasize available help needed for severe stress instead of equating suicidality and mental illness. Findings also indicate the relevance of assessing clinical stigma in a cultural formulation and the value of integrated qualitative and quantitative stigma research methods.
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Affiliation(s)
- Mitchell G Weiss
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Clinical Research, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Shubhangi R Parkar
- Department of Psychiatry, Seth GS Medical College and KEM Hospital, Mumbai, India
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Abstract
Psychiatry is a complex enterprise, requiring the longest training period required of any mental health profession. Yet doctors are playing a declining role in deciding health care policy. It is almost as if while acknowledging they would rather see a doctor than anyone else when seriously ill, lay public and politicians also prefer practically any alternative, other than a physician, when determining who should decide how health care is delivered.
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Khan MN, Dherani M, Chiumento A, Atif N, Bristow K, Sikander S, Rahman A. Evaluating feasibility and acceptability of a local psycho-educational intervention for pregnant women with common mental problems affected by armed conflict in Swat, Pakistan: A parallel randomized controlled feasibility trial. Int J Soc Psychiatry 2017; 63:724-735. [PMID: 29145792 DOI: 10.1177/0020764017734001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The current research was conducted in the Swat valley, where widespread conflict and militancy had been experienced prior to the field activities. The aim of this trial was to evaluate the feasibility and acceptability of a locally developed psycho-educational intervention. METHODS This mixed-methods study incorporated a quantitative and qualitative component. For the quantitative component, trial participants were identified from a cross-sectional study conducted in the earlier phase of the research, with Self-Reporting Questionnaire (SRQ) score of ≥9. Participants with suicidal ideation, severe mental or medical illness, recently given birth or living with another woman with an SRQ score of 9 or above were excluded. Participants fulfilling eligibility were randomized on a 1:1 allocation ratio using simple randomization to the psycho-educational intervention or routine care arm. The intervention arm received two psycho-educational sessions at their homes delivered by local community health worker from the study area. The primary outcome was help-seeking for psychological distress, measured by a semi-structured interview by a researcher blind to the allocation status at 2 months post-intervention. Secondary outcomes include psychological distress and social support measured by SRQ and Multidimensional Scale of Perceived Social Support (MSPSS), respectively, at 2 months post-intervention. Intervention acceptability was explored through in-depth interviews. RESULTS Local community health workers with no mental health experience successfully delivered the psycho-educational sessions in the community. The uptake of intervention was good and the intervention was taken well by the families and the community health workers. The outcome evaluation was not powered; however, more women sought assistance for their distress from their community health workers in the intervention arm, compared to women in the control arm. CONCLUSION This trial showed good acceptance and feasible delivery of a locally developed psycho-educational intervention through community health workers following conflict, giving way for further adaptation and evaluation.
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Affiliation(s)
- Muhammad Naseem Khan
- 1 Institute of Public Health & Social Sciences (IPH&SS), Khyber Medical University, Peshawar, Pakistan
| | | | | | - Najia Atif
- 3 Human Development Research Foundation, Islamabad, Pakistan
| | | | - Siham Sikander
- 3 Human Development Research Foundation, Islamabad, Pakistan
| | - Atif Rahman
- 2 University of Liverpool, Liverpool, UK.,3 Human Development Research Foundation, Islamabad, Pakistan
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Public attitudes toward depression and help-seeking: Impact of the OSPI-Europe depression awareness campaign in four European regions. J Affect Disord 2017; 217:252-259. [PMID: 28437762 DOI: 10.1016/j.jad.2017.04.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/28/2017] [Accepted: 04/02/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Public attitudes toward depression and help-seeking behaviour are important factors influencing depressed people to obtain professional help and adequate treatment. OSPI-Europe is a multi-level suicide prevention programme including a public awareness campaign. It was implemented in four regions of four European countries (Germany, Hungary, Ireland and Portugal). This paper reports the results of the evaluation of the campaign, including its visibility and effects of the campaign on stigma associated with depression and help-seeking behaviour. METHODS A representative general population survey (N=4004) including measures on personal stigma, perceived stigma, openness to help, perceived value of help, and socio-demographic variables was conducted in the four intervention and four control regions in a cross-sectional pre-post design. RESULTS The public awareness campaign was considerably more visible in Germany and Portugal compared to Ireland and Hungary. Visibility was further affected by age and years of schooling. Personal stigma, perceived stigma and openness toward professional help varied significantly across the four countries. Respondents in the intervention regions showed significantly less personal depression stigma than respondents in the control regions after the campaign. Respondents of the intervention region who were aware of the campaign reported more openness toward seeking professional help than respondents who were unaware of it. CONCLUSION The OSPI-Europe awareness campaign was visible and produced some positive results. At the same time, it proved to be difficult to show strong, measurable and unambiguous effects, which is in line with previous studies. Public awareness campaigns as conducted within OSPI-Europe can contribute to improved attitudes and knowledge about depression in the general public and produce synergistic effects, in particular when the dissemination of awareness campaign materials is simultaneously reinforced by other intervention levels of a multi-level intervention programme. LIMITATIONS The survey was cross-sectional and based on self-report, so no causal inferences could be drawn.
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Henderson L. Popular television and public mental health: creating media entertainment from mental distress. CRITICAL PUBLIC HEALTH 2017. [DOI: 10.1080/09581596.2017.1309007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lesley Henderson
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
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Culjak G, Kowalenko N, Tennant C. Awareness, Access and Use of Internet Self-Help Websites for Depression by University Students. JMIR Ment Health 2016; 3:e48. [PMID: 27789425 PMCID: PMC5104907 DOI: 10.2196/mental.5311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 07/09/2016] [Accepted: 07/26/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND University students have a higher prevalence rate of depression than the average 18 to 24 year old. Internet self-help has been demonstrated to be effective in decreasing self-rated measures of depression in this population, so it is important to explore the awareness, access and use of such self-help resources in this population. OBJECTIVE The objective of this study is to explore university students' awareness, access and use of Internet self-help websites for depression and related problems. METHODS A total of 2691 university students were surveyed at 3 time points. RESULTS When asked about browsing behavior, 69.6% (1494/2146) of students reported using the Internet for entertainment. Most students were not familiar with self-help websites for emotional health, although this awareness increased as they completed further assessments. Most students considered user-friendliness, content and interactivity as very important in the design of a self-help website. After being exposed to a self-help website, more students reported visiting websites for emotional health than those who had not been exposed. CONCLUSIONS More students reported visiting self-help websites after becoming aware of such resources. Increased awareness of depression and related treatment resources may increase use of such resources. It is important to increase public awareness with the aim of increasing access to targeted strategies for young people.
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Affiliation(s)
- Gordana Culjak
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Nick Kowalenko
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Christopher Tennant
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
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Johnson TM, Busby-Whitehead J, Ashford-Works C, Clarke MK, Fowler L, Williams ME. Promoting Help-Seeking Behavior for Urinary Incontinence. J Appl Gerontol 2016. [DOI: 10.1177/073346489801700402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The authors evaluated the effectiveness of a combined primary care physician education and public awareness campaign about urinary incontinence. The campaign was designed to (a) trig ger help-seeking behavior in older adults with urine leakage problems and (b) encourage pri mary care providers to offer appropriate treatment for urinary incontinence (UI). Outcome measures included datafrom helpline callers and physician surveys before and after the two in terventions. Most callers who later sought care turned to their primary care physician. The me dian estimated number of patients presenting with UI in primary care doctor's offices changed from 9 per month to 11 per month, a change that was not statistically significant. Physicians'op timism for the potential gains from incontinence treatment increased.
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Nittrouer CL, Trump RCE, O'Brien KR, Hebl M. Stand Up and Be Counted: In the Long Run, Disclosing Helps All. INDUSTRIAL AND ORGANIZATIONAL PSYCHOLOGY-PERSPECTIVES ON SCIENCE AND PRACTICE 2015. [DOI: 10.1111/iops.12139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Goodfellow B, Defromont L, Calandreau F, Roelandt JL. Images of the "Insane," the "Mentally Ill," and the "Depressed" in Nouméa, New Caledonia. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2014. [DOI: 10.2753/imh0020-7411390105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Benjamin Goodfellow
- a Georges Pompidou European Public Hospital Emergency Department, French WHO Collaborating Center (WHOCC), Paris
| | - Laurent Defromont
- b Information and Medical Research Department, Lille City Public Mental Health Center
| | - Fanny Calandreau
- c General Psychiatry Department, Albert Bousquet Hospital, Nouméa, New Caledonia
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Moon YS, Kim HJ, Kim DH. The relationship of the Korean version of the WHO Five Well-Being Index with depressive symptoms and quality of life in the community-dwelling elderly. Asian J Psychiatr 2014; 9:26-30. [PMID: 24813032 DOI: 10.1016/j.ajp.2013.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/20/2013] [Accepted: 12/26/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression in the geriatric population is becoming markedly more prevalent. Quality of life has been linked with the development of depression. A screening tool for assessing both geriatric depression and quality of life is needed. OBJECTIVE The purpose of this study was to assess the utility of the Korean version of the World Health Organization Five Well-Being Index (WHO-5) in evaluating geriatric depression and quality of life as compared to the widely used Short Geriatric Depression Scale of Korean version (SGDS-K). METHODS Two hundred and forty four elderly people (>60-years-of-age) living in the Yanggu and Inje areas of Gangwon Province, Korea, were interviewed and responded to scales including WHO-5, SGDS-K, Mini Mental Status Examination in the Korean version of the CERAD assessment packet (MMSE-KC), and Geriatric Quality of Life-Dementia (GQOL-D). A total WHO-5 score<13 indicated low well-being. RESULTS The SGDS-K score showed a reverse correlation with the WHO-5, MMSE-KC, and GQOL-D scores. The WHO-5 score reversely correlated with the SGDS-K score and positively correlated with GQOL-D, but showed no significant correlation with MMSE-KC score. Subjects ranked as having poor well-being (WHO-5 score<13) had a significantly lower GQOL-D score and a significantly higher SGDS-K score. In multiple regression analysis, WHO-5 was significantly associated with GQOL-D and SGDS-K. CONCLUSION The Korean version of WHO-5 is useful in evaluating both depressive symptoms and quality of life of community-dwelling elderly.
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Affiliation(s)
- Yoo Sun Moon
- Institute for Skeletal Aging, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea; Department of Psychiatry, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Hyun Ji Kim
- Department of Psychiatry, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Do Hoon Kim
- Department of Psychiatry, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea.
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Pirkis J, Hickie I, Young L, Burns J, Highet N, Davenport T. An Evaluation ofbeyondblue, Australia's National Depression Initiative. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2012. [DOI: 10.1080/14623730.2005.9721865] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Mojtabai R, Olfson M, Sampson NA, Jin R, Druss B, Wang PS, Wells KB, Pincus HA, Kessler RC. Barriers to mental health treatment: results from the National Comorbidity Survey Replication. Psychol Med 2011; 41:1751-1761. [PMID: 21134315 PMCID: PMC3128692 DOI: 10.1017/s0033291710002291] [Citation(s) in RCA: 501] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim was to examine barriers to initiation and continuation of treatment among individuals with common mental disorders in the US general population. METHOD Respondents in the National Comorbidity Survey Replication with common 12-month DSM-IV mood, anxiety, substance, impulse control and childhood disorders were asked about perceived need for treatment, structural barriers and attitudinal/evaluative barriers to initiation and continuation of treatment. RESULTS Low perceived need was reported by 44.8% of respondents with a disorder who did not seek treatment. Desire to handle the problem on one's own was the most common reason among respondents with perceived need both for not seeking treatment (72.6%) and for dropping out of treatment (42.2%). Attitudinal/evaluative factors were much more important than structural barriers both to initiating (97.4% v. 22.2%) and to continuing (81.9% v. 31.8%) of treatment. Reasons for not seeking treatment varied with illness severity. Low perceived need was a more common reason for not seeking treatment among individuals with mild (57.0%) than moderate (39.3%) or severe (25.9%) disorders, whereas structural and attitudinal/evaluative barriers were more common among respondents with more severe conditions. CONCLUSIONS Low perceived need and attitudinal/evaluative barriers are the major barriers to treatment seeking and staying in treatment among individuals with common mental disorders. Efforts to increase treatment seeking and reduce treatment drop-out need to take these barriers into consideration as well as to recognize that barriers differ as a function of sociodemographic and clinical characteristics.
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Affiliation(s)
- Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health and Department of Psychiatry, Johns Hopkins University, Baltimore, MD
| | - Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Robert Jin
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Benjamin Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Philip S. Wang
- Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD
| | - Kenneth B. Wells
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | | | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA
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Reducing suicides through an alliance against depression? Gen Hosp Psychiatry 2010; 32:514-8. [PMID: 20851273 DOI: 10.1016/j.genhosppsych.2010.06.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 06/24/2010] [Accepted: 06/29/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Since 2003, the Regensburg Alliance Against Depression, the regional partner of the German Alliance Against Depression, has been conducting a four-level intervention program to improve early detection and treatment of patients with depression, which was successfully piloted in the framework of the German Research Network on Depression and Suicidality. METHODS After 5 years of campaign, the suicide rates before and after the intervention were evaluated in comparison with two control regions and with the German overall rate. FINDINGS The results show that only the suicide rate in Regensburg fell significantly during the intervention period. The drop in the suicide rate was due to a significant decrease in male suicides. INTERPRETATION An intensive community-based campaign could be effective in lowering suicide rates. Especially, the combination of continuing medical educations (CMEs) for general practitioners focusing on 'male depression' and low-threshold campaigns for the general public seems to reach male depressive patients.
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Strömberg R, Backlund LG, Löfvander M. A comparison between the Beck's Depression Inventory and the Gotland Male Depression Scale in detecting depression among men visiting a drop-in clinic in primary care. Nord J Psychiatry 2010; 64:258-64. [PMID: 20100134 DOI: 10.3109/08039480903511407] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Anger attacks and alcohol use may mask depressive symptoms in men. Only the Gotland Male Depression Scale (GS) includes such items. AIMS To study the usefulness of the GS and Beck Depression Inventory (BDI) in detecting depression among men in primary care. METHODS At a family doctor's drop-in clinic in Stockholm, Sweden, all men were invited into the study 2 days a week (opportunistic screening). On other days, the men who mentioned mental symptoms were invited (targeted screening). The men filled in BDI, GS and a social questionnaire. The doctor invited the men with BDI > or = 10 and /or GS > or = 13 to a repeat visit. The outcome was depression diagnosed according to DSM-IV and the severity was assessed with the Montgomery-Asberg Depression Rating Scale. RESULTS 223 men were recruited, 190 by opportunistic and 33 by targeted screening. Seventeen per cent of the men reported an alcohol consumption that might put them at risk. In the opportunistic screening, 23% scored BDI > or = 10 and 14% scored GS > or = 13. The prevalence of depression in the opportunistic screening was 10.5%. The proportion of depressed men in the targeted screening was 60.6%. In total, 40 men were depressed, 63% had a mild and 35% moderate depression. The correlation between the scales was 0.80. The GS identified no additional cases. CONCLUSIONS Clinical depression was quite common among those men who often had a high alcohol consumption, indicating an advantage for the GS when screening for depression among men. In primary care, a targeted screening procedure seems to be the most feasible method.
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Affiliation(s)
- Ranja Strömberg
- Center for Family and Community Medicine, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
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Isacsson G, Rich CL, Jureidini J, Raven M. The increased use of antidepressants has contributed to the worldwide reduction in suicide rates. Br J Psychiatry 2010; 196:429-33. [PMID: 20513850 DOI: 10.1192/bjp.bp.109.076166] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Numerous ecological studies have shown an inverse association between antidepressant use and suicide rates and a smaller number of individual-based studies have shown an association between current antidepressant use and reduced suicide risk. Such evidence is often cited in support of the notion that antidepressants prevent suicide. However, more recently, the premises underlying this proposition, namely that suicide is caused by depression and that antidepressants relieve depression, have been challenged and the potential harm caused by antidepressants has been highlighted. In this article, Goran Isacsson and Charles Rich debate with Jon Jureidini and Melissa Raven the motion that the increased use of antidepressants has contributed to the worldwide reduction in suicide rates.
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Affiliation(s)
- Göran Isacsson
- Karolinska University Hospital in Huddinge, M59, Stockholm S-14186, Sweden.
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Nurses’ attitudes to mental illness: A comparison of a sample of nurses from five European countries. Int J Nurs Stud 2010; 47:350-62. [DOI: 10.1016/j.ijnurstu.2009.08.008] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 06/15/2009] [Accepted: 08/25/2009] [Indexed: 11/19/2022]
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Henshaw EJ, Freedman-Doan CR. Conceptualizing mental health care utilization using the health belief model. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1468-2850.2009.01181.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Dadich A. Communicating evidence-based mental health care to service users. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2009. [DOI: 10.1080/00049530802579499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ann Dadich
- University of Western Sydney, Centre for Industry and Innovation Studies (CInIS), College of Business, Penrith South, New South Wales, Australia
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Abstract
In the first in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Neerja Chowdary and colleagues discuss the treatment of depression.
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Affiliation(s)
- Vikram Patel
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Sangath, Alto-Porvorim, Goa, India
| | - Gregory Simon
- Group Health Center for Health Studies, Seattle, Washington, United States of America
| | | | - Sylvia Kaaya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ricardo Araya
- Academic Unit of Psychiatry, University of Bristol, United Kingdom
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Connery H, Davidson KM. A survey of attitudes to depression in the general public: A comparison of age and gender differences. J Ment Health 2009. [DOI: 10.1080/09638230600608818] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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de Graaf LE, Gerhards SAH, Arntz A, Riper H, Metsemakers JFM, Evers SMAA, Severens JL, Widdershoven G, Huibers MJH. Clinical effectiveness of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial. Br J Psychiatry 2009; 195:73-80. [PMID: 19567900 DOI: 10.1192/bjp.bp.108.054429] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Computerised cognitive-behavioural therapy (CCBT) might offer a solution to the current undertreatment of depression. AIMS To determine the clinical effectiveness of online, unsupported CCBT for depression in primary care. METHOD Three hundred and three people with depression were randomly allocated to one of three groups: Colour Your Life; treatment as usual (TAU) by a general practitioner; or Colour Your Life and TAU combined. Colour Your Life is an online, multimedia, interactive CCBT programme. No assistance was offered. We had a 6-month follow-up period. RESULTS No significant differences in outcome between the three interventions were found in the intention-to-treat and per protocol analyses. CONCLUSIONS Online, unsupported CCBT did not outperform usual care, and the combination of both did not have additional effects. Decrease in depressive symptoms in people with moderate to severe depression was moderate in all three interventions. Online CCBT without support is not beneficial for all individuals with depression.
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Affiliation(s)
- L E de Graaf
- Erasmus Medical Centre, Department of Medical Psychology and Psychotherapy, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands.
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Allgaier AK, Kramer D, Mergl R, Hegerl U. Wissens- und Einstellungsänderung zu Depression und Suizidalität bei Altenpflegekräften: Evaluation eines Fortbildungsprojektes. Z Gerontol Geriatr 2009; 42:228-35. [DOI: 10.1007/s00391-008-0010-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 07/28/2008] [Indexed: 11/24/2022]
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Henson C, Chapman S, McLeod L, Johnson N, McGeechan K, Hickie I. More us than them: positive depictions of mental illness on Australian television news. Aust N Z J Psychiatry 2009; 43:554-60. [PMID: 19440888 DOI: 10.1080/00048670902873623] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of the present study was to review television news coverage of mental illness including self-depictions from people with mental illness, and views expressed by mental health experts and politicians in all 538 news and current affairs items related to mental illness broadcast on free-to-air Sydney television, May 2005-October 2007. METHODS Content and frame analysis was done of news actors (those with mental illnesses, experts and politicians) of whether depictions were positive 'one of us', or negative 'one of them'. RESULTS Only 6% of all items with a main focus on a specific health condition, focused on mental health. Individuals with mental illness were present in 264 (49%) of 538 items, with most (174, 66%) of these self-depictions categorized as either neutral or positive. Experts and politicians overwhelmingly represented and described people with mental illnesses in neutral or positive ways (95% and 84%, respectively). Overall news angle included 299 items (55%), which were categorized as positive 'recovery focused' items. Another 156 items (29%) were neutral, and 62 items (12%) were classified as negative. Twenty-one (4%) had unclear or mixed themes. CONCLUSIONS The present findings differ from previous descriptions of media depiction of mental illness, which have been largely negative. The present study provides support for the importance of involving those with histories of mental illness in news coverage.
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Affiliation(s)
- Connie Henson
- School of Public Health, University of Sydney, Sydney, NSW, Australia
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Affiliation(s)
- Rob Whitley
- Dartmouth Psychiatric Research Center, 2 Whipple Place, Lebanon, NH 03766, USA.
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30
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Hegerl U, Wittmann M, Arensman E, Van Audenhove C, Bouleau JH, Van Der Feltz-Cornelis C, Gusmao R, Kopp M, Löhr C, Maxwell M, Meise U, Mirjanic M, Oskarsson H, Sola VP, Pull C, Pycha R, Ricka R, Tuulari J, Värnik A, Pfeiffer-Gerschel T. The 'European Alliance Against Depression (EAAD)': a multifaceted, community-based action programme against depression and suicidality. World J Biol Psychiatry 2008; 9:51-8. [PMID: 17853299 DOI: 10.1080/15622970701216681] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Action programmes fostering partnerships and bringing together regional and national authorities to promote the care of depressed patients are urgently needed. In 2001 the 'Nuremberg Alliance Against Depression' was initiated as a community-based model project within the large-scale 'German Research Network on Depression and Suicidality' (Kompetenznetz 'Depression, Suizidalität'). The 'Nuremberg Alliance Against Depression' was an action programme, conducted in the city of Nuremberg (500,000 inhabitants) in 2001/2002, addressing four intervention levels (Hegerl et al. Psychol Med 2006;36:1225). Based on the positive results of the Nuremberg project (a significant reduction of suicidal behaviour by more than 20%) 18 international partners representing 16 different European countries established the 'European Alliance Against Depression' (EAAD) in 2004. Based on the four-level approach of the Nuremberg project, all regional partners initiated respective regional intervention programmes addressing depression and suicidality. Evaluation of the activities takes place on regional and international levels. This paper gives a brief overview of the background for and experiences with the EAAD. It describes the components of the programme, provides the rationale for the intervention and outlines the current status of the project. The aim of the paper is to disseminate information about the programme's potential to reduce suicidal behaviour and to provide examples of how European community-based 'best practice' models for improving the care of depressed patients and suicidal persons can be implemented using a bottom-up approach. EAAD is mentioned by the European commission as a best practice example within the Green Paper 'Improving the mental health of the population: Towards a strategy on mental health for the European Union' (European Commission 2005).
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Affiliation(s)
- Ulrich Hegerl
- Klinik und Poliklinik für Psychiatrie, Universität Leipzig, Leipzig, Germany.
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de Graaf LE, Gerhards SAH, Evers SM, Arntz A, Riper H, Severens JL, Widdershoven G, Metsemakers JFM, Huibers MJH. Clinical and cost-effectiveness of computerised cognitive behavioural therapy for depression in primary care: design of a randomised trial. BMC Public Health 2008; 8:224. [PMID: 18590518 PMCID: PMC2474681 DOI: 10.1186/1471-2458-8-224] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 06/30/2008] [Indexed: 11/10/2022] Open
Abstract
Background Major depression is a common mental health problem in the general population, associated with a substantial impact on quality of life and societal costs. However, many depressed patients in primary care do not receive the care they need. Reason for this is that pharmacotherapy is only effective in severely depressed patients and psychological treatments in primary care are scarce and costly. A more feasible treatment in primary care might be computerised cognitive behavioural therapy. This can be a self-help computer program based on the principles of cognitive behavioural therapy. Although previous studies suggest that computerised cognitive behavioural therapy is effective, more research is necessary. Therefore, the objective of the current study is to evaluate the (cost-) effectiveness of online computerised cognitive behavioural therapy for depression in primary care. Methods/Design In a randomised trial we will compare (a) computerised cognitive behavioural therapy with (b) treatment as usual by a GP, and (c) computerised cognitive behavioural therapy in combination with usual GP care. Three hundred mild to moderately depressed patients (aged 18–65) will be recruited in the general population by means of a large-scale Internet-based screening (N = 200,000). Patients will be randomly allocated to one of the three treatment groups. Primary outcome measure of the clinical evaluation is the severity of depression. Other outcomes include psychological distress, social functioning, and dysfunctional beliefs. The economic evaluation will be performed from a societal perspective, in which all costs will be related to clinical effectiveness and health-related quality of life. All outcome assessments will take place on the Internet at baseline, two, three, six, nine, and twelve months. Costs are measured on a monthly basis. A time horizon of one year will be used without long-term extrapolation of either costs or quality of life. Discussion Although computerised cognitive behavioural therapy is a promising treatment for depression in primary care, more research is needed. The effectiveness of online computerised cognitive behavioural therapy without support remains to be evaluated as well as the effects of computerised cognitive behavioural therapy in combination with usual GP care. Economic evaluation is also needed. Methodological strengths and weaknesses are discussed. Trial registration The study has been registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236).
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Affiliation(s)
- L Esther de Graaf
- Department of Clinical Psychological Science, Faculty of Psychology, Maastricht University, The Netherlands.
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Woods NF, Alexander JL, Dennerstein L, Richardson G. Impact of clinician and patient attitudes on clinical decision making for the symptomatic menopausal woman with or without comorbidity. Expert Rev Neurother 2008; 7:S27-34. [PMID: 18039065 DOI: 10.1586/14737175.7.11s.s27] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Culture, individual health beliefs and distressing symptoms frequently determine women's perceptions of their menopausal transitions. Women's perceptions of mental health problems and the acceptability of different interventions greatly affect if and what a woman is willing to try as a treatment option and whether or not she will accept the possibility that her menopausal symptoms represent a comorbidity with a diagnosis, such as depression or anxiety. These perceptions have a significant impact on women's choices with regard to health practices, as well as on whether or not they will seek out medical care for their distressing symptom(s). Working with a woman's beliefs, sharing decision making, and empowering her through health education are all critical aspects of the treatment of the patient with comorbid perimenopausal symptoms, regardless of their etiology.
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Berner MM, Kriston L, Sitta P, Härter M. Treatment of depressive symptoms and attitudes towards treatment options in a representative German general population sample. Int J Psychiatry Clin Pract 2008; 12:5-10. [PMID: 24916490 DOI: 10.1080/13651500701330783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective. To estimate treatment rates, self-medication, and preferences for treatment options of depressive symptoms. Methods. A German nationwide representative sample (n=2224) was interviewed. Subjects were asked to fill in a depressive symptom checklist, as well as to answer questions about current treatments and treatment preferences. Results. A total of 16.7% was mildly, 7.5% moderately and 6.5% strongly affected by depressive symptoms; 22.7% of the total affected group were currently or previously being treated by a physician. Self-initiated treatments had been stated as effective in 54.2% of cases. The preference for phytotherapeutic treatment approaches was about 3-6-fold higher than for standard antidepressants and psychotherapies. Treatment preference and wish for treatment increased with increasing severity of symptoms with regard to treatments that had to be professionally initiated. Conclusion. Despite considerable educational efforts, the prevalence of untreated and undiagnosed depressive symptoms seems to be high. There is still little acceptance for the most efficacious therapies for depression. More efforts should be made to increase knowledge about self-administered phytotherapeutic drugs, which might play an important role in a stepped-care approach of future depression management.
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Affiliation(s)
- Michael M Berner
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
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Althaus D, Niklewski G, Schmidtke A, Hegerl U. [Changes in the frequency of suicidal behaviour after a 2-year intervention campaign]. DER NERVENARZT 2007; 78:272-6, 278-80, 282. [PMID: 16523357 DOI: 10.1007/s00115-005-2031-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Insufficient treatment of depression is one of the most important causes of suicide. The Nuremberg Alliance against Depression (funded by the German Ministry of Education and Research) tried to improve the quality of care for patients suffering from depression. This multilevel programme focussed on close cooperation with general practitioners, a public relation campaign about depression, involvement of other professional groups, and reinforcement of self-help activities. METHODS The project was realised in the city of Nuremberg, Germany in 2001-2002. Changes in the frequency of suicidal acts (successful and attempted suicides) compared to a baseline (2000) and a control region (Wuerzburg, Germany) were prospectively defined as the main outcome criterion. RESULTS The frequency of suicidal acts decreased significantly (-21.7%) compared to the control region. This reduction was mainly due to a lower rate of suicide attempts. CONCLUSIONS Many other regions in Germany and Europe followed the Nuremberg model project and have initiated regional alliances against depression.
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Affiliation(s)
- D Althaus
- Kompetenznetz Depression, Suizidalität, Nussbaumstrasse 7, 80336 München.
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Wittkampf KA, Naeije L, Schene AH, Huyser J, van Weert HC. Diagnostic accuracy of the mood module of the Patient Health Questionnaire: a systematic review. Gen Hosp Psychiatry 2007; 29:388-95. [PMID: 17888804 DOI: 10.1016/j.genhosppsych.2007.06.004] [Citation(s) in RCA: 341] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Revised: 06/12/2007] [Accepted: 06/12/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The nine-item mood module of the Patient Health Questionnaire (PHQ-9) was developed to screen and to diagnose patients in primary care with depressive disorders. We systematically reviewed the psychometric literature on the PHQ-9 and performed a meta-analysis to ascertain its summary sensitivity and specificity. METHODS EMBASE, PubMed and PsycINFO were used to search literature up to July 2006. Studies were included if (1) they investigated the diagnostic accuracy of the PHQ-9 and (2) the PHQ-9 had been compared with a reference test. The quality of the studies was appraised using the Quality Assessment of Diagnostic Accuracy Studies. We calculated sensitivity, specificity and confidence intervals for each included study. We used the random effects model to calculate the summary sensitivity and specificity. RESULTS We found a sensitivity of 0.77 (0.71-0.84) and a specificity of 0.94 (0.90-0.97) for the PHQ-9. The positive predictive value in an unselected primary care population was 59%, which increased to 85-90% when the prior probability increased to 30-40%. CONCLUSION In primary care, the PHQ-9 is a valid diagnostic tool if used in selected subgroups of patients with a high prevalence of depressive disorder.
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Affiliation(s)
- Karin A Wittkampf
- Department of Psychiatry, Programme for Mood Disorders, Academic Medical Center, University of Amsterdam, Tafelbergweg 25, 1105 BC Amsterdam, The Netherlands.
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Kovess-Masféty V, Saragoussi D, Sevilla-Dedieu C, Gilbert F, Suchocka A, Arveiller N, Gasquet I, Younes N, Hardy-Bayle MC. What makes people decide who to turn to when faced with a mental health problem? Results from a French survey. BMC Public Health 2007; 7:188. [PMID: 17672899 PMCID: PMC1976618 DOI: 10.1186/1471-2458-7-188] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 07/31/2007] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The unequal use of mental health care is a great issue, even in countries with universal health coverage. Better knowledge of the factors that have an impact on the pathway to mental health care may be a great help for designing education campaigns and for best organizing health care delivery. The objective of this study is to explore the determinants of help-seeking intentions for mental health problems and which factors influence treatment opinions and the reliance on and compliance with health professionals' advice. METHODS 441 adults aged 18 to 70 were randomly selected from the general population of two suburban districts near Paris and agreed to participate in the study (response rate = 60.4%). The 412 respondents with no mental health problems based on the CIDI-SF and the CAGE, who had not consulted for a mental health problem in the previous year, were asked in detail about their intentions to seek help in case of a psychological disorder and about their opinion of mental health treatments. The links between the respondents' characteristics and intentions and opinions were explored. RESULTS More than half of the sample (57.8%) would see their general practitioner (GP) first and 46.6% would continue with their GP for follow-up. Mental health professionals were mentioned far less than GPs. People who would choose their GP first were older and less educated, whereas those who would favor mental health specialists had lower social support. For psychotherapy, respondents were split equally between seeing a GP, a psychiatrist or a psychologist. People were reluctant to take psychotropic drugs, but looked favorably on psychotherapy. CONCLUSION GPs are often the point of entry into the mental health care system and need to be supported. Public information campaigns about mental health care options and treatments are needed to educate the public, eliminate the stigma of mental illness and eliminate prejudices.
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Affiliation(s)
- Viviane Kovess-Masféty
- MGEN Foundation for Public Health; EA 4069 University of Paris 5, 3 square Max Hymans, 75748 Paris Cedex 15, France
| | - Delphine Saragoussi
- MGEN Foundation for Public Health; EA 4069 University of Paris 5, 3 square Max Hymans, 75748 Paris Cedex 15, France
| | - Christine Sevilla-Dedieu
- MGEN Foundation for Public Health; EA 4069 University of Paris 5, 3 square Max Hymans, 75748 Paris Cedex 15, France
| | - Fabien Gilbert
- MGEN Foundation for Public Health; EA 4069 University of Paris 5, 3 square Max Hymans, 75748 Paris Cedex 15, France
| | - Agnieszka Suchocka
- MGEN Foundation for Public Health; EA 4069 University of Paris 5, 3 square Max Hymans, 75748 Paris Cedex 15, France
| | - Nathalie Arveiller
- Versailles Hospital, 177 rue de Versailles, 78157 Le Chesnay Cedex, France
| | - Isabelle Gasquet
- Medical Policy Division (AP-HP), 3 avenue Victoria, 75184 Paris Cedex 04, France
| | - Nadia Younes
- Versailles Hospital, 177 rue de Versailles, 78157 Le Chesnay Cedex, France
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Inoue K, Tanii H, Abe S, Kaiya H, Okazaki Y, Nata M, Fukunaga T. Suicidal tendencies among the elderly in Mie Prefecture, Japan, between 1996 and 2002. Leg Med (Tokyo) 2007; 9:134-8. [PMID: 17150399 DOI: 10.1016/j.legalmed.2006.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Revised: 10/04/2006] [Accepted: 10/07/2006] [Indexed: 10/23/2022]
Abstract
This study aims to show the causative factors of suicide among the elderly (over 65) in Mie Prefecture, and to discuss the prevention of the factors contributing to suicide in the elderly group. We obtained an agreement from the Mie Prefectural Police Headquarters and investigated all inquest records collected between 1996 and 2002 in Mie Prefecture and focused on suicide in the elderly group. During the test period, the number of suicides in the elderly group was 842. In causative factors, the two major causative factors of suicide were "suffering from physical illness" and "psychiatric disorders". In particular, the three most frequent physical illnesses were "cardiovascular disease", "orthopedic disorder", and "digestive organ disease", and these physical illnesses are mentally stressful, and thus have a psychiatric component, the same as psychiatric illnesses do. Consequently, it is concluded that improvements in the home nursing and mental health care should include the prevention of suicide in the elderly who "suffer from physical illness" and "psychiatric disorders" to prevent suicide. In addition, medical staff and the general public should be educated on the factors that can influence elderly persons' mental condition, and should be cautioned to observe elderly persons for suicidal signs and symptoms.
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Affiliation(s)
- Ken Inoue
- Department of Psychiatry, Mie University Graduate School of Medicine, Tsu 514-8507,
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Van Voorhees BW, Fogel J, Houston TK, Cooper LA, Wang NY, Ford DE. Attitudes and illness factors associated with low perceived need for depression treatment among young adults. Soc Psychiatry Psychiatr Epidemiol 2006; 41:746-54. [PMID: 16896516 DOI: 10.1007/s00127-006-0091-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND We do not yet fully understand how low perceived need for treatment leads many young adults to not seek care for their depression. METHODS A cross-sectional study of 10,962 depressed young adults (ages 16-29) who visited a depression screening/education Internet website. Based on the Theory of Reasoned Action, we developed a multivariate model to determine the effects of beliefs and attitudes, social norms, past treatment behavior, and symptom severity on low perceived depression treatment need (i.e., not agreeing that one needs depression treatment). RESULTS Negative beliefs and attitudes, social norms, and past treatment behavior predicted low perceived depression treatment need and explained more than half the model variance. Even after adjusting for depression severity and symptoms of other mental disorders, lacking confidence in either a biological or counseling based explanation or treatment approach for depression predicted low perceived depression treatment need. CONCLUSIONS Lack of helpful treatment experiences and/or confidence in either of the currently practiced depression treatment models may prevent many young adults from seeking depression treatment.
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Affiliation(s)
- Benjamin W Van Voorhees
- Department of Medicine, Section of General Internal Medicine, The University of Chicago, 5841 South Maryland Avenue, MC 20007, Chicago, IL 60637, USA.
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Möller HJ. Evidence for beneficial effects of antidepressants on suicidality in depressive patients: a systematic review. Eur Arch Psychiatry Clin Neurosci 2006; 256:329-43. [PMID: 16783501 DOI: 10.1007/s00406-006-0650-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Accepted: 01/23/2006] [Indexed: 10/24/2022]
Abstract
The role of antidepressants in suicide prevention is a major public health question, given the high prevalence of both depression and depression-related suicidality. Therefore all means available should be utilised to clarify the influence of antidepressants on suicidality. This paper gives a comprehensive overview of the positive effects of antidepressants on suicidality. In the first section, principal methodological issues related to suicidology in general as well as to clinical and epidemiological studies that investigate the influence of antidepressants on suicidality are discussed. In the second section, the results of controlled clinical studies on the efficacy of antidepressants in suicidality are presented. The third section reports on the results of other types of studies, especially epidemiological studies. Altogether, there seems to be reasonable evidence from different research approaches that antidepressants are able to reduce suicidal ideation and also suicidal behaviour in depressive patients. While the evidence for the beneficial effect on suicidal ideation comes from randomised control group studies, some of which used a placebo arm, the evidence for the prophylactic effect on suicidal behaviour, especially suicide, was primarily obtained from well-designed epidemiological studies.
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Affiliation(s)
- Hans-Jürgen Möller
- Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany.
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Daigle M, Beausoleil L, Brisoux J, Raymond S, Charbonneau L, Desaulniers J. Reaching Suicidal People with Media Campaigns. CRISIS 2006; 27:172-80. [PMID: 17219749 DOI: 10.1027/0227-5910.27.4.172] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Five variables were investigated in the evaluation of Suicide Prevention Weeks (SPW) held in 1999, 2000, and 2001 in Québec, Canada: exposure to the campaign, previous suicide ideation, knowledge, attitudes, and intentions. After the year 2000 campaign, a telephone survey conducted on a representative sample of 1020 men revealed that only those actually exposed to the SPW had gained more knowledge of suicide facts and resources. However, the SPW did not influence attitudes or intentions to seek help. Results are not surprising, considering the low intensity of the campaign, especially in the media. Campaigns aimed at changing suicidal behaviors must be intensive.
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Affiliation(s)
- Marc Daigle
- University of Québec at Trois-Rivières, Canada.
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Pirkis J, Blood RW, Francis C, McCallum K. On-screen portrayals of mental illness: extent, nature, and impacts. JOURNAL OF HEALTH COMMUNICATION 2006; 11:523-41. [PMID: 16846952 DOI: 10.1080/10810730600755889] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This article reviews the published literature on the extent, nature, and impacts of portrayal of mental illness in fictional films and television programs. The literature suggests that on-screen portrayals are frequent and generally negative, and have a cumulative effect on the public's perception of people with mental illness and on the likelihood of people with mental illness seeking appropriate help. The article concludes that there is a need for the mental health sector and the film and television industries to collaborate to counter negative portrayals of mental illness, and to explore the potential for positive portrayals to educate and inform, as well as to entertain.
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Affiliation(s)
- Jane Pirkis
- Program Evaluation Unit, School of Population Health, The University of Melbourne, Victoria, Australia.
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Godard C, Chevalier A, Lecrubier Y, Lahon G. APRAND programme: an intervention to prevent relapses of anxiety and depressive disorders. First results of a medical health promotion intervention in a population of employees. Eur Psychiatry 2006; 21:451-9. [PMID: 16675204 DOI: 10.1016/j.eurpsy.2006.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The study sought to determine whether an organized health promotion intervention during medical consultations improves the outcome for patients who meet the ICD10 criteria for anxiety or depressive disorders. METHODS In 2001, physicians used the MINI to screen 9743 employees on sick leave and consulting physicians in 21 medical centres of a large company. A health promotion intervention was implemented in eight "active" centres. It took place immediately after diagnosis and consisted of explaining the disorders, delivering the test results and leaflets based on WHO recommendations, and advising patients to consult their personal physician, psychiatrist or occupational physician, if necessary. Its effectiveness, evaluated by symptom severity and outcome over 1 year, was assessed by comparing the eight active centres to 13 control centres (without the intervention). RESULTS Disorders were detected among 10.6% of the subjects, 29.4% of whom had no previous diagnosis of anxiety or depressive disorder. The intervention was associated with a positive effect on the 6-week and 6-month HAD scores. Total absence of disorders at 1 year was associated with age, sex, and intervention, among all identified cases (OR=1.53), among those with at least one anxiety disorder (OR=1.45), and among those with at least one depressive disorder (OR=1.40). CONCLUSION Combining detection with organized provision of information including printed material improves patients' outcome and physicians' diagnostic abilities.
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Affiliation(s)
- C Godard
- Service Général de Médecine de Contrôle of EDF GDF, 22-28, rue Joubert, 75009 Paris, France.
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Abstract
BACKGROUND Major depression is such a prevalent illness worldwide that practically everyone has either direct or indirect experience of it. It is important, then, from both practical and theoretical points of view, to examine this particular experience and related conceptions. AIM Drawing on the theory of social representations, this research set out to examine the ways in which people define depression in terms of the symptoms they attribute to people they know personally and consider to suffer from depression. METHOD A group of adult participants (n = 117) were instructed to think of an individual whom they knew personally and considered to suffer from depression, to indicate the age and gender of the person, and to describe his/her symptoms. RESULTS A great majority of the female participants thought of a female, while the male participants thought of male and female target persons quite evenly. The symptoms attributed to depression with fair unanimity included fatigue and decreased capacity to work, to concentrate, to make decisions and to take part in hobbies. The descriptions of the depressive person were quite unanimously distinguished from the signal symptoms attaching to schizophrenia. The descriptions varied according to the characteristics of the target individuals, and their gender and age in particular, rather than the characteristics of the participants. CONCLUSION People have perceptive personal experiences of depression, which are guided by socially shared interpretative frameworks.
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Affiliation(s)
- Hannu Räty
- Department of Psychology, University of Joensuu, Finland.
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Lawrence V, Murray J, Banerjee S, Turner S, Sangha K, Byng R, Bhugra D, Huxley P, Tylee A, Macdonald A. Concepts and causation of depression: a cross-cultural study of the beliefs of older adults. THE GERONTOLOGIST 2006; 46:23-32. [PMID: 16452281 DOI: 10.1093/geront/46.1.23] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Vanessa Lawrence
- PO26, Section of Mental Health and Ageing, Health Services Research Department, The David Goldberg Centre, The Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
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Clarke D, Smith G, Peake JA, Trauer T, McCall L, Blashki G, Piterman L. Evaluation of a short course in psychiatry for general practitioners. Australas Psychiatry 2006; 14:76-80. [PMID: 16630204 DOI: 10.1080/j.1440-1665.2006.02250.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the acceptability and benefits to general practitioners (GPs) of a short course on the management of depression and anxiety. METHOD One hundred and twenty-two GPs from southeast metropolitan Melbourne participated in a five-session short course. Pre- and post-measures of knowledge, attitude and self-evaluated clinical practice and a post-measure of participant satisfaction were completed. RESULTS The course was overwhelmingly appreciated by participating GPs. In the group as a whole, knowledge, attitude and certain elements of clinical practice changed in a positive and predicted direction. General practitioners affirmed the use of an interpersonal and problem-solving framework for patients more commonly than a cognitive-behavioural one. CONCLUSIONS Brief educational interventions are useful and, through improving GP knowledge, attitude and clinical practice, have an important role to play in enhancing the capacity of GPs to assist people with depression and anxiety.
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Affiliation(s)
- David Clarke
- Department of Psychological Medicine, Monash University, Clayton, Vic., Australia. ,edu.au
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Tylee A, Gandhi P. The importance of somatic symptoms in depression in primary care. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2005; 7:167-76. [PMID: 16163400 PMCID: PMC1192435 DOI: 10.4088/pcc.v07n0405] [Citation(s) in RCA: 182] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Accepted: 04/13/2005] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Patients with depression present with psychological and somatic symptoms, including general aches and pains. In primary care, somatic symptoms often dominate. A review of the literature was conducted to ascertain the importance of somatic symptoms in depression in primary care. DATA SOURCES AND EXTRACTION MEDLINE, EMBASE, and PsychLIT/PsychINFO databases (1985-January 2004) were searched for the terms depression, depressive, depressed AND physical, somatic, unexplained symptoms, complaints, problems; somatised, somatized symptoms; somatisation, somatization, somatoform, psychosomatic; pain; recognition, under-recognition; diagnosis, underdiagnosis; acknowledgment, under-acknowledgment; treatment, undertreatment AND primary care, ambulatory care; primary physician; office; general practice; attribution, re-attribution; and normalising, normalizing. Only English-language publications and abstracts were considered. STUDY SELECTION More than 80 papers related to somatic symptoms in depression were identified using the content of their titles and abstracts. DATA SYNTHESIS Approximately two thirds of patients with depression in primary care present with somatic symptoms. These patients are difficult to diagnose, feel an increased burden of disease, rely heavily on health care services, and are harder to treat. Patient and physician factors that prevent discussion of psychological symptoms during consultations must be overcome. CONCLUSIONS Educational initiatives that raise awareness of somatic symptoms in depression and help patients to re-attribute these symptoms should help to improve the recognition of depression in primary care.
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Affiliation(s)
- André Tylee
- Institute of Psychiatry, Health Services Research Department, Denmark Hill, London, UK.
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Beck CA, Patten SB, Williams JVA, Wang JL, Currie SR, Maxwell CJ, El-Guebaly N. Antidepressant utilization in Canada. Soc Psychiatry Psychiatr Epidemiol 2005; 40:799-807. [PMID: 16179967 DOI: 10.1007/s00127-005-0968-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Antidepressant utilization can be used as an indicator of appropriate treatment for major depression. The objective of this study was to characterize antidepressant utilization in Canada, including the relationships of antidepressant use with sociodemographic variables, past-year and lifetime depression, number of past depressive episodes, and other possible indications for antidepressants. METHOD We examined data from the Canadian Community Health Survey (CCHS) Cycle 1.2. The CCHS was a nationally representative mental health survey (N=36,984) conducted in 2002 that included a diagnostic instrument for past-year and lifetime major depressive episodes and other psychiatric disorders and a record of past-year antidepressant use. RESULTS Overall, 5.8% of Canadians were taking antidepressants, higher than the annual prevalence of major depressive episode (4.8%) in the survey. Among persons with a past-year major depressive episode, the frequency of antidepressant use was 40.4%. After application of adjustments for probable successful outcomes of treatment, the estimated frequency of antidepressant use for major depression was more than 50%. Frequency of antidepressant treatment among those with a history of depression but without a past-year episode increased with the number of previous episodes. Among those taking antidepressants over the past year, only 33.1% had had a past-year episode of major depression. Migraine, fibromyalgia, anxiety disorder, or past depression was present in more than 60% of those taking antidepressants without a past-year episode of depression. CONCLUSIONS The CCHS results suggest that antidepressant use has increased substantially since the early 1990s, and also that these medications are employed extensively for indications other than depression.
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Affiliation(s)
- Cynthia A Beck
- Dept. of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
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Wang J, Patten SB, Williams JVA, Currie S, Beck CA, Maxwell CJ, El-Guebaly N. Help-seeking behaviours of individuals with mood disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2005; 50:652-9. [PMID: 16276857 DOI: 10.1177/070674370505001012] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study had the following objectives: 1) to estimate the 12-month prevalence of conventional and unconventional mental health service use by individuals with major depressive disorder (MDD) or mania in the past year, and 2) to identify factors associated with the use of conventional mental health services by individuals with MDD or mania in the past year. METHODS We examined data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). Respondents with MDD (n = 1563) or manic episodes (n = 393) in the past 12 months were included in this analysis. RESULTS An estimated 63.9% of respondents with MDD and 59.0% of those with manic episodes reported having used some type of help in the past 12 months; 52.9% of those with MDD and 49.0% of those with manic episodes used conventional mental health services. Approximately 21% of respondents with either MDD or manic episodes used natural health products specifically for emotional, mental health, and drug or alcohol use problems. Respondents who reported comorbid anxiety disorders and long-term medical conditions were more likely to have used conventional mental health services. CONCLUSIONS Relative to previous Canadian literature, our analysis suggests that the frequency of conventional mental health service use among persons with MDD has not increased significantly in the past decade. Further, the rate of conventional mental health service use by persons with manic episodes is unexpectedly low. These findings may reflect the lack of national initiatives targeting mood disorders in Canada. They have important implications for planning future education, promotion, and research efforts.
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Affiliation(s)
- JianLi Wang
- Department of Psychiatry, University of Calgary, Alberta.
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Reuber M, Mitchell AJ, Howlett SJ, Crimlisk HL, Grünewald RA. Functional symptoms in neurology: questions and answers. J Neurol Neurosurg Psychiatry 2005; 76:307-14. [PMID: 15716517 PMCID: PMC1739564 DOI: 10.1136/jnnp.2004.048280] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Between 10 and 30% of patients seen by neurologists have symptoms for which there is no current pathophysiological explanation. The objective of this review is to answer questions many neurologists have about disorders characterised by unexplained symptoms (functional disorders) by conducting a multidisciplinary review based on published reports and clinical experience. Current concepts explain functional symptoms as resulting from auto-suggestion, innate coping styles, disorders of volition or attention. Predisposing, precipitating, and perpetuating aetiological factors can be identified and contribute to a therapeutic formulation. The sympathetic communication of the diagnosis by the neurologist is important and all patients should be screened for psychiatric or psychological symptoms because up to two thirds have symptomatic psychiatric comorbidity. Treatment programmes are likely to be most successful if there is close collaboration between neurologists, (liaison) psychiatrists, psychologists, and general practitioners. Long term, symptoms persist in over 50% of patients and many patients remain dependent on financial help from the government. Neurologists can acquire the skills needed to engage patients in psychological treatment but would benefit from closer working relationships with liaison psychiatry or psychology.
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Affiliation(s)
- M Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
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Ozmen E, Ogel K, Aker T, Sagduyu A, Tamar D, Boratav C. Public attitudes to depression in urban Turkey - the influence of perceptions and causal attributions on social distance towards individuals suffering from depression. Soc Psychiatry Psychiatr Epidemiol 2004; 39:1010-6. [PMID: 15583910 DOI: 10.1007/s00127-004-0843-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND The aim of this study was to determine public attitudes towards patients with depression and the influence of perception and causal attributions on social distance towards individuals suffering from depression in urban areas. METHODS This study was carried out with a representative sample in Istanbul which is the biggest metropolis in Turkey. Seven hundred and seven subjects completed the public survey form which consisted of ten items screening the demographic features and health status of the participants, and 32 items rating attitudes towards depression. RESULTS The respondents' attitudes towards depression were very negative and nearly half of the subjects perceived people with depression as dangerous. More than half of the subjects stated that they would not marry a person with depression, and nearly half of the subjects stated that they would not rent their house to a person with depression. One-quarter of the subjects stated that depressive patients should not be free in the community. The subjects who considered depression as a disease and who believed that weakness of personality and social problems cause depression had negative attitudes towards depression. CONCLUSIONS In Istanbul, people recognise depression well, but their attitudes towards it are fairly negative. The urban public has unfavourable attitudes towards depression and a tendency to isolate patients from the society. Notwithstanding the high prevalence, there is still considerable stigmatisation associated with depression.
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Affiliation(s)
- Erol Ozmen
- Celal Bayar University Medical School, Dept. of Psychiatry, Manisa, Turkey.
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