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Melville CA, Hatton C, Beer E, Hastings RP, Cooper SA, McMeekin N, Dagnan D, Appleton K, Scott K, Fulton L, Jones RSP, McConnachie A, Zhang R, Knight R, Knowles D, Williams C, Briggs A, Jahoda A. Predictors and moderators of the response of adults with intellectual disabilities and depression to behavioural activation and guided self-help therapies. J Intellect Disabil Res 2023; 67:986-1002. [PMID: 37344986 DOI: 10.1111/jir.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 05/20/2023] [Accepted: 05/24/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND No previous studies have reported predictors and moderators of outcome of psychological therapies for depression experienced by adults with intellectual disabilities (IDs). We investigated baseline variables as outcome predictors and moderators based on a randomised controlled trial where behavioural activation was compared with guided self-help. METHODS This study was an exploratory secondary data analysis of data collected during a randomised clinical trial. Participants (n = 161) were randomised to behavioural activation or guided self-help and followed up for 12 months. Pre-treatment variables were included if they have previously been shown to be associated with an increased risk of having depression in adults with IDs or have been reported as a potential predictor or moderator of outcome of treatment for depression with psychological therapies. The primary outcome measure, the Glasgow Depression Scale for Adults with Learning Disabilities (GDS-LD), was used as the dependant variable in mixed effects regression analyses testing for predictors and moderators of outcome, with baseline GDS-LD, treatment group, study centre and antidepressant use as fixed effects, and therapist as a random effect. RESULTS Higher baseline anxiety (mean difference in outcome associated with a 1 point increase in anxiety 0.164, 95% confidence interval [CI] 0.031, 0.297; P = 0.016), lower performance intelligence quotient (IQ) (mean difference in outcome associated with a 1 point increase in IQ 0.145, 95% CI 0.009, 0.280; P = 0.037) and hearing impairment (mean difference 3.449, 95% CI 0.466, 6.432; P = 0.024) were predictors of poorer outcomes, whilst greater severity of depressive symptoms at baseline (mean difference in outcome associated with 1 point increase in depression -0.160, 95% CI -0.806, -0.414; P < 0.001), higher expectation of change (mean difference in outcome associated with a 1 point increase in expectation of change -1.013, 95% CI -1.711, -0.314; p 0.005) and greater percentage of therapy sessions attended (mean difference in outcome with 1 point increase in percentage of sessions attended -0.058, 95% CI -0.099, -0.016; P = 0.007) were predictors of more positive outcomes for treatment after adjusting for randomised group allocation. The final model included severity of depressive and anxiety symptoms, lower WASI performance IQ subscale, hearing impairment, higher expectation of change and percentage of therapy sessions attended and explained 35.3% of the variance in the total GDS-LD score at 12 months (R2 = 0.353, F4, 128 = 17.24, P < 0.001). There is no evidence that baseline variables had a moderating effect on outcome for treatment with behavioural activation or guided self-help. CONCLUSIONS Our results suggest that baseline variables may be useful predictors of outcomes of psychological therapies for adults with IDs. Further research is required to examine the value of these potential predictors. However, our findings suggest that therapists consider how baseline variables may enable them to tailor their therapeutic approach when using psychological therapies to treat depression experienced by adults with IDs.
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Affiliation(s)
- C A Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C Hatton
- Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK
| | - E Beer
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - R P Hastings
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
- Department of Psychiatry, Monash University, Melbourne, Australia
| | - S-A Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - N McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - D Dagnan
- Clinical Psychology, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and University of Cumbria, Newcastle upon Tyne Tyne, UK
| | - K Appleton
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - K Scott
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - L Fulton
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - R S P Jones
- School of Psychology, Bangor University, Bangor, UK
| | - A McConnachie
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - R Zhang
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - R Knight
- Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK
| | - D Knowles
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - C Williams
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - A Briggs
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A Jahoda
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Moore SE, McEvoy CT, Prior L, Lawton J, Patterson CC, Kee F, Cupples M, Young IS, Appleton K, McKinley MC, Woodside JV. Barriers to adopting a Mediterranean diet in Northern European adults at high risk of developing cardiovascular disease. J Hum Nutr Diet 2017; 31:451-462. [PMID: 29159932 DOI: 10.1111/jhn.12523] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Strong evidence links the consumption of a Mediterranean diet (MD) with a reduced cardiovascular disease (CVD) risk; however, there is uncertainty as to whether non-Mediterranean regions will adopt this diet. The present qualitative research aimed to investigate attitudes towards a MD in individuals at high CVD risk in a Northern European population. This information is needed to inform development of MD interventions in non-Mediterranean high-risk populations. METHODS Focus groups (n = 12) were held with individuals at high CVD risk from Northern Europe (≥2 CVD risk factors, aged ≥50 years, no established CVD/type 2 diabetes). Attitudes to dietary change towards a MD were explored. Data were analysed using inductive thematic analysis. RESULTS Sixty-seven adults participated (60% female, mean age 64 years). There was some awareness of the term MD but limited knowledge of its composition. Barriers to general dietary change were evident, including perception of expense, concern over availability, expectation of time commitment, limited knowledge, lack of cooking skills, amount and conflicting nature of media information on diets, changing established eating habits and resistance to dietary change. Barriers specific to MD adoption were also identified, including perceived difficulty living in a colder climate, perceived impact on body weight, acceptability of a MD and cultural differences. CONCLUSIONS Knowledge of a MD was limited in this Northern European sample at high CVD risk. In addition to general barriers to dietary change, barriers specific to a MD were identified. These findings have implications for the development of interventions aiming to promote MD adoption in non-Mediterranean populations.
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Affiliation(s)
- S E Moore
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - C T McEvoy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - L Prior
- UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
| | - J Lawton
- Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, UK
| | - C C Patterson
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
| | - F Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
| | - M Cupples
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
| | - I S Young
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - K Appleton
- Department of Psychology, Bournemouth University, Bournemouth, UK
| | - M C McKinley
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
| | - J V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
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Robinson K, Staples V, Appleton K, Sheffield D. Illness perceptions and obesity. Obesity related illness representations vary according to BMI category. Appetite 2014. [DOI: 10.1016/j.appet.2014.06.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Glasspool RM, Brown R, Gore ME, Rustin GJS, McNeish IA, Wilson RH, Pledge S, Paul J, Mackean M, Hall GD, Gabra H, Halford SER, Walker J, Appleton K, Ullah R, Kaye S. A randomised, phase II trial of the DNA-hypomethylating agent 5-aza-2'-deoxycytidine (decitabine) in combination with carboplatin vs carboplatin alone in patients with recurrent, partially platinum-sensitive ovarian cancer. Br J Cancer 2014; 110:1923-9. [PMID: 24642620 PMCID: PMC3992493 DOI: 10.1038/bjc.2014.116] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/05/2014] [Accepted: 02/09/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Our previous laboratory and clinical data suggested that one mechanism underlying the development of platinum resistance in ovarian cancer is the acquisition of DNA methylation. We therefore tested the hypothesis that the DNA hypomethylating agent 5-aza-2'-deoxycytodine (decitabine) can reverse resistance to carboplatin in women with relapsed ovarian cancer. METHODS Patients progressing 6-12 months after previous platinum therapy were randomised to decitabine on day 1 and carboplatin (AUC 6) on day 8, every 28 days or carboplatin alone. The primary objective was response rate in patients with methylated hMLH1 tumour DNA in plasma. RESULTS After a pre-defined interim analysis, the study closed due to lack of efficacy and poor treatment deliverability in 15 patients treated with the combination. Responses by GCIG criteria were 9 out of 14 vs 3 out of 15 and by RECIST were 6 out of 13 vs 1 out of 12 for carboplatin and carboplatin/decitabine, respectively. Grade 3/4 neutropenia was more common with the combination (60% vs 15.4%) as was G2/3 carboplatin hypersensitivity (47% vs 21%). CONCLUSIONS With this schedule, the addition of decitabine appears to reduce rather than increase the efficacy of carboplatin in partially platinum-sensitive ovarian cancer and is difficult to deliver. Patient-selection strategies, different schedules and other demethylating agents should be considered in future combination studies.
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Affiliation(s)
- R M Glasspool
- The Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, UK
| | - R Brown
- Department Surgery and Cancer, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - M E Gore
- Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - G J S Rustin
- Mount Vernon Cancer Centre, Northwood, Middlesex HA6 2RN, UK
| | - I A McNeish
- St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - R H Wilson
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast BT9 7AB, N. Ireland, UK
| | - S Pledge
- Sheffield Weston Park Hospital, Whitham Road, Sheffield, South Yorkshire S10 2SJ, UK
| | - J Paul
- The Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, UK
| | - M Mackean
- Edinburgh Western General Hospital, Crewe Road S, Edinburgh EH4 2XU, UK
| | - G D Hall
- St James's Institute of Oncology, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - H Gabra
- Department Surgery and Cancer, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - S E R Halford
- Drug Development Office Cancer Research UK, Angel Building, 407 Street, John Street, Islington, London EC1V 4AD, UK
| | - J Walker
- Analytical Services Unit, Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Glasgow G61 1QH, UK
| | - K Appleton
- Analytical Services Unit, Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Glasgow G61 1QH, UK
| | - R Ullah
- Analytical Services Unit, Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Glasgow G61 1QH, UK
| | - S Kaye
- Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
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Appleton K, Strathdee G, Plumb J, Schaetzlein A, Reade S, Barrett S, Lee C, Judson I, Vasey P, Brown R. 617 Pharmacodynamic analysis of surrogate tissue responses to the demethylating agent 2′-deoxy-5-azacytidine (Decitabine). EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)80625-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Lee C, Appleton K, Plumb J, Kaye S, Cruickshank C, Twelves C, Vasey P, Judson I, Brown R, Mackay H. A phase I trial of the DNA-hypomethylating agent 5-Aza-2'-Deoxycytidine in combination with carboplatin both given 4 weekly by intravenous injection in patients with advanced solid tumours. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.2005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. Lee
- Institute of Cancer Research, Sutton, United Kingdom; Beatson Laboratories & Beatson Oncology Centre, Glasgow, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - K. Appleton
- Institute of Cancer Research, Sutton, United Kingdom; Beatson Laboratories & Beatson Oncology Centre, Glasgow, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - J. Plumb
- Institute of Cancer Research, Sutton, United Kingdom; Beatson Laboratories & Beatson Oncology Centre, Glasgow, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - S. Kaye
- Institute of Cancer Research, Sutton, United Kingdom; Beatson Laboratories & Beatson Oncology Centre, Glasgow, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - C. Cruickshank
- Institute of Cancer Research, Sutton, United Kingdom; Beatson Laboratories & Beatson Oncology Centre, Glasgow, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - C. Twelves
- Institute of Cancer Research, Sutton, United Kingdom; Beatson Laboratories & Beatson Oncology Centre, Glasgow, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - P. Vasey
- Institute of Cancer Research, Sutton, United Kingdom; Beatson Laboratories & Beatson Oncology Centre, Glasgow, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - I. Judson
- Institute of Cancer Research, Sutton, United Kingdom; Beatson Laboratories & Beatson Oncology Centre, Glasgow, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - R. Brown
- Institute of Cancer Research, Sutton, United Kingdom; Beatson Laboratories & Beatson Oncology Centre, Glasgow, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - H. Mackay
- Institute of Cancer Research, Sutton, United Kingdom; Beatson Laboratories & Beatson Oncology Centre, Glasgow, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
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Strathdee G, Appleton K, Illand M, Millan DW, Sargent J, Paul J, Brown R. Primary ovarian carcinomas display multiple methylator phenotypes involving known tumor suppressor genes. Am J Pathol 2001; 158:1121-7. [PMID: 11238060 PMCID: PMC1850352 DOI: 10.1016/s0002-9440(10)64059-x] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Mounting evidence suggests that aberrant methylation of CpG islands is a major pathway leading to the inactivation of tumor suppressor genes and the development of cancer. Recent studies on colorectal and gastric cancer have defined a CpG island methylator phenotype (CIMP), which involves the targeting of multiple genes by promoter hypermethylation. To determine the role of methylation in ovarian cancer, we have investigated the methylation status of 93 primary ovarian tumors at ten loci using methylation-specific polymerase chain reaction (MSP). Seven of the loci (BRCA1, HIC1, MINT25, MINT31, MLH1, p73 and hTR) were found to be methylated in a significant proportion of the ovarian tumors, and methylation of at least one of these was found in the majority (71%) of samples. Although concurrent methylation of multiple genes was commonly seen, this did not seem to be due to a single CIMP phenotype. Instead the results suggest the presence of at least three groups of tumors, two CIMP-positive groups, each susceptible to methylation of a different subset of genes, and a further group of tumors not susceptible to CpG island methylation, at least at the loci studied.
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Affiliation(s)
- G Strathdee
- Cancer Research Campaign Department of Medical Oncology, CRC Beatson Laboratories, Glasgow University, Glasgow G61 1BD, United Kingdom
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Abstract
The psychological health and job satisfaction of 285 GPs and 89 medical house officers from Leeds was compared using standardized self-report measures. Forty-eight per cent of the GPs and 20% of the house officers scored as 'cases' of psychiatric disorder. The GPs were less satisfied with the recognition they received for their work and their hours of work, but more satisfied with their job variety and job autonomy. Further research examining the sources of work-related distress in different medical settings could help inform future organizational changes.
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Affiliation(s)
- N Kapur
- Department of Psychiatry and Behavioural Sciences, Rawnsley Building, Manchester Royal Infirmary, UK
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Abstract
Exercise is known to cause physiological changes that could affect the impact of nutrients on appetite control. This study was designed to assess the effect of drinks containing either sucrose or high-intensity sweeteners on food intake following exercise. Using a repeated-measures design, three drink conditions were employed: plain water (W), a low-energy drink sweetened with artificial sweeteners aspartame and acesulfame-K (L), and a high-energy, sucrose-sweetened drink (H). Following a period of challenging exercise (70% VO2 max for 50 min), subjects consumed freely from a particular drink before being offered a test meal at which energy and nutrient intakes were measured. The degree of pleasantness (palatability) of the drinks was also measured before and after exercise. At the test meal, energy intake following the artificially sweetened (L) drink was significantly greater than after water and the sucrose (H) drinks (p < 0.05). Compared with the artificially sweetened (L) drink, the high-energy (H) drink suppressed intake by approximately the energy contained in the drink itself. However, there was no difference between the water (W) and the sucrose (H) drink on test meal energy intake. When the net effects were compared (i.e., drink + test meal energy intake), total energy intake was significantly lower after the water (W) drink compared with the two sweet (L and H) drinks. The exercise period brought about changes in the perceived pleasantness of the water, but had no effect on either of the sweet drinks. The remarkably precise energy compensation demonstrated after the higher energy sucrose drink suggests that exercise may prime the system to respond sensitively to nutritional manipulations. The results may also have implications for the effect on short-term appetite control of different types of drinks used to quench thirst during and after exercise.
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Affiliation(s)
- N A King
- Department of Psychology, University of Leeds, UK.
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Appleton K, House A, Dowell A. A survey of job satisfaction, sources of stress and psychological symptoms among general practitioners in Leeds. Br J Gen Pract 1998; 48:1059-63. [PMID: 9624747 PMCID: PMC1410027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The past seven years have seen rapid changes in general practice in the United Kingdom (UK), commencing with the 1990 contract. During the same period, concern about the health and morale of general practitioners (GPs) has increased and a recruitment crisis has developed. AIM To determine levels of psychological symptoms, job satisfaction, and subjective ill health in GPs and their relationship to practice characteristics, and to compare levels of job satisfaction since the introduction of the 1990 GP contract with those found before 1990. METHOD Postal questionnaire survey of all GP principals on the Leeds Health Authority list. The main outcome measures included quantitative measures of practice characteristics, job satisfaction, mental health (General Health Questionnaire), and general physical health. Qualitative statements about work conditions, job satisfaction, and mental health were collected. RESULTS A total of 285/406 GPs (70%) returned the questionnaires. One hundred and forty-eight (52%) scored 3 or more on the General Health Questionnaire (GHQ-12), which indicates a high level of psychological symptoms. One hundred and sixty GPs (56%) felt that work had affected their recent physical health. Significant associations were found between GHQ-12 scores, total job satisfaction scores, and GPs' perceptions that work had affected their physical health. Problems with physical and mental health were associated with several aspects of workload, including list size, number of sessions worked per week, amount of time spent on call, and use of deputizing services. In the qualitative part of the survey, GPs reported overwork and excessive hours, paperwork and administration, recent National Health Service (NHS) changes, and the 1990 GP contract as the most stressful aspects of their work. CONCLUSIONS Fifty-two per cent of GPs in Leeds who responded showed high levels of psychological symptoms. Job satisfaction was lower than in a national survey conducted in 1987, and GPs expressed the least satisfaction with their hours, recognition for their work, and rates of pay. Nearly 60% felt that their physical health had been affected by their work. These results point to a need to improve working conditions in primary care and for further research to determine the effect of any such changes.
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Affiliation(s)
- K Appleton
- Academic Unit of Child and Adolescent Mental Health, Leeds University
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Lockie P, Appleton K. Phacoemulsification using a can-opener capsulotomy. Aust N Z J Ophthalmol 1996; 24:392-3. [PMID: 8985558 DOI: 10.1111/j.1442-9071.1996.tb01618.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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