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Pettrey C, Kerr PL, Dickey TO. Physical Exercise as an Intervention for Depression: Evidence for Efficacy and Mu-Opioid Receptors as a Mechanism of Action. ADVANCES IN NEUROBIOLOGY 2024; 35:221-239. [PMID: 38874725 DOI: 10.1007/978-3-031-45493-6_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Physical exercise is often cited as an important part of an intervention for depression, and there is empirical evidence to support this. However, the mechanism of action through which any potential antidepressant effects are produced is not widely understood. Recent evidence points toward the involvement of endogenous opioids, and especially the mu-opioid system, as a partial mediator of these effects. In this chapter, we discuss the current level of empirical support for physical exercise as either an adjunctive or standalone intervention for depression. We then review the extant evidence for involvement of endogenous opioids in the proposed antidepressant effects of exercise, with a focus specifically on evidence for mu-opioid system involvement.
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Affiliation(s)
| | - Patrick L Kerr
- Behavioral Medicine & Psychiatry, WVU School of Medicine, Charleston, WV, USA
| | - T O Dickey
- West Virginia University School of Medicine-Charleston, Charleston, WV, USA
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Catanzano M, Bennett SD, Tibber MS, Coughtrey AE, Liang H, Heyman I, Shafran R. A Mental Health Drop-In Centre Offering Brief Transdiagnostic Psychological Assessment and Treatment in a Paediatric Hospital Setting: A One-Year Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105369. [PMID: 34069973 PMCID: PMC8157880 DOI: 10.3390/ijerph18105369] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
AIM This study was part of a broader project to examine the acceptability, feasibility and impact of a transdiagnostic mental health drop-in centre offering brief psychological assessment and treatment for children and young people and/or their families with mental health needs in the context of long-term physical health conditions (LTCs). The aims of this investigation were to characterise: (i) the use of such a centre, (ii) the demographics and symptoms of those presenting to the centre, and (iii) the types of support that are requested and/or indicated. METHODS A mental health "booth" was located in reception of a national paediatric hospital over one year. Characteristics of young people with LTCs and their siblings/parents attending the booth were defined. Emotional/behavioural symptoms were measured using standardised questionnaires including the Strengths and Difficulties Questionnaire (SDQ). Participants subsequently received one of four categories of intervention: brief transdiagnostic cognitive behaviour therapy (CBT), referral to other services, neurodevelopmental assessment or signposting to resources. RESULTS One hundred and twenty-eight participants were recruited. The mean age of young people was 9.14 years (standard deviation: 4.28); 61% identified as white and 45% were male. Over half of young people recruited scored in the clinical range with respect to the SDQ. Presenting problems included: anxiety (49%), challenging behaviour (35%), low mood (22%) and other (15%). CONCLUSIONS A considerable proportion of young people with LTC in a paediatric hospital scored in the clinical range for common mental health problems, indicating a potential for psychological interventions.
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Affiliation(s)
- Matteo Catanzano
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
- Correspondence: ; Tel.: +44-(0)20-7405-9200
| | - Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Marc S Tibber
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK;
| | - Anna E Coughtrey
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Holan Liang
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - The Lucy Project Team
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
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Claassen D, Ascoli M, Berhe T, Priebe S. Research on mental disorders and their care in immigrant populations: a review of publications from Germany, Italy and the UK. Eur Psychiatry 2020; 20:540-9. [PMID: 15963698 DOI: 10.1016/j.eurpsy.2005.02.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Accepted: 02/15/2005] [Indexed: 11/28/2022] Open
Abstract
AbstractObjectiveThe review aims to identify the extent and nature of research on mental disorders and their care in immigrant populations in three major European countries with high levels of immigration, i.e. Germany, Italy, United Kingdom (UK).MethodsPeer-reviewed publications on the subject from the three countries between 1996 and 2004 were analyzed. The research questions addressed, the methods used, and the results obtained were assessed.ResultsThirteen papers reporting empirical studies were found from Germany, four from Italy and 95 from the UK. Studies addressed a range of research questions and most frequently assessed rates of service utilization in different immigrant groups. The most consistent finding is a higher rate of hospital admissions for Afro-Caribbean patients in the UK. Many studies had serious methodological shortcomings with low sample sizes and unspecified inclusion criteria.DiscussionDespite large scale immigration in each of the three studied countries, the numbers of relevant research publications vary greatly with a relatively high level of empirical research in the UK. Possible reasons for this are a generally stronger culture of mental health service research and a higher number of researchers who are themselves from immigrant backgrounds in the UK.ConclusionOverall the evidence base to guide the development of mental health services for immigrant populations appears limited. Future research requires appropriate funding, should be of sufficient methodological quality and may benefit from collaboration across Europe.
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Affiliation(s)
- Dirk Claassen
- Unit for Social and Community Psychiatry, Queen Mary (University of London), Newham Centre for Mental Health, Glen Road, Plaistow, London E13 8SP, UK.
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Möller HJ, Bitter I, Bobes J, Fountoulakis K, Höschl C, Kasper S. Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression. Eur Psychiatry 2020; 27:114-28. [DOI: 10.1016/j.eurpsy.2011.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 12/28/2022] Open
Abstract
AbstractThis position statement will address in an evidence-based approach some of the important issues and controversies of current drug treatment of depression such as the efficacy of antidepressants, their effect on suicidality and their place in a complex psychiatric treatment strategy including psychotherapy. The efficacy of antidepressants is clinically relevant. The highest effect size was demonstrated for severe depression. Based on responder rates and based on double-blind placebo-controlled studies, the number needed to treat (NNT) is 5–7 for acute treatment and four for maintenance treatment. Monotherapy with one drug is often not sufficient and has to be followed by other antidepressants or by comedication/augmentation therapy approaches. Generally, antidepressants reduce suicidality, but under special conditions like young age or personality disorder, they can also increase suicidality. However, under the conditions of good clinical practice, the risk–benefit relationship of treatment with antidepressants can be judged as favourable also in this respect. The capacity of psychiatrists to individualise and optimise treatment decisions in terms of ‘the right drug/treatment for the right patient’ is still restricted since currently there are no sufficient powerful clinical or biological predictors which could help to achieve this goal. There is hope that in future pharmacogenetics will contribute significantly to a personalised treatment. With regard to plasma concentration, therapeutic drug monitoring (TDM) is a useful tool to optimize plasma levels therapeutic outcome. The ideal that all steps of clinical decision-making can be based on the strict rules of evidence-based medicine is far away from reality. Clinical experience so far still has a great impact.
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Cabrera Mateos J, Touriño González R, Núñez González E. Los trastornos mentales y su infradiagnóstico en atención primaria. Semergen 2018; 44:234-242. [DOI: 10.1016/j.semerg.2016.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/09/2016] [Accepted: 11/11/2016] [Indexed: 11/28/2022]
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Nurmela K, Mattila A, Heikkinen V, Uitti J, Ylinen A, Virtanen P. Identification of major depressive disorder among the long-term unemployed. Soc Psychiatry Psychiatr Epidemiol 2018; 53:45-52. [PMID: 29124293 DOI: 10.1007/s00127-017-1457-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Depression is a common mental health disorder among the unemployed, but research on identifying their depression in health care is scarce. The present study aimed to explore the identification of major depressive disorder (MDD) in health care on long-term unemployed and find out if the duration of unemployment correlates with the risk for unidentified MDD. METHODS The study sample consisted the patient files of long-term unemployed people (duration of unemployment 1-35 years, median 11 years), who in a screening project diagnosed with MDD (n = 243). The MDD diagnosis was found in the health care records of 101. Binomial logistic regression models were used to explore the effect of the duration of unemployment, as a discrete variable, to the identification of MDD in health care. RESULTS MDD was appropriately identified in health care for 42% (n = 101) of the participants with MDD. The odds ratio for unidentified MDD in health care was 1.060 (95% confidence interval 1.011; 1.111, p = 0.016) per unemployment year. When unemployment had continued, for example, for five years the odds ratio for having unidentified MDD was 1.336. The association remained significant throughout adjustments for the set of background factors (gender, age, occupational status, marital status, homelessness, criminal record, suicide attempts, number of health care visits). CONCLUSIONS This study among depressed long-term unemployed people indicates that the longer the unemployment period has lasted, the more commonly these people suffer from unidentified MDD. Health services should be developed with respect to sensitivity to detect signs of depression among the long-term unemployed.
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Affiliation(s)
- Kirsti Nurmela
- Faculty of Social Sciences, University of Tampere, 33014, Tampere, Finland. .,Mental Health and Substance Abuse Services, Tampere, Finland.
| | - Aino Mattila
- Faculty of Social Sciences, University of Tampere, 33014, Tampere, Finland.,Department of Adult Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Virpi Heikkinen
- Faculty of Social Sciences, University of Tampere, 33014, Tampere, Finland.,Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Jukka Uitti
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Clinic of Occupational Medicine, Tampere University Hospital, Tampere, Finland.,Finnish Institute of Occupational Health, Tampere, Finland
| | - Aarne Ylinen
- Department of Neurological Sciences, University of Helsinki, Helsinki, Finland.,Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Pekka Virtanen
- Faculty of Social Sciences, University of Tampere, 33014, Tampere, Finland
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Garrido-Elustondo S, Reneses B, Navalón A, Martín O, Ramos I, Fuentes M. [Ability to detect psychiatric disorders by the family physician]. Aten Primaria 2016; 48:449-57. [PMID: 26775265 PMCID: PMC6877835 DOI: 10.1016/j.aprim.2015.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 08/04/2015] [Accepted: 09/10/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine the ability of family physicians to detect psychiatric disorders, comparing the presence of psychiatric disorders detected using validated tests and referrals by family physicians. DESIGN Cross-sectional, two-phase study. LOCATION Primary healthcare centres in an urban area of Madrid. PARTICIPANTS Patients between 18 and 65years attending primary healthcare centres for non-administrative purposes. MAIN MEASUREMENTS To detect psychiatric disorders in the waiting room, an interview was performed using GHQ-28 and MULTICAGE CAD-4 in the screening phase (considered positive: score of 6 or higher on the GHQ-28 or a score 2 or higher on MULTICAGE CAD-4). Patients with a positive score and 20% with negative were recruited for the second phase (case identification) using MINI interview. During family physician consultation, the patient gave his doctor a card with an identification number to record the presence of psychiatric illness in his/her opinion and whether there was treatment with psychotropic drugs. RESULTS A total of 628 subjects participated. The prevalence of psychiatric disorders corrected by two phase methodology was 31.7% (95%CI: 27.9 to 35.5). Of the 185 patients with a psychiatric disorder detected, 44.2% (95%CI: 36.7 to 51.7) were identified as patients with psychiatric disorders by their family physician. Disorders best detected were: hypomania, dysthymic disorder, depressive episode with melancholic symptoms, and panic disorder. CONCLUSIONS A significant percentage of patients with possible psychiatric disorders detected with validated test have not been identified by their family physician.
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Affiliation(s)
- Sofía Garrido-Elustondo
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISECC). Unidad de Apoyo a la Investigación, Gerencia de Atención Primaria, Madrid, España.
| | - Blanca Reneses
- Instituto de Psiquiatría y Salud Mental, Instituto de Investigación (IdISSC), Hospital Clínico San Carlos, Departamento de Psiquiatría, Universidad Complutense, Madrid, España
| | - Aida Navalón
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Madrid, España
| | - Olga Martín
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Madrid, España
| | - Isabel Ramos
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Madrid, España
| | - Manuel Fuentes
- Instituto de Investigación (IdISSC), Hospital Clínico San Carlos, Madrid, España
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Abstract
OBJECTIVE General Medical Practitioners play a crucial role in the detection and referral of mental health problems in primary care. This study describes the referral patterns of Irish General Practitioners (GPs) to psychological therapies and profiles the range of psychological therapies available. METHOD A 21-item study-specific questionnaire exploring referral processes to psychological therapies was sent to all GPs listed by the Irish College of General Practitioners in one county in Ireland. A 19-item questionnaire exploring details of psychological therapies offered and referral pathways was sent to members of psychological therapy accrediting bodies in the same county. RESULTS Of 97 GP respondents (33% response rate), their estimation of the percentage of their patients who have presenting or underlying mental health issues averaged 22%. When asked to indicate which psychological therapies they consider for referrals, psychiatric referrals was the most frequent referral option (94%), followed by Counsellors (69%), Clinical psychologist (60%) and Psychotherapists (30%). GPs indicated they had some or very little knowledge of specific psychological therapies. Of 129 psychological therapists (45% response rate), self-referral and GP referral were their main referral pathways; 80% worked in private practice; highest qualification level was Undergraduate/Higher Diploma (66%), Master Level (39%) and Doctoral Level (5%). CONCLUSION GPs refer patients presenting with mental health problems to psychiatrists with significantly lower percentages referring to other types of psychological therapists. Findings demonstrate that there is a need for greater education and information-sharing between GPs and providers of accredited psychological therapies to increase knowledge on specific therapies and their evidence base.
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Udedi M, Swartz L, Stewart RC, Kauye F. Health service utilization by patients with common mental disorder identified by the Self-Reporting Questionnaire in a primary care setting in Zomba, Malawi: a descriptive study. Int J Soc Psychiatry 2014; 60:454-61. [PMID: 23877337 PMCID: PMC4171248 DOI: 10.1177/0020764013495527] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There has been no study carried out to assess health service utilization by people with common mental disorder (CMD) in Malawi. AIM The aim of the study was to evaluate health service utilization patterns of patients with CMD in primary health care (PHC) clinics. METHODS The study was conducted in two PHC clinics in one of the 28 districts in Malawi. Face-to-face interviews with the Self-Reporting Questionnaire (SRQ-20) were conducted in a sample of 323 PHC attendees aged 18 years and older who attended the PHC clinics for any reason. RESULTS The prevalence of probable CMD in the sample was 20.1%. People with probable CMD had a higher mean number of health facility visits in the previous three months compared to those without probable CMD (1.6 vs 1.19, p = .02). CONCLUSION The study reveals high utilization of health services for people with CMD in the PHC setting. There is a need for PHC workers to improve skills in diagnosing patients with CMD to make PHC services more effective by reducing re-attendance and improving patient outcomes.
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Affiliation(s)
- Michael Udedi
- Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Matieland, South Africa Clinical Psychiatry Department, Zomba Mental Hospital, Zomba, Malawi
| | - Leslie Swartz
- Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Matieland, South Africa
| | - Robert C Stewart
- Department of Mental Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Felix Kauye
- Clinical Psychiatry Department, Zomba Mental Hospital, Zomba, Malawi Department of Mental Health, College of Medicine, University of Malawi, Blantyre, Malawi
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Ryan JG, Buford U, Arias E, Alfonsin-Vittoria I, Fedders M, Jennings T, Grubb W. Participation in and Impact of a Depression Care Management Program Targeting Low-Income Minority Patients in an Urban Community-Based Clinic. Clin Ther 2014; 36:778-90. [DOI: 10.1016/j.clinthera.2014.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
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Cooper C, Spiers N, Livingston G, Jenkins R, Meltzer H, Brugha T, McManus S, Weich S, Bebbington P. Ethnic inequalities in the use of health services for common mental disorders in England. Soc Psychiatry Psychiatr Epidemiol 2013; 48:685-92. [PMID: 22893107 DOI: 10.1007/s00127-012-0565-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 07/28/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study is to investigate whether minority ethnic people were less likely to receive treatment for mental health problems than the white population were, controlling for symptom severity. METHOD We analysed data from 23,917 participants in the 1993, 2000 and 2007 National Psychiatric Morbidity Surveys. Survey response rates were 79, 69 and 57 %, respectively. The revised Clinical Interview Schedule was used to adjust for symptom severity. RESULTS Black people were less likely to be taking antidepressants than their white counterparts were (Odds ratio 0.4; 95 % confidence interval 0.2-0.9) after controlling for symptom severity. After controlling for symptom severity and socioeconomic status, people from black (0.7; 0.5-0.97) and South Asian (0.5; 0.3-0.8) ethnic groups were less likely to have contacted a GP about their mental health in the last year. CONCLUSIONS Interventions to reduce these inequalities are needed to ensure that NHS health care is delivered fairly according to need to all ethnic groups.
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Affiliation(s)
- Claudia Cooper
- Department of Mental Health Sciences (Bloomsbury Campus), UCL, 67-73 Riding House Street, 2nd Floor, Charles Bell House, London, W1W 7EJ, UK.
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Mangalore R, Knapp M. Income-related inequalities in common mental disorders among ethnic minorities in England. Soc Psychiatry Psychiatr Epidemiol 2012; 47:351-9. [PMID: 21293847 DOI: 10.1007/s00127-011-0345-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 01/06/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The relative prevalence of common mental health problems among different ethnic groups in Britain is one of the least researched topics in health variations research. We calculate and compare income-related inequalities in common mental disorders among ethnic groups in Britain. METHOD Data from a nationally representative survey of ethnic minorities (the EMPIRIC survey) were used to calculate concentration index values to indicate the extent of income-related inequalities within and across ethnic groups. RESULTS Looking at income-related inequalities in common mental disorders within each of the ethnic groups, it was found that the burden of these disorders were greater for the lower income groups among the Irish, White and African Caribbean communities. Within-group inequality was less clearly defined for each of the three Asian communities: Indian, Bangladeshi and Pakistani. However, when the data were pooled and individuals were assigned income ranks in the pooled set (not within their own ethnic group), the relative position of those in lower income groups among the different groups was striking. The poor among the Bangladeshi, Pakistani and the African Caribbean groups clearly suffered both from low income and a greater burden of mental health morbidity than the other three groups. The effect of lower income is thus worse for the mental health of populations if they are African Caribbean, Pakistani or Bangladeshi than if they are White, Irish or Indian. CONCLUSION Inequality in mental health morbidity between and within ethnic groups is at least partly linked to income, and thus to employment and education. Tackling disadvantage and discrimination in these areas could help to tackle the challenge of mental ill-health.
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Affiliation(s)
- Roshni Mangalore
- Department of Social Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
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Sociodemographic profile and mental health needs of referrals to an Irish psychiatric service: a transcultural perspective. Ir J Psychol Med 2011; 28:141-144. [PMID: 30200024 DOI: 10.1017/s079096670001212x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study describes the social, demographic and clinical characteristics of all the new referrals in a mental health catchment area. This study aims to compare Irish and non-Irish service users in terms of their mental health needs and service utilization. METHOD Case notes were reviewed retrospectively to investigate demographic, clinical and service utilization parameters among new referrals to the psychiatric services in Galway, Ireland over a six-month period. RESULTS One hundred and fifty-four new referrals, of whom 41 were non-Irish, presented over a six-month period. Results showed no difference between Irish and non-Irish service users in terms of socio-demographic variables. Alcohol problems and subsequent need for detoxification and counselling were significantly higher among service users from the new EU accession states with a significant impact on the duration of their hospital stay and the need for intensive psychiatric care. CONCLUSIONS There is an urgent need for enhanced resources for the delivery of mental healthcare to immigrants. Service utilisation and mental health needs are not explained merely by illness-related aspects in immigrant service users. Social and cultural factors have to be recognised in order to prevent disadvantages in psychiatric care.
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Norton J, de Roquefeuil G, David M, Boulenger JP, Ritchie K, Mann A. The mental health of doctor-shoppers: experience from a patient-led fee-for-service primary care setting. J Affect Disord 2011; 131:428-32. [PMID: 21237514 DOI: 10.1016/j.jad.2010.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 12/09/2010] [Accepted: 12/09/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Doctor-shopping may reflect unmet patient needs and places a significant burden on health resources; however little is known about its underlying reasons and how it relates to mental illness and its recognition in an open access fee-for-service setting. METHODS In 2003-2004, consecutive patients of 46 French general practitioners (GPs), completed in the waiting room the self-report Patient Health Questionnaire and reported on service use in the past six months. During the consultation, GPs rated the severity of any physical and psychiatric disorders. RESULTS Of 1079 patients, those rated by the GP as having a common mental disorder were significantly more likely to be doctor-shoppers but only if visiting another GP because of dissatisfaction with previous care (OR=2.3, 95% CI: 1.4-3.7). A similar trend is observed for those identified as having a common mental disorder by the Patient Health Questionnaire. Among patients with a common mental disorder, 'dissatisfied' doctor-shoppers were significantly more likely to be recognised as cases by the GP, adjusting for covariates (OR=6, 95% CI: 2.1-17.2). This was not the case for those doctor-shopping for practical reasons alone. CONCLUSION Doctor-shopping behaviour is associated with higher rates of mental illness and, among cases, an increased likelihood of recognition by the GP, only however for doctor-shoppers dissatisfied with previous care. This suggests a benefit to letting patients choose their GP as is the case in France and change if not satisfied.
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Affiliation(s)
- Joanna Norton
- Inserm U888, Pathologies of the Nervous System, Montpellier, France.
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Mitchell AJ, Vahabzadeh A, Magruder K. Screening for distress and depression in cancer settings: 10 lessons from 40 years of primary-care research. Psychooncology 2011; 20:572-84. [PMID: 21442689 DOI: 10.1002/pon.1943] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 01/10/2011] [Accepted: 01/25/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE There has been at least 40 years of active research on screening for depression and distress in primary care. Both successes and failures have been documented. The purpose of this focussed narrative review was to summarise this research and present the key lessons for clinicians and researchers working in psychosocial oncology. METHODS We searched for studies assessing the utility of screening in primary care in seven electronic bibliographic databases (CENTRAL, CINAHL, Embase, HMIC, Medline, PsycINFO, Web of Knowledge) from inception to December 2010. Results were reviewed and summarised into key areas. RESULTS We found that research could be distilled into the following key learning points. (1) Primary care is an important partner in psychosocial care. (2) Both over and under detection are problematic. (3) Barriers to identification involve patient and clinician factors. (4) Acceptability of screening is critical to implementation. (5) Underserved groups need special attention in screening. (6) Patient-clinician trust is an important modifiable variable. (7) Greater contact influences detection. (8) Clinician confidence/skills influence screening success and subsequent action. (9) Training may improve confidence but effects upon long-term outcomes are modest. (10) Screening is generally ineffective without aftercare. CONCLUSIONS Primary care has shown largely what does not work in relation to screening. Namely relying on clinicians' unassisted judgement without infrastructural support, using over-complex scales with low acceptability, looking for depression alone, using screening without linked treatment, treating in the absence of follow-up and failing to engage patients in their own care. These pitfalls can and should be avoided in psychosocial oncology.
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Norton JL, Pommié C, Cogneau J, Haddad M, Ritchie KA, Mann AH. Beliefs and attitudes of French family practitioners toward depression: the impact of training in mental health. Int J Psychiatry Med 2011; 41:107-22. [PMID: 21675343 PMCID: PMC3596352 DOI: 10.2190/pm.41.2.a] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To study, in a sample of French Family Practitioners (FPs), beliefs and attitudes toward depression and how they vary according to training received in mental health. METHODS The Depression Attitude Questionnaire (DAQ) was completed by 468 FPs from all regions of France, recruited by pharmaceutical company representatives to attend focus groups on the management of depression in general practice. RESULTS A three-factor model was derived from the DAQ, accounting for 37.7% of the total variance. The correlations between individual items of each component varied from 0.4 to 0.65, with an overall internal consistency of 0.47 (Cronbach's alpha). FPs had an overall neutral position on component 1, professional ease, a positive view on the origins of depression and its amenability to change (component 2), and a belief in the necessity of medication and the benefit of antidepressant therapy (component 3). Training in mental health, specifically through continuing medical education and postgraduate psychiatric hospital training, was significantly and positively associated with both professional ease and a medication approach to treating depression. CONCLUSION This study is the first description of the beliefs and attitudes of French FPs toward depression using a standardized measure, the DAQ, despite the instrument's limited psychometric properties. It shows the positive effect of training in mental health on attitudes toward depression.
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Affiliation(s)
- Joanna L. Norton
- Neuropsychiatrie : recherche épidémiologique et clinique
INSERM : U1061Université Montpellier IHôpital La Colombière 39 AV Charles Flahault BP 34493 -Pav 42 Calixte Cavalier 34093 CEDEX 5 Montpellier,FR,* Correspondence should be addressed to: Joanna Norton
| | - Christelle Pommié
- Neuropsychiatrie : recherche épidémiologique et clinique
INSERM : U1061Université Montpellier IHôpital La Colombière 39 AV Charles Flahault BP 34493 -Pav 42 Calixte Cavalier 34093 CEDEX 5 Montpellier,FR
| | - Joël Cogneau
- IRMG, Institut de Recherche en Médecine Générale
Institut de recherche en médecine générale105 rue de Javel 75015 Paris,FR
| | - Mark Haddad
- Health Services and Population Research Department
Institute of psychiatryNIHR Biomedical Research CentreKings CollegeLondon SE5 8AF,GB
| | - Karen A. Ritchie
- Neuropsychiatrie : recherche épidémiologique et clinique
INSERM : U1061Université Montpellier IHôpital La Colombière 39 AV Charles Flahault BP 34493 -Pav 42 Calixte Cavalier 34093 CEDEX 5 Montpellier,FR
| | - Anthony H. Mann
- Health Services and Population Research Department
Institute of psychiatryNIHR Biomedical Research CentreKings CollegeLondon SE5 8AF,GB
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Abstract
Referrals for psychological treatment have been problematic for many years. Even though GPs have attempted to limit access into the small psychological treatment services, long waiting lists have developed which have deterred referrals and deferred psychological care. GPs have understandably been frustrated. In addition, the consultation rate for psychological problems is low when compared with the rate of identified mental health problems in population surveys. Possible reasons include patients' failure to recognise the problem as psychological and thus not consulting one's GP, and/or the problem not being detected by the GP. While a self-referral system may be seen as a way of trying to allow non-consulters to receive treatment, this has been viewed with some scepticism since it may allow the 'worried well' to access already limited services. However, a study has shown that those self-referring to advertised psychological workshops had high levels of psychological morbidity and also were more representative of the population, in terms of ethnicity, than GP referrals. The government has set up the Increasing Access to Psychological Therapies (IAPT) programme to address some of the service shortfalls by expanding the provision of psychological therapists. Notably, the IAPT programme is allowing self-referrals such that any member of the public can access the service directly, bypassing general practice. Although not available at all the sites, this represents a radical shift from the present system in which access to talking therapy is generally only available through direct referral by the GP. The implications of this new development are discussed.
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Fassaert T, Nielen M, Verheij R, Verhoeff A, Dekker J, Beekman A, de Wit M. Quality of care for anxiety and depression in different ethnic groups by family practitioners in urban areas in the Netherlands. Gen Hosp Psychiatry 2010; 32:368-76. [PMID: 20633740 DOI: 10.1016/j.genhosppsych.2010.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 04/29/2010] [Accepted: 04/30/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is widespread concern about access to good quality health care for ethnic minority groups. This study investigates differences between ethnic groups regarding prevalence of anxiety and depression, and adherence to treatment guidelines by family practitioners in urban areas in the Netherlands. METHOD Data from electronic medical records, collected for the Netherlands Information Network of General Practice. Diagnoses were based on the International Classification of Primary Care. Adherence to guidelines included at least five consultations, prescription of psychotropics for 6 weeks at most (indicative of cessation in case of nonresponse) or 5 months at least (suggesting continuation in case of response), and/or a referral to a mental health care specialist. Data were analyzed using multilevel logistic regression analyses. RESULTS A total of 6413 patients (4.4% of practice population) were diagnosed with anxiety and/or depression. Prevalence was highest in Turkish patients (5.2%). Of diagnosed patients, 42.9% received guideline-concordant treatment. Only Surinamese/Antillean patients were less likely than ethnic Dutch to receive treatments according to guidelines. CONCLUSION Prevalence of and quality of care for anxiety and depression were comparable between ethnic minority clients, but some differences suggest that efforts to educate primary care providers in management of anxiety/depression should be continued and tailored to specific ethnic groups.
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Affiliation(s)
- Thijs Fassaert
- Department of Epidemiology, Documentation and Health Promotion, Municipal Health Service, 1000 CE Amsterdam, The Netherlands.
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Norredam M, Garcia-Lopez A, Keiding N, Krasnik A. Excess use of coercive measures in psychiatry among migrants compared with native Danes. Acta Psychiatr Scand 2010; 121:143-51. [PMID: 19594483 DOI: 10.1111/j.1600-0447.2009.01418.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate differences in risk of compulsory admission and other coercive measures in psychiatric emergencies among refugees and immigrants compared with that among native Danes. METHOD A register-based retrospective cohort design. All refugees (n = 29 174) and immigrants (n = 33 287) who received residence permission in Denmark from 1.1.1993 to 31.12.1999 were included and matched 1 : 4 on age and sex with native Danes. Civil registration numbers were cross-linked to the Danish Psychiatric Central Register and the Registry of Coercive Measures in Psychiatric Treatment. RESULTS Refugees (RR = 1.82; 95%CI: 1.45; 2.29) and immigrants (RR = 1.14; 95%CI: 0.83; 1.56) experienced higher rates of compulsory admissions than did native Danes. This was most striking for refugee men (RR = 2.00; 95%CI: 1.53; 2.61) and immigrant women (RR = 1.73; 95%CI: 1.45; 2.60). Moreover, refugees and immigrants experienced higher frequencies of other coercive measures during hospitalisation compared with native Danes. CONCLUSION Coercive measures in psychiatry are more likely to be experienced by migrants than by native Danes.
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Affiliation(s)
- M Norredam
- Department of Health Services Research, Institute of Public Health, University of Copenhagen, 1014Copenhagen, Denmark.
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Variations in anxiolytic and hypnotic prescribing by GPs: a cross-sectional analysis using data from the UK Quality and Outcomes Framework. Br J Gen Pract 2009; 59:e191-8. [PMID: 19520017 DOI: 10.3399/bjgp09x420923] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Wide variations in anxiolytic and hypnotic prescribing by GPs in England have been described, but are largely unexplained. AIM To examine the relationships between the volume of anxiolytics and hypnotics prescribed by GPs and their practice characteristics, population demography, and performance indicators. DESIGN OF STUDY Cross-sectional study. SETTING All general practices in England. METHODS A dataset was constructed for 8469 (98.8%) general practices including: standardised prescribing volume data for anxiolytics and hypnotics (average daily quantities per 1000 STAR-PUs [Specific Therapeutic group Age-sex weightings Related Prescribing Units]), practice descriptors, Index of Multiple Deprivation 2004, ethnicity data (2001 UK Census), and Quality and Outcomes Framework (QOF) data. RESULTS The standardised volume of anxiolytics and hypnotics prescribed varied eightfold between practices on the 5th and 95th centiles. A regression model was constructed which explained 20.5% of the variation. Higher prescribing practices were located in more deprived areas (standardised beta 0.31), but also in areas with a lower proportion of ethnic minorities (black or black British = -0.22; Asian or Asian British = -0.12). Higher volumes were also prescribed by practices with lower QOF scores ('Clinical Care' domain = -0.12; 'Organisational' domain = -0.08). Other significant but weaker predictors were: lower proportions of female GPs, higher recorded prevalence of serious mental illness and non-training status. The proportion of GPs trained outside UK was not a predictor. CONCLUSION Demographic factors were more powerful determinants of prescribing than characteristics of the practice itself. Nevertheless, the findings provide some support for the notion that high prescribing practices were less well developed, in that their QOF scores were lower and they were less likely to be training practices.
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Abstract
BACKGROUND Depression is a major burden for the health-care system worldwide. Most care for depression is delivered by general practitioners (GPs). We assessed the rate of true positives and negatives, and false positives and negatives in primary care when GPs make routine diagnoses of depression. METHODS We undertook a meta-analysis of 118 studies that assessed the accuracy of unassisted diagnoses of depression by GPs. 41 of these studies were included because they had a robust outcome standard of a structured or semi-structured interview. FINDINGS 50 371 patients were pooled across 41 studies and examined. GPs correctly identified depression in 47.3% (95% CI 41.7% to 53.0%) of cases and recorded depression in their notes in 33.6% (22.4% to 45.7%). 19 studies assessed both rule-in and rule-out accuracy; from these studies, the weighted sensitivity was 50.1% (41.3% to 59.0%) and specificity was 81.3% (74.5% to 87.3%). At a rate of 21.9%, the positive predictive value was 42.0% (39.6% to 44.3%) and the negative predictive value was 85.8% (84.8% to 86.7%). This finding suggests that for every 100 unselected cases seen in primary care, there are more false positives (n=15) than either missed (n=10) or identified cases (n=10). Accuracy was improved with prospective examination over an extended period (3-12 months) rather than relying on a one-off assessment or case-note records. INTERPRETATION GPs can rule out depression in most people who are not depressed; however, the modest prevalence of depression in primary care means that misidentifications outnumber missed cases. Diagnosis could be improved by re-assessment of individuals who might have depression. FUNDING None.
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Affiliation(s)
- Alex J Mitchell
- Leicestershire Partnership Trust, Leicester General Hospital, Leicester, UK.
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Agyemang C, Addo J, Bhopal R, Aikins ADG, Stronks K. Cardiovascular disease, diabetes and established risk factors among populations of sub-Saharan African descent in Europe: a literature review. Global Health 2009; 5:7. [PMID: 19671137 PMCID: PMC2734536 DOI: 10.1186/1744-8603-5-7] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 08/11/2009] [Indexed: 11/18/2022] Open
Abstract
Background Most European countries are ethnically and culturally diverse. Globally, cardiovascular disease (CVD) is the leading cause of death. The major risk factors for CVD have been well established. This picture holds true for all regions of the world and in different ethnic groups. However, the prevalence of CVD and related risk factors vary among ethnic groups. Methods This article provides a review of current understanding of the epidemiology of vascular disease, principally coronary heart disease (CHD), stroke and related risk factors among populations of Sub-Sahara African descent (henceforth, African descent) in comparison with the European populations in Europe. Results Compared with European populations, populations of African descent have an increased risk of stroke, whereas CHD is less common. They also have higher rates of hypertension and diabetes than European populations. Obesity is highly prevalent, but smoking rate is lower among African descent women. Older people of African descent have more favourable lipid profile and dietary habits than their European counterparts. Alcohol consumption is less common among populations of African descent. The rate of physical activity differs between European countries. Dutch African-Suriname men and women are less physically active than the White-Dutch whereas British African women are more physically active than women in the general population. Literature on psychosocial stress shows inconsistent results. Conclusion Hypertension and diabetes are highly prevalent among African populations, which may explain their high rate of stroke in Europe. The relatively low rate of CHD may be explained by the low rates of other risk factors including a more favourable lipid profile and the low prevalence of smoking. The risk factors are changing, and on the whole, getting worse especially among African women. Cohort studies and clinical trials are therefore needed among these groups to determine the relative contribution of vascular risk factors, and to help guide the prevention efforts. There is a clear need for intervention studies among these populations in Europe.
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Affiliation(s)
- Charles Agyemang
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Waller G, Schmidt U, Treasure J, Emanuelli F, Alenya J, Crockett J, Murray K. Ethnic origins of patients attending specialist eating disorders services in a multiethnic urban catchment area in the United Kingdom. Int J Eat Disord 2009; 42:459-63. [PMID: 19115370 DOI: 10.1002/eat.20631] [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: 11/12/2022]
Abstract
OBJECTIVE This study considered the impact of ethnicity on the referral process for patients with eating disorders, at the levels of referral rate, diagnosis, and treatment offered. METHOD A catchment area cohort of 648 patients was referred and assessed at specialist eating disorders services in a multiethnic urban area (all boroughs in South London, UK). Each patient was diagnosed and offered treatment (or an alternative appropriate end-point to the referral), and self-identified their ethnicity. For comparison purposes, the local ethnic minority population was taken from census data. RESULTS Ethnic minority patients were substantially less likely to be referred to the services than white patients, relative to the local population. The ethnic minority group were more likely to suffer from bulimia nervosa, and less likely to be found to have no eating disorder. However, the treatments offered did not differ substantially across the ethnic groups. DISCUSSION Referrals to specialist eating disorder services do not reflect local populations' ethnic composition, though this disparity seems to be less by the time that the patient is offered treatment. It will be important to determine the source of these ethnic differences, and to take steps to reduce them.
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Affiliation(s)
- Glenn Waller
- Eating Disorders Section, Institute of Psychiatry, King's College, University of London, England.
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Bischoff A, Schneider M, Denhaerynck K, Battegay E. Health and ill health of asylum seekers in Switzerland: an epidemiological study. Eur J Public Health 2009; 19:59-64. [PMID: 19158102 DOI: 10.1093/eurpub/ckn113] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although the focus of health care for people seeking asylum in Western European countries is usually on communicable diseases, there is little data about the general health care need of this population. In this study, we investigated the actual burden of disease among asylum seekers. METHODS Data were collected from a Swiss Health Maintenance Organisation (HMO; a type of managed care organization in which physicians act as gate keepers) that was set up specifically to provide health care for asylum seekers. The data included socio-demographic characteristics, international classification of diseases (ICD-10) diagnoses and number of clinic visits. Descriptive statistics were used to assess the types of health problems and the number of clinic visits. Logistic regression analysis was used to determine whether age, gender or country or region of origin was predictive in terms of incidence of disease as diagnosed by using ICD classifications. RESULTS The total number of asylum seekers (mean age 22 years; 38% women) enrolled in the HMO from 2000 through 2003 was 979. Half of this group came from the former country of Yugoslavia. The remainder came primarily from sub-Saharan Africa, Turkey, Iraq and Sri Lanka. The most common health problems encountered in the population included musculoskeletal diseases, respiratory diseases, depression and post-traumatic stress disorder. The prevalence of all disease clusters was significantly associated with age. One-fifth of the population did not request health care at all during the time they were enrolled in the HMO. It is not known whether those who did not visit the medical clinic did not require health care or just chose not to request clinic services. CONCLUSIONS The most frequent health problems encountered in the study population were chronic medical conditions, not communicable acute diseases. Although health care services provided to asylum seekers usually focus on episodic acute care, what this group actually needs is continuity of care.
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The identification of young people's emotional distress: a study in primary care. Br J Gen Pract 2009; 59:e61-70. [PMID: 19275825 DOI: 10.3399/bjgp09x419510] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Primary care is a key step in young people's pathway to mental health care. Despite the high prevalence of mental disorder in this age group, little is known about the factors that determine the identification of young people's mental disorder in primary care. AIM To provide a detailed description of the factors associated with both 'correct' and 'excessive' identification of youth mental disorder in primary care. DESIGN OF THE STUDY Cross-sectional study. SETTING Twenty-six randomly selected general practices in Victoria, Australia. METHOD Consecutive young people (16-24 years) were interviewed before their consultation, using a semi-structured interview. They completed Kessler's scale of emotional distress (K10). GPs completed a questionnaire after the consultation. Multinomial logistic regression was used to examine the factors associated with GP identification of mental disorder in those with high and low probability of disorder on the K10. RESULTS Altogether, 450/501 (90%) of approached young people participated; 36.1% (95% confidence interval [CI] = 32.3 to 40.2%) had high probability of mental disorder on the K10. Young people's perception that they had a mental illness was highly associated with GP identification (odds ratio [OR] = 62.6, 95% CI = 22.8 to 172.0). Other significantly associated factors were: patient fears (OR = 2.4, 95% CI = 1.1 to 5.1), frequent consultations (OR = 3.0, 95% CI = 1.0 to 8.4), days out of role (OR = 2.7, 95% CI = 1.2 to 5.7), and continuity of care (OR = 3.4, 95% CI = 1.6 to 6.9). The latter two were also associated with 'over-identification' of young people who had low probability of mental disorder. GP characteristics were not associated with identification. CONCLUSION These findings provide guidance for GPs in their clinical work and training. They should also inform the further development of mental health literacy programmes in the community.
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Perceived need for mental health care among non-western labour migrants. Soc Psychiatry Psychiatr Epidemiol 2009; 44:208-16. [PMID: 18787746 DOI: 10.1007/s00127-008-0418-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 07/04/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is a supposed higher prevalence of common mental disorders among many migrant groups. At the same time, problems are reported regarding underutilisation of mental health services by migrants. Since perceived need for care is a powerful predictor of actual care utilisation, we aimed to study the hypothesis that, given the same level of mental morbidity, non-Western migrants would perceive less need for mental health care than ethnic Dutch residents. Additionally, we studied the extent to which needs are met in both groups, as well as several possible barriers to care. METHODS A cross-sectional study with data from the 2004/2005 Amsterdam Health Monitor. Data were complete from 626 ethnic Dutch and non-Western (Turkish and Moroccan) labour migrants. Respondents participated in a structured interview in their own language, which included the perceived need for care questionnaire (PNCQ) and the composite international diagnostic interview (CIDI) version 2.1 for anxiety and depressive disorders. RESULTS Perceived need was much higher among Turkish migrants. Among Moroccans the perceived need was comparable to ethnic Dutch. Turkish migrants also reported that needs were met less often than ethnic Dutch. Differences were explained by a higher prevalence of common mental disorders and higher symptom levels among Turkish. When differences in mental morbidity were taken into account, Moroccans perceived less need for information, drugs, referral to specialised mental health care, or for counselling. The most important barrier to care in all ethnic groups was the preference to solve the problem on one's own. CONCLUSION In case of similar mental morbidity, perceived need for care was lower than among ethnic Dutch. The results did not support the hypothesis that in case of similar mental distress, needs of migrants were less often met than needs of ethnic Dutch.
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Haddad M, Walters P, Tylee A. District nursing staff and depression: A psychometric evaluation of Depression Attitude Questionnaire findings. Int J Nurs Stud 2007; 44:447-56. [PMID: 16979641 DOI: 10.1016/j.ijnurstu.2006.07.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 06/22/2006] [Accepted: 07/13/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Mental health problems such as depression are common in primary care settings and patients with chronic medical problems are at an increased risk. This co-morbidity suggests that district nursing services are particularly likely to encounter psychological problems in their patients. Mental health problems are poorly recognised and inadequately treated in primary care. In part this may be due to stigmatising views of mental illness, which negatively influence help-seeking and user experiences. Likewise providers' attitudes are likely to play a significant part in the management of such problems. OBJECTIVES The aims of this study were extend knowledge of district nursing staff attitudes to depression and explore the psychometric properties of a depression attitude measure used with this staff group. DESIGN AND SETTINGS The Depression Attitude Questionnaire (DAQ) was used within a postal questionnaire survey of district nursing services in three areas, Jersey (Channel Islands), Lewisham, and Hertfordshire. PARTICIPANTS All staff (community nurses, district nurses and home care staff) were contacted; 217 (66%) staff responded to the survey, and 189 (57%) completed the DAQ. RESULTS Three factors were derived from the DAQ accounting for 47% of the variance. The factor solution appeared stable and provided meaningful dimensions, however the internal consistency of the measure and of its derived subscales was low (Cronbach's alpha between 0.59 and 0.64). The factors were labelled pessimism about depression and its treatment, tendency to defer to specialists, and professional ease in working with depressed patients. Staff responses revealed generally optimistic views concerning depression treatment, strongly rejecting deterministic attitudes to this condition. CONCLUSIONS The DAQ has been widely employed to measure and compare attitudes of staff from various disciplines and specialisms. The current evaluation has provided a more detailed examination of its psychometric properties than previously available, but low internal consistency levels indicate further examination of this area is warranted.
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Affiliation(s)
- Mark Haddad
- Section of Psychiatric Nursing, King's College London, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, UK.
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Hegel MT, Oxman TE, Hull JG, Swain K, Swick H. Watchful waiting for minor depression in primary care: remission rates and predictors of improvement. Gen Hosp Psychiatry 2006; 28:205-12. [PMID: 16675363 DOI: 10.1016/j.genhosppsych.2006.02.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Revised: 02/22/2006] [Accepted: 02/22/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The objectives of this study were to determine remission rates and predictors of improvement for minor depression following a 1-month watchful waiting period in primary care and to describe the watchful waiting processes. METHODS Prior to randomization into a clinical trial for minor depression, 111 participants were entered into a 1-month watchful waiting period. Depression severity and predictors of improvement were measured at the start of watchful waiting. At the end of watchful waiting, remission rates were calculated and predictor variables were analyzed for their contribution toward predicting improvement. RESULTS Remission rates were low, ranging from 9% to 13%, depending on the measure. Avoidant coping style and frequency of engaging in active pleasant events at baseline accounted for the majority of change in depression. During watchful waiting, about one fifth of the sample (21%) had at least one contact with their physician and 27% reported using self-initiated treatments. CONCLUSIONS There is a low likelihood of spontaneous remission for treatment-seeking samples with minor depression in primary care. An avoidant coping style seriously interferes with remission, and engaging in regular active pleasant events confers an advantage. Feasible interventions for primary care that promote activity and decrease avoidant coping styles may improve outcomes. These findings may not generalize to community and non-treatment-seeking samples.
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Affiliation(s)
- Mark T Hegel
- Department of Psychiatry, Dartmouth Medical School, Hanover, NH 03755, USA.
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Verhaak PFM, Schellevis FG, Nuijen J, Volkers AC. Patients with a psychiatric disorder in general practice: determinants of general practitioners' psychological diagnosis. Gen Hosp Psychiatry 2006; 28:125-32. [PMID: 16516062 DOI: 10.1016/j.genhosppsych.2005.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Revised: 10/30/2005] [Accepted: 11/09/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although psychiatric disorders are highly prevalent in the community, many patients with a psychiatric morbidity remain unidentified as such in primary care. OBJECTIVE The aim of this study was to analyze which clinical and sociodemographic characteristics of patients with psychiatric morbidity are related to general practitioners' (GPs) diagnosis of mental illness. METHODS A 1-year naturalistic survey of primary care contacts of patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnosis of affective disorder, anxiety disorder or alcohol abuse was carried out. RESULTS Of the patients with a DSM-IV diagnosis, 10% did not visit their GP at all during 1 year, 40% visited their GP but were only diagnosed as having somatic diagnoses and 50% were given a psychological or social diagnosis at least once during 1 year. Affective disorders are more frequently diagnosed than anxiety disorders or alcohol abuse. The chances of psychological GP diagnosis increase with the number of GP contacts. CONCLUSIONS GPs appear to have few indications to help them distinguish patients with a psychiatric morbidity from others, as long as the patients themselves do not express more explicit clues to their condition. Public mental health education and a better public relations policy are badly needed.
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Affiliation(s)
- Peter F M Verhaak
- Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands.
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Brown JSL, Boardman J, Elliott SA, Howay E, Morrison J. Are self-referrers just the worried well?--A cross-sectional study of self-referrers to community psycho-educational Stress and Self-Confidence workshops. Soc Psychiatry Psychiatr Epidemiol 2005; 40:396-401. [PMID: 15902410 DOI: 10.1007/s00127-005-0896-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2004] [Indexed: 12/12/2022]
Abstract
BACKGROUND Reluctance to seek formal help has been seen as a major problem in trying to reduce the prevalence of anxiety and depression. AIMS The aims of this study were to assess the psychiatric status of those self-referring to psycho-educational Stress and Self-Confidence community workshops using a cognitive behavioural therapy (CBT) approach. METHOD Cross-sectional analysis of 196 people who referred themselves to community workshops was carried out using the Clinical Interview Schedule (CIS-R) psychiatric interview and the Beck Depression Inventory (BDI) and Spielberger Trait Anxiety Inventory (STAI-T) scale self-report assessments. RESULTS Over 70% of all self-referrers had an ICD-10 diagnosis. Those without diagnoses had experienced recurrent significant psychological problems and 29.7% had never consulted their General Practitioner (GP) for anxiety/depression problems. Total CIS-R scores and white ethnic group best predicted previous GP consultation. CONCLUSION Setting up a self-referral system can enable those with diagnosable psychiatric problems, who may otherwise be reluctant to seek help, to come forward. This may have significant public mental health implications.
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Affiliation(s)
- June S L Brown
- Psychology Dept. (PO77), Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
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