130 research outputs found
Depression in primary care patients with coronary heart disease: baseline findings from the UPBEAT UK study
No full textBACKGROUND:\ud
An association between depression and coronary heart disease is now accepted but there has been little primary care research on this topic. The UPBEAT-UK studies are centred on a cohort of primary patients with coronary heart disease assessed every six months for up to four years. The aim of this research was to determine the prevalence and associations of depression in this cohort at baseline.\ud
METHOD:\ud
Participants with coronary heart disease were recruited from general practice registers and assessed for cardiac symptoms, depression, quality of life and social problems.\ud
RESULTS:\ud
803 people participated. 42% had a documented history of myocardial infarction, 54% a diagnosis of ischaemic heart disease or angina. 44% still experienced chest pain. 7% had an ICD-10 defined depressive disorder. Factors independently associated with this diagnosis were problems living alone (OR 5.49, 95% CI 2.11-13.30), problems carrying out usual activities (OR 3.71, 95% CI 1.93-7.14), experiencing chest pain (OR 3.27, 95% CI 1.58-6.76), other pains or discomfort (OR 3.39, 95% CI 1.42-8.10), younger age (OR 0.95 per year 95% CI 0.92-0.98).\ud
CONCLUSION:\ud
Problems living alone, chest pain and disability are important predictors of depression in this population
'Antidepressants unlimited'. Are antidepressants the best option for treating depression in general practice? Debating session WONCA 2004
No full textAntidepressants are among the worlds' most prescribed drugs. However, there are several controversies around their extensive use in primary care, and doubts about their effects, especially in children and older people. Psychological interventions are probably at least as effective as antidepressants, and are preferred by many patients. These issues were discussed at the debating sessions at WONCA 2004 in Amsterdam
Better Outcomes in Mental Health Care?
No full textAims The Australian Better Outcomes in Mental Health Care (BOiMHC) initiative strives to achieve better outcomes for people with mental health problems by providing general practitioners (GPs) with training, incentives for delivering structured, quality care, and access to specialists. The initiative has five components, including the Access to Allied Health Services component, which enables GPs to refer consumers to allied health professionals for psychological interventions, via 102 projects conducted through divisions of general practice. In order to assess whether the BOiMHC initiative is in fact achieving better outcomes, outcomes must be measured systematically. This paper explores the current nature and extent of outcome measurement in the Access to Allied Health Services projects. Methods A brief survey elicited information from divisions on the current and intended use of outcome measures in these projects. Results Responses were received from 92 projects (90%). Eighty of these (87%) currently use or intend to use an outcome measure, with the most common being the Kessler 10 (78%) and the Depression Anxiety Stress Scales (25%). GPs are involved in administering these measures at assessment and review, although there is a greater reliance on allied health professionals at review. There is considerable potential for aggregating outcome data nationally: in 78% of projects, outcome data are being provided to the division; in 71% outcome data can be linked to an individual consumer (through a unique identifier); and in 80% there is commitment to submitting outcome data to a purpose-designed dataset. Conclusions Outcome measurement provides a common metric against which to assess the effectiveness (and cost-effectiveness) of projects in terms of impacts for consumers. The time is ripe to introduce routine collation of outcome measures data into these projects, in order to showcase their achievements and provide lessons about their limitations. Implications for others implementing outcome measurement as part of primary mental healthcare reforms are discussed
The development and psychometric properties of a measure of clinicians’ attitudes to depression: the revised Depression Attitude Questionnaire (R-DAQ)
No full textBackground: Depression is a common mental disorder associated with substantial disability. It is inadequately recognised and managed, and clinicians’ attitudes to this condition and its treatment may play a part in this. Most research in this area has used the Depression Attitude Questionnaire (DAQ), but analyses have shown this measure to exhibit problems in psychometric properties and suitability for the health professionals and settings where depression recognition may occur.
Methods: We revised the DAQ using a pooled review of findings from studies using this measure, together with a Delphi study which sought the opinions of a panel of relevant experts based in the UK, USA, Australia, and European countries (n = 24) using 3 rounds of questioning to consider attitude dimensions, content, and item wording. After item generation, revision and consensus (agreement >70%) using the Delphi panel, the revised DAQ (R-DAQ) was tested with 1193 health care providers to determine its psychometric properties. Finally the test-retest reliability of the R-DAQ was examined with 38 participants.
Results: The 22-item R-DAQ scale showed good internal consistency: Cronbach’s alpha coefficient was 0.84; and satisfactory test-retest reliability: intraclass correlation coefficient was 0.62 (95% C.I. 0.37 to 0.78). Exploratory factor analysis favoured a three-factor structure (professional confidence, therapeutic optimism/pessimism, and a generalist perspective), which accounted for 45.3% of the variance.
Conclusions: The R-DAQ provides a revised tool for examining clinicians’ views and understanding of depression. It addresses important weaknesses in the original measure whilst retaining items and dimensions that appeared valid. This revised scale is likely to be useful in examining attitudes across the health professional workforce and beyond the confines of the UK, and may be valuable for the purpose of evaluating training that aims to address clinicians’ attitudes to depression. It incorporates key dimensions of attitudes with a modest number of items making it applicable to use in busy clinical settings
The UPBEAT nurse-delivered personalized care intervention for people with coronary heart disease who report current chest pain and depression: a randomised controlled pilot study
No full textBackground: Depression is common in people with coronary heart disease (CHD) and associated with worse outcome. This study explored the acceptability and feasibility of procedures for a trial and for an intervention, including its potential costs, to inform a definitive randomized controlled trial (RCT) of a nurse-led personalised care intervention for primary care CHD patients with current chest pain and probable depression.
Methods: Multi-centre, outcome assessor-blinded, randomized parallel group study. CHD patients reporting chest pain and scoring 8 or more on the HADS were randomized to personalized care (PC) or treatment as usual (TAU) for 6 months and followed for 1 year. Primary outcome was acceptability and feasibility of procedures; secondary outcomes included mood, chest pain, functional status, well being and psychological process variables.
Result: 1001 people from 17 General Practice CHD registers in South London consented to be contacted; out of 126 who were potentially eligible, 81 (35% female, mean age = 65 SD11 years) were randomized. PC participants (n = 41) identified wide ranging problems to work on with nurse-case managers. Good acceptability and feasibility was indicated by low attrition (9%), high engagement and minimal nurse time used (mean/SD = 78/19 mins assessment, 125/91 mins telephone follow up). Both groups improved on all outcomes. The largest between group difference was in the proportion no longer reporting chest pain (PC 37% vs TAU 18%; mixed effects model OR 2.21 95% CI 0.69, 7.03). Some evidence was seen that self efficacy (mean scale increase of 2.5 vs 0.9) and illness perceptions (mean scale increase of 7.8 vs 2.5) had improved in PC vs TAU participants at 1 year. PC appeared to be more cost effective up to a QALY threshold of approximately £3,000.
Conclusions: Trial and intervention procedures appeared to be feasible and acceptable. PC allowed patients to work on unaddressed problems and appears cheaper than TAU
Improve access to quality primary care for patients with anxiety or depression – Authors' reply
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