Journal articles
Wilkinson B, Trick L, Knight A, Valton V, Goodhand J, Kennedy N, Heerasing N, Ahmad T, Bland A, Elliott R, et al (In Press). Factors associated with depression in people with inflammatory bowel disease: the relationship between active disease and biases in neurocognitive processing. Neuogastroenterology & Motility
Moore D, Nunns M, Shaw L, Rogers M, Walker E, Ford T, Garside R, Ukoumunne O, Titman P, Shafran R, et al (In Press). Interventions to improve the mental health of children and young people with long-term physical conditions: Linked evidence syntheses. Health Technology Assessment
Trick LV, Watkins E, Henley W, Gandhi M, Dickens CM (In Press). Perservative negative thinking predicts depression in people with acute coronary syndrome. General Hospital Psychiatry
Jabakhanji SB, Sorensen J, Carney RM, Dickens C, Dempster M, Gallagher J, Caramlau I, Doyle F (2022). Depression interventions for individuals with coronary artery disease – Cost-effectiveness calculations from an Irish perspective.
Journal of Psychosomatic Research,
155Abstract:
Depression interventions for individuals with coronary artery disease – Cost-effectiveness calculations from an Irish perspective
Background: a substantial proportion of individuals with coronary artery disease experience moderate or severe acute depression that requires treatment. We assessed the cost-effectiveness of four interventions for depression in individuals with coronary artery disease. Methods: We assessed effectiveness of pharmacotherapy, psychotherapy, collaborative care and exercise as remission rate after 8 and 26 weeks using estimates from a recent network meta-analysis. The cost assessment included standard doses of antidepressants, contact frequency, and staff time per contact. Unit costs were calculated as health services' purchase price for pharmaceuticals and mid-point staff salaries obtained from the Irish Health Service Executive and validated by clinical staff. Incremental cost-effectiveness ratios were calculated as the incremental costs over incremental remissions compared to usual care. High- and low-cost scenarios and sensitivity analysis were performed with changed contact frequencies, and assuming individual vs. group psychotherapy or exercise. Results: After 8 weeks, the estimated incremental cost-effectiveness ratio was lowest for group exercise (€526 per remission), followed by pharmacotherapy (€589), individual psychotherapy (€3117) and collaborative care (€4964). After 26 weeks, pharmacotherapy was more cost-effective (€591) than collaborative care (€7203) and individual psychotherapy (€9387); no 26-week assessment for exercise was possible. Sensitivity analysis showed that group psychotherapy could be most cost-effective after 8 weeks (€519) and cost-effective after 26 weeks (€1565); however no group psychotherapy trials were available investigating its effectiveness. Discussion: Large variation in incremental cost-effectiveness ratios was seen. With the current assumptions, the most cost-effective depression intervention for individuals with coronary artery disease after 8 weeks was group exercise.
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Grigoroglou C, van der Feltz-Cornelis C, Hodkinson A, Coventry PA, Zghebi SS, Kontopantelis E, Bower P, Lovell K, Gilbody S, Waheed W, et al (2021). Effectiveness of collaborative care in reducing suicidal ideation: an individual participant data meta-analysis.
Gen Hosp Psychiatry,
71, 27-35.
Abstract:
Effectiveness of collaborative care in reducing suicidal ideation: an individual participant data meta-analysis.
UNLABELLED: to assess whether CC is more effective at reducing suicidal ideation in people with depression compared with usual care, and whether study and patient factors moderate treatment effects. METHOD: We searched Medline, Embase, PubMed, PsycINFO, CINAHL, CENTRAL from inception to March 2020 for Randomised Controlled Trials (RCTs) that compared the effectiveness of CC with usual care in depressed adults, and reported changes in suicidal ideation at 4 to 6 months post-randomisation. Mixed-effects models accounted for clustering of participants within trials and heterogeneity across trials. This study is registered with PROSPERO, CRD42020201747. RESULTS: We extracted data from 28 RCTs (11,165 patients) of 83 eligible studies. We observed a small significant clinical improvement of CC on suicidal ideation, compared with usual care (SMD, -0.11 [95%CI, -0.15 to -0.08]; I2, 0·47% [95%CI 0.04% to 4.90%]). CC interventions with a recognised psychological treatment were associated with small reductions in suicidal ideation (SMD, -0.15 [95%CI -0.19 to -0.11]). CC was more effective for reducing suicidal ideation among patients aged over 65 years (SMD, - 0.18 [95%CI -0.25 to -0.11]). CONCLUSION: Primary care based CC with an embedded psychological intervention is the most effective CC framework for reducing suicidal ideation and older patients may benefit the most.
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Doyle F, Freedland KE, Carney RM, de Jonge P, Dickens C, Pedersen SS, Sorensen J, Dempster M (2021). Hybrid Systematic Review and Network Meta-Analysis of Randomized Controlled Trials of Interventions for Depressive Symptoms in Patients with Coronary Artery Disease.
Psychosom Med,
83(5), 423-431.
Abstract:
Hybrid Systematic Review and Network Meta-Analysis of Randomized Controlled Trials of Interventions for Depressive Symptoms in Patients with Coronary Artery Disease.
OBJECTIVE: Depression is common in patients with coronary artery disease (CAD) and is associated with poor outcomes. Although different treatments are available, it is unclear which are best or most acceptable to patients, so we conducted a network meta-analysis of evidence from randomized controlled trials (RCTs) of different depression treatments to ascertain relative efficacy. METHODS: We searched for systematic reviews of RCTs of depression treatments in CAD and updated these with a comprehensive search for recent individual RCTs. RCTs comparing depression treatments (pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) were included. Primary outcomes were acceptability (dropout rate) and change in depressive symptoms 8 week after treatment commencement. Change in 26-week depression and mortality were secondary outcomes. Frequentist, random-effects network meta-analysis was used to synthesize the evidence, and evidence quality was evaluated following Grading of Recommendations, Assessment, Development and Evaluations recommendations. RESULTS: Thirty-three RCTs (7240 participants) provided analyzable data. All treatments were equally acceptable. At 8 weeks, combination therapy (1 study), exercise (1 study), and antidepressants (10 studies) yielded the strongest effects versus comparators. At 26 weeks, antidepressants were consistently effective, but psychotherapy was only effective versus usual care. There were no differences in treatment groups for mortality. Grading of Recommendations, Assessment, Development and Evaluations ratings ranged from very low to low. CONCLUSIONS: Overall, the evidence was limited and biased. Although all treatments for post-CAD depression were equally acceptable, antidepressants have the most robust evidence base and should be the first-line treatment. Combinations of antidepressants and psychotherapy, along with exercise, could be more effective than antidepressants alone but require further rigorous, multiarm intervention trials.Systematic Review Registration: CRD42018108293 (International Prospective Register of Systematic Reviews).
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Parker D, Byng R, Dickens C, McCabe R (2020). "Every structure we're taught goes out the window": General practitioners' experiences of providing help for patients with emotional concerns'.
Health Soc Care Community,
28(1), 260-269.
Abstract:
"Every structure we're taught goes out the window": General practitioners' experiences of providing help for patients with emotional concerns'.
Up to 40% of general practitioners (GP) consultations contain an emotional component. General practitioners (GPs) have to provide care with limited time and resources. This qualitative study aimed to explore how GPs care for patients experiencing emotional concerns within the constraints of busy clinical practice. Seven GPs participated in three focus groups. Groups were recorded, transcribed and analysed thematically. Three themes were identified. (a) Collaboratively negotiated diagnosis: How patients' emotional concerns are understood and managed is the result of a negotiation between patient and GP belief models and the availability of treatments including talking therapy. (b) Doctor as drug: Not only is a continuous relationship between GPs and patients therapeutic in its own right, it is also necessary to effectively diagnose and engage patients in treatment as patients may experience stigma regarding emotional concerns. (c) Personal responsibility and institutional pressure: GPs feel personally responsible for supporting patients through their care journey, however, they face barriers due to lack of time and pressure from guidelines. GPs are forced to prioritise high-risk patients and experience an emotional toll. In conclusion, guidelines focus on diagnosis and a stepped-care model, however, this assumes diagnosis is relatively straightforward. GPs and patients have different models of psychological distress. This and the experience of stigma mean that establishing rapport is an important step before the GP and patient negotiate openly and develop a shared understanding of the problem. This takes time and emotional resources to do well. Longer consultations, continuity of care and formal supervision for GPs could enable them to better support patients.
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Parker D, Byng R, Dickens C, Kinsey D, McCabe R (2020). Barriers and facilitators to GP-patient communication about emotional concerns in UK primary care: a systematic review.
Fam Pract,
37(4), 434-444.
Abstract:
Barriers and facilitators to GP-patient communication about emotional concerns in UK primary care: a systematic review.
BACKGROUND: in the UK, general practitioners (GPs) are the most commonly used providers of care for emotional concerns. OBJECTIVE: to update and synthesize literature on barriers and facilitators to GP-patient communication about emotional concerns in UK primary care. DESIGN: Systematic review and qualitative synthesis. METHOD: We conducted a systematic search on MEDLINE (OvidSP), PsycInfo and EMBASE, supplemented by citation chasing. Eligible papers focused on how GPs and adult patients in the UK communicated about emotional concerns. Results were synthesized using thematic analysis. RESULTS: Across 30 studies involving 342 GPs and 720 patients, four themes relating to barriers were: (i) emotional concerns are difficult to disclose; (ii) tension between understanding emotional concerns as a medical condition or arising from social stressors; (iii) unspoken assumptions about agency resulting in too little or too much involvement in decisions and (iv) providing limited care driven by little time. Three facilitative themes were: (v) a human connection improves identification of emotional concerns and is therapeutic; (vi) exploring, explaining and negotiating a shared understanding or guiding patients towards new understandings and (vii) upfront information provision and involvement manages expectations about recovery and improves engagement in treatment. CONCLUSION: the findings suggest that treatment guidelines should acknowledge: the therapeutic value of a positive GP-patient relationship; that diagnosis is a two-way negotiated process rather than an activity strictly in the doctor's domain of expertise; and the value of exploring and shaping new understandings about patients' emotional concerns and their management.
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Rifkin-Zybutz R, MacNeill S, Davies SJ, Dickens C, Campbell J, Anderson IM, Chew-Graham CA, Peters TJ, Lewis G, Wiles N, et al (2020). Does anxiety moderate the effectiveness of mirtazapine in patients with treatment-resistant depression? a secondary analysis of the MIR trial.
J Psychopharmacol,
34(12), 1342-1349.
Abstract:
Does anxiety moderate the effectiveness of mirtazapine in patients with treatment-resistant depression? a secondary analysis of the MIR trial.
BACKGROUND: There is a lack of evidence to guide treatment of comorbid depression and anxiety. Preliminary evidence suggests mirtazapine may be effective in treating patients with both depression and anxiety symptoms. METHODS: We undertook a secondary analysis of mirtazapine (MIR): a placebo-controlled trial of the addition of mirtazapine to a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor in treatment-resistant depression (TRD) in primary care. We subdivided participants into three groups by baseline generalized anxiety disorder score (GAD-7): severe (GAD-7 ⩾ 16), moderate (GAD-7 = 11-15), no/mild (GAD-7 ⩽ 10). We used linear regression including likelihood-ratio testing of interaction terms to assess how baseline anxiety altered the response of participants to mirtazapine as measured by 12-week GAD-7 and Beck Depression Inventory II (BDI-II) scores. RESULTS: Baseline generalized anxiety moderated mirtazapine's effect as measured by GAD-7 (p = 0.041) and BDI-II (p = 0.088) at 12 weeks. Participants with severe generalized anxiety receiving mirtazapine had lower 12-week GAD-7 score (adjusted difference between means (ADM) -2.82, 95% confidence interval (CI) -0.69 to -4.95) and larger decreases in BDI-II score (ADM -6.36, 95% CI -1.60 to -10.84) than placebo. Conversely, there was no anxiolytic benefit (ADM 0.28, 95% CI -1.05 to 1.60) or antidepressant benefit (ADM -0.17, 95% CI -3.02 to 2.68) compared with placebo in those with no/mild generalized anxiety. CONCLUSIONS: These findings extend the evidence for the effectiveness of mirtazapine to reduce generalized anxiety in TRD in primary care. These results may inform targeted prescribing in depression based on concurrent anxiety symptoms, although these conclusions are constrained by the post-hoc nature of this analysis.
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Davis KAS, Coleman JRI, Adams M, Allen N, Breen G, Cullen B, Dickens C, Fox E, Graham N, Holliday J, et al (2020). Mental health in UK Biobank - development, implementation and results from an online questionnaire completed by 157 366 participants: a reanalysis.
BJPSYCH OPEN,
6(2).
Author URL.
Parker D, Byng R, Dickens C, McCabe R (2020). Patients' experiences of seeking help for emotional concerns in primary care: doctor as drug, detective and collaborator.
BMC Fam Pract,
21(1).
Abstract:
Patients' experiences of seeking help for emotional concerns in primary care: doctor as drug, detective and collaborator.
BACKGROUND: NICE guidelines for the management of emotional concerns in primary care emphasise the importance of communication and a trusting relationship, which is difficult to operationalise in practice. Current pressures in the NHS mean that it is important to understand care from a patient perspective. This study aimed to explore patients' experiences of primary care consultations for emotional concerns and what patients valued when seeking care from their GP. METHODS: Eighteen adults with experience of consulting a GP for emotional concerns participated in 4 focus groups. Data were analysed thematically. RESULTS: (1) Doctor as Drug: Patients' relationship with their GP was considered therapeutic with continuity particularly valued. (2) Doctor as Detective and Validator: Patients were often puzzled by their symptoms, not recognising their emotional concerns. GPs needed to play the role of detective by exploring not just symptoms, but the person and their life circumstances. GPs were crucial in helping patients understand and validate their emotional concerns. (3) Doctor as Collaborator: Patients prefer a collaborative partnership, but often need to relinquish involvement because they are too unwell, or take a more active role because they feel GPs are ill-equipped or under too much pressure to help. Patients valued: GPs booking their follow up appointments; acknowledgement of stressful life circumstances; not relying solely on medication. CONCLUSIONS: Seeking help for emotional concerns is challenging due to stigma and unfamiliar symptoms. GPs can support disclosure and understanding of emotional concerns by fully exploring and validating patients' concerns, taking into account patients' life contexts. This process of exploration and validation forms the foundation of a curative, trusting GP-patient relationship. A trusting relationship, with an emphasis on empathy and understanding, can make patients more able to share involvement in their care with GPs. This process is cyclical, as patients feel that their GP is caring, interested, and treating them as a person, further strengthening their relationship. NICE guidance should acknowledge the importance of empathy and validation when building an effective GP-patient partnership, and the role this has in supporting patients' involvement in their care.
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Moriarty AS, Coventry PA, Hudson JL, Cook N, Fenton OJ, Bower P, Lovell K, Archer J, Clarke R, Richards DA, et al (2020). The role of relapse prevention for depression in collaborative care: a systematic review.
J Affect Disord,
265, 618-644.
Abstract:
The role of relapse prevention for depression in collaborative care: a systematic review.
BACKGROUND: Relapse (the re-emergence of depression symptoms before full recovery) is common in depression and relapse prevention strategies are not well researched in primary care settings. Collaborative care is effective for treating acute phase depression but little is known about the use of relapse prevention strategies in collaborative care. We undertook a systematic review to identify and characterise relapse prevention strategies in the context of collaborative care. METHODS: We searched for Randomised Controlled Trials (RCTs) of collaborative care for depression. In addition to published material, we obtained provider and patient manuals from authors to provide more detail on intervention content. We reported the extent to which collaborative care interventions addressed four relapse prevention components. RESULTS: 93 RCTs were identified. 31 included a formal relapse prevention plan; 42 had proactive monitoring and follow-up after the acute phase; 39 reported strategies for optimising sustained medication adherence; and 20 of the trials reported psychological or psycho-educational treatments persisting beyond the acute phase or focussing on long-term health/relapse prevention. 30 (32.3%) did not report relapse prevention approaches. LIMITATIONS: We did not receive trial materials for approximately half of the trials, which limited our ability to identify relevant features of intervention content. CONCLUSION: Relapse is a significant risk amongst people treated for depression and interventions are needed that specifically address and minimise this risk. Given the advantages of collaborative care as a delivery system for depression care, there is scope for more consistency and increased effort to implement and evaluate relapse prevention strategies.
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Blakemore A, Dickens CM, Chew-Graham CA, Afzal CW, Tomenson B, Coventry PA, Guthrie E (2019). Depression predicts emergency care use in people with chronic obstructive pulmonary disease: a large cohort study in primary care. International Journal of Chronic Obstructive Pulmonary Disease
Shaw L, Moore D, Nunns M, Thompson Coon J, Ford T, Berry V, Walker E, Heyman I, Dickens C, Bennett S, et al (2019). Experiences of interventions aiming to improve the mental health and well-being of children and young people with a long-term physical condition: a systematic review and meta-ethnography.
Child Care Health Dev,
45(6), 832-849.
Abstract:
Experiences of interventions aiming to improve the mental health and well-being of children and young people with a long-term physical condition: a systematic review and meta-ethnography.
BACKGROUND: Children and young people with long-term physical health conditions are at increased risk of experiencing mental health and well-being difficulties. However, there is a lack of research that explores the experiences of and attitudes towards interventions aiming to improve their mental health and well-being. This systematic review seeks to address this gap in the literature by exploring what children and young people with long-term conditions, their caregivers, and health practitioners perceive to be important aspects of interventions aiming to improve their mental health and well-being. METHODS: an information specialist searched five academic databases using predefined criteria for qualitative evaluations of interventions aiming to improve the mental health or well-being of children with long-term physical conditions. Reviewers also performed supplementary citation and grey literature searches. Two reviewers independently screened titles, abstracts, and full texts that met the inclusion criteria and conducted data extraction and quality assessment. Meta-ethnography was used to synthesize the findings. RESULTS: Screening identified 60 relevant articles. We identified five overarching constructs through the synthesis: (a) Getting in and Staying In, (b) Therapeutic Foundation, (c) Social Support, (d) a Hopeful Alternative, and (e) Empowerment. The line of argument that links these constructs together indicates that when interventions can provide an environment that allows young people to share their experiences and build empathetic relationships, it can enable participants to access social support and increase feelings of hope and empowerment. CONCLUSION: These findings may provide a framework to inform the development of mental health interventions for this population and evaluate existing interventions that already include some of the components or processes identified by this research. Further research is needed to establish which of the constructs identified by the line of argument are most effective in improving the mental well-being of young people living with long-term conditions.
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Hudson JL, Bower P, Kontopantelis E, Bee P, Archer J, Clarke R, Moriarty AS, Richards DA, Gilbody S, Lovell K, et al (2019). Impact of telephone delivered case-management on the effectiveness of collaborative care for depression and anti-depressant use: a systematic review and meta-regression.
PLoS One,
14(6).
Abstract:
Impact of telephone delivered case-management on the effectiveness of collaborative care for depression and anti-depressant use: a systematic review and meta-regression.
BACKGROUND: the health service delivery framework collaborative care is an effective intervention for depression. However, uncertainties remain about how to optimise its delivery at scale. Structured case management is a core component of collaborative care; its delivery via the telephone may improve access. AIMS: to examine using meta-regression if telephone delivered case management diminishes the clinical effectiveness of collaborative care on depressive symptoms and anti-depressant use relative to face-to-face delivery methods. METHODS: Randomised controlled trials were eligible if they included collaborative care interventions for adults with depression identified using self-report measures or diagnostic interviews and reported depression outcomes. Sociodemographics, intervention characteristics, depressive symptoms, and anti-depressant use were extracted. Random effects univariable and multivariable meta-regression analyses were used to examine the moderating effect of telephone delivered case-management on outcomes. RESULTS: Ninety-four trials were identified comprising of 103 comparisons across 24, 132 participants with depression outcomes and 67 comparisons from 15,367 participants with anti-depressant use outcomes. Telephone delivered case management did not diminish the effects of collaborative care on depressive symptoms (β = -0.01, 95% CI -0.12 to 0.10; p = 0.86). Telephone delivered case management decreased anti-depressant medication use (relative risk 0.76, 95% CI 0.63 to 0.92; p = 0.005); this effect remained when assessed simultaneously alongside other study-level moderators of collaborative care. CONCLUSION: Using remote platforms such as the telephone to deliver case management may be a feasible way to implement collaborative care with no loss of effectiveness on depressive symptoms. However, adherence to anti-depressant medication may decrease when telephone case management is used.
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Doyle F, Freedland K, Carney R, De Jonge P, Dickens C, Pedersen S, Sorensen J, Dempster M (2019). Network meta-analysis of randomised trials of pharmacological, psychotherapeutic, exercise and collaborative care interventions for depressive symptoms in patients with coronary artery disease: Hybrid systematic review of systematic reviews protocol.
Systematic Reviews,
8(1).
Abstract:
Network meta-analysis of randomised trials of pharmacological, psychotherapeutic, exercise and collaborative care interventions for depressive symptoms in patients with coronary artery disease: Hybrid systematic review of systematic reviews protocol
Background: Depression is common in patients with coronary artery disease (CAD) and is associated with poorer outcomes and higher costs. Several randomised controlled trials (RCTs) targeting depression, of various modalities (including pharmacological, psychotherapeutic and other approaches), have been conducted and summarised in pairwise meta-analytic reviews. However, no study has considered the cumulative evidence within a network, which can provide valuable indirect comparisons and information about the relative efficacy of interventions. Therefore, we will adopt a review of review methodology to develop a network meta-analysis (NMA) of depression interventions for depression in CAD. Methods: We will search relevant databases from inception for systematic reviews of RCTs of depression treatments for people with CAD, supplementing this with comprehensive searches for recent or ongoing studies. We will extract data from and summarise characteristics of individual RCTs, including participants, study characteristics, outcome measures and adverse events. Cochrane risk of bias ratings will also be extracted or if not present will be conducted by the authors. RCTs that compare depression treatments (grouped as pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) to placebo, usual care, waitlist control or attention controls, or directly in head-to-head comparisons, will be included. Primary outcomes will be the change in depressive symptoms (summarised with a standardised mean difference) and treatment acceptability (treatment discontinuation: % of people who withdrew). Secondary outcomes will include change in 6-month depression outcomes, health-related quality of life (HRQoL), mortality, cardiovascular morbidity, health services use and adverse events. Secondary analyses will form further networks with individual anti-depressants and psychotherapies. We will use frequentist, random effects multivariate network meta-analysis to synthesise the evidence for depression intervention and to achieve a ranking of treatments, using Stata. Rankograms and surface under the cumulative ranking curves will be used for treatment ranking. Local and global methods will evaluate consistency. GRADE will be used to assess evidence quality for primary outcomes. Discussion: the present review will address uncertainties about the evidence in terms of depression management in CAD and may allow for a ranking of treatments, including providing important information for future research efforts.
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Davis KAS, Coleman JRI, Adams M, Allen N, Breen G, Cullen B, Dickens C, Fox E, Graham N, Holliday J, et al (2019). Retraction: Mental health in UK Biobank: Development, implementation and results from an online questionnaire completed by 157 366 participants (BJPsych Open 4:3 (83-90) DOI: 10.1192/bjo.2018.12).
BJPsych Open,
5(4).
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Retraction: Mental health in UK Biobank: Development, implementation and results from an online questionnaire completed by 157 366 participants (BJPsych Open 4:3 (83-90) DOI: 10.1192/bjo.2018.12)
We, the Editors of BJPsych Open, have retracted the following article: Davis et al, ‘Mental health in UK Biobank: development, implementation and results froman online questionnaire completed by 157 366 participants’, BJPsych Open, Volume 4, Issue 3, pp. 83–90 – Retracted. In January 2019, the authors of this paper voluntarily submitted a corrigendum to the publisher which acknowledged that a data analysis coding error for Alcohol Use Disorders Identification Test (AUDIT) resulted in decreased alcohol use disorders prevalence and a resultant decrease in total psychiatric disorder prevalence. An investigation by the Senior Editorial Board revealed that whilst this was a relatively minor coding error, it had led to a major and important change in the findings noted in the abstract, results section and associated comorbidity tables. To ensure research integrity, the board decided that retraction of the original article with subsequent resubmission of a corrected paper would be the best course of action. No institutional investigation or sanctioning by the Journal is indicated. All of the authors agree to the retraction. We discuss more fully the issues and our response to them in an accompanying editorial (Kaufman et al. 2019).
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Gossage-Worrall R, Hind D, Barnard-Kelly KD, Shiers D, Etherington A, Swaby L, Holt RIG, Holt RIG, Barnard-Kelly K, Gossage-Worrall R, et al (2019). STructured lifestyle education for people WIth SchizophrEnia (STEPWISE): mixed methods process evaluation of a group-based lifestyle education programme to support weight loss in people with schizophrenia.
BMC PSYCHIATRY,
19(1).
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Holt RIG, Gossage-Worrall R, Hind D, Bradburn MJ, McCrone P, Morris T, Edwardson C, Barnard K, Carey ME, Davies MJ, et al (2019). Structured lifestyle education for people with schizophrenia, schizoaffective disorder and first-episode psychosis (STEPWISE): randomised controlled trial.
BRITISH JOURNAL OF PSYCHIATRY,
214(2), 63-73.
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Richards SH, Dickens C, Anderson R, Richards DA, Taylor RS, Ukoumunne OC, Turner KM, Gandhi M, Kuyken W, Gibson A, et al (2018). Assessing the effectiveness of Enhanced Psychological Care for patients with depressive symptoms attending cardiac rehabilitation compared with treatment as usual (CADENCE): a pilot cluster randomised controlled trial.
Trials,
19(1).
Abstract:
Assessing the effectiveness of Enhanced Psychological Care for patients with depressive symptoms attending cardiac rehabilitation compared with treatment as usual (CADENCE): a pilot cluster randomised controlled trial.
BACKGROUND: Around 17% of people attending UK cardiac rehabilitation programmes have depression. Optimising psychological wellbeing is a rehabilitation goal, but provision of psychological care is limited. We developed and piloted an Enhanced Psychological Care (EPC) intervention embedded within cardiac rehabilitation, aiming to test key areas of uncertainty to inform the design of a definitive randomised controlled trial (RCT) and economic evaluation. METHODS: an external pilot randomised controlled trial (RCT) randomised eight cardiac rehabilitation teams (clusters) to either usual care of cardiac rehabilitation provision (UC), or EPC in addition to UC. EPC comprised mental health care coordination and patient-led behavioural activation with nurse support. Adults eligible for cardiac rehabilitation following an acute coronary syndrome and identified with new-onset depressive symptoms during an initial nurse assessment were eligible. Measures were performed at baseline and 5- and 8-month follow-ups and compared between EPC and UC. Team and participant recruitment and retention rates, and participant outcomes (clinical events, depression, anxiety, health-related quality of life, patient experiences, and resource use) were assessed. RESULTS: Eight out of twenty teams were recruited and randomised. of 614 patients screened, 55 were eligible and 29 took part (5%, 95% CI 3 to 7% of those screened), with 15 patient participants cluster randomised to EPC and 14 to UC. Nurse records revealed that 8/15 participants received the maximum number of EPC sessions offered; and 4/15 received no sessions. Seven out of fifteen EPC participants were referred to another NHS psychological service compared to none in UC. We followed up 27/29 participants at 5 months and 17/21 at 8 months. The mean difference (EPC minus UC) in depressive symptoms (Beck Depression Inventory) at follow-up (adjusting for baseline score) was 1.7 (95% CI - 3.8 to 7.3; N = 26) at 5 months and 4.4 (95% CI - 1.4 to 10.2; N = 17) at 8 months. DISCUSSION: While valued by patients and nurses, organisational and workload constraints are significant barriers to EPC implementation. There remains a need to develop and test new models of psychological care within cardiac rehabilitation. Our study offers important data to inform the design of future trials of similar interventions. TRIAL REGISTRATION: ISRCTN34701576. Registered on 29 May 2014. Funding details: UK NIHR HTA Programme (project 12/189/09).
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Kessler D, Burns A, Tallon D, Lewis G, Macneill S, Round J, Hollingworth W, Chew-Graham C, Anderson I, Campbell J, et al (2018). Combining mirtazapine with ssris or snris for treatment-resistant depression: the MIR RCT.
Health Technology Assessment,
22(63), I-136.
Abstract:
Combining mirtazapine with ssris or snris for treatment-resistant depression: the MIR RCT
Background: Depression is usually managed in primary care and antidepressants are often the first-line treatment, but only half of those treated respond to a single antidepressant. Objectives: to investigate whether or not combining mirtazapine with serotonin–noradrenaline reuptake inhibitor (SNRI) or selective serotonin reuptake inhibitor (SSRI) antidepressants results in better patient outcomes and more efficient NHS care than SNRI or SSRI therapy alone in treatment-resistant depression (TRD). Design: the MIR trial was a two-parallel-group, multicentre, pragmatic, placebo-controlled randomized trial with allocation at the level of the individual. Setting: Participants were recruited from primary care in Bristol, Exeter, Hull/York and Manchester/Keele. Participants: Eligible participants were aged ≥ 18 years; were taking a SSRI or a SNRI antidepressant for at least 6 weeks at an adequate dose; scored ≥ 14 points on the Beck Depression Inventory-II (BDI-II); were adherent to medication; and met the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, criteria for depression. Interventions: Participants were randomised using a computer-generated code to either oral mirtazapine or a matched placebo, starting at a dose of 15 mg daily for 2 weeks and increasing to 30 mg daily for up to 12 months, in addition to their usual antidepressant. Participants, their general practitioners (GPs) and the research team were blind to the allocation. Main outcome measures: the primary outcome was depression symptoms at 12 weeks post randomization compared with baseline, measured as a continuous variable using the BDI-II. Secondary outcomes (at 12, 24 and 52 weeks) included response, remission of depression, change in anxiety symptoms, adverse events (AEs), quality of life, adherence to medication, health and social care use and cost-effectiveness. Outcomes were analysed on an intention-to-treat basis. A qualitative study explored patients’ views and experiences of managing depression and GPs’ views on prescribing a second antidepressant. Results: There were 480 patients randomised to the trial (mirtazapine and usual care, n = 241; placebo and usual care, n = 239), of whom 431 patients (89.8%) were followed up at 12 weeks. BDI-II scores at 12 weeks were lower in the mirtazapine group than the placebo group after adjustment for baseline BDI-II score and minimisation and stratification variables [difference –1.83 points, 95% confidence interval (CI) –3.92 to 0.27 points; p = 0.087]. This was smaller than the minimum clinically important difference and the CI included the null. The difference became smaller at subsequent time points (24 weeks: –0.85 points, 95% CI –3.12 to 1.43 points; 12 months: 0.17 points, 95% CI –2.13 to 2.46 points). More participants in the mirtazapine group withdrew from the trial medication, citing mild AEs (46 vs. 9 participants). Conclusions: This study did not find convincing evidence of a clinically important benefit for mirtazapine in addition to a SSRI or a SNRI antidepressant over placebo in primary care patients with TRD. There was no evidence that the addition of mirtazapine was a cost-effective use of NHS resources. GPs and patients were concerned about adding an additional antidepressant. Limitations: Voluntary unblinding for participants after the primary outcome at 12 weeks made interpretation of longer-term outcomes more difficult. Future work: Treatment-resistant depression remains an area of important, unmet need, with limited evidence of effective treatments. Promising interventions include augmentation with atypical antipsychotics and treatment using transcranial magnetic stimulation.
Abstract.
Davis KAS, Coleman JRI, Adams M, Allen N, Breen G, Cullen B, Dickens C, Fox E, Graham N, Holliday J, et al (2018). Corrigendum: Mental health in UK Biobank: Development, implementation and results from an online questionnaire completed by 157 366 participants (BJPsych Open (2018) 4:3 (83-90) DOI: 10.1192/bjo.2018.12).
BJPsych Open,
4(5), 352-353.
Abstract:
Corrigendum: Mental health in UK Biobank: Development, implementation and results from an online questionnaire completed by 157 366 participants (BJPsych Open (2018) 4:3 (83-90) DOI: 10.1192/bjo.2018.12)
It has recently come to our attention that the above paper contains an error. One of the variables in table 3 labelled "moderate activity ≥ three times a week", and also referred to in the text as "Achieving recommended levels of physical activity", was extracted incorrectly. Please see below an updated version of table 3 with the changes highlighted. The numbers of participants who are positive for this measure is much reduced, but our conclusion that there was no difference between the groups is unchanged. The authors apologise for this error. (Table Presented).
Abstract.
Davis KAS, Coleman JRI, Adams M, Allen N, Breen G, Cullen B, Dickens C, Fox E, Graham N, Holliday J, et al (2018). Corrigendum: Mental health in UK Biobank: Development, implementation and results from an online questionnaire completed by 157 366 participants (BJPsych Open (2018) 4:3 (83-90) DOI: 10.1192/bjo.2018.12).
BJPsych Open,
4(3).
Abstract:
Corrigendum: Mental health in UK Biobank: Development, implementation and results from an online questionnaire completed by 157 366 participants (BJPsych Open (2018) 4:3 (83-90) DOI: 10.1192/bjo.2018.12)
There was an error in the author list of this article1 and an author was inadvertently omitted from the article. The author list has now been updated in both PDF and HTML versions. The authors apologise to Daniel Smith for this omission.
Abstract.
Richards SH, Campbell JL, Dickens C, Anderson R, Gandhi M, Gibson A, Kessler D, Knight L, Kuyken W, Richards DA, et al (2018). Enhanced psychological care in cardiac rehabilitation services for patients with new-onset depression: the CADENCE feasibility study and pilot RCT.
Health Technology Assessment,
22(30), 1-219.
Abstract:
Enhanced psychological care in cardiac rehabilitation services for patients with new-onset depression: the CADENCE feasibility study and pilot RCT
Background: Around 19% of people screened by UK cardiac rehabilitation programmes report having moderate or severe symptoms of depression. These individuals are at an increased risk of cardiac mortality and morbidity, reduced quality of life and increased use of health resources compared with their non-depressed counterparts. Maximising psychological health is a goal of cardiac rehabilitation, but psychological care is patchy. Objective(s): to examine the feasibility and acceptability of embedding enhanced psychological care (EPC) within cardiac rehabilitation, we tested the feasibility of developing/implementing EPC and documented the key uncertainties associated with undertaking a definitive evaluation. Design: a two-stage multimethods study; a feasibility study and a qualitative evaluation, followed by an external pilot cluster randomised controlled trial (RCT) with a nested qualitative study. Setting: UK comprehensive cardiac rehabilitation teams. Participants: Adults eligible for cardiac rehabilitation following an acute coronary syndrome with new-onset depressive symptoms on initial nurse assessment. Patients who had received treatment for depression in the preceding 6 months were excluded. Interventions: the EPC intervention comprised nurse-led mental health-care co-ordination and behavioural activation within cardiac rehabilitation. The comparator was usual cardiac rehabilitation care. Main outcome measures: Measures at baseline, and at the 5-(feasibility and pilot) and 8-month follow-ups (pilot only). Process measures related to cardiac team and patient recruitment, and participantretention. Outcomes included depressive symptoms, cardiac mortality and morbidity, anxiety, health-related quality of life and service resource use. Interviews explored participant and nurses’ views and experiences. Results: Between September 2014 and May 2015, five nurses from four teams recruited participants into the feasibility study. of the 203 patients screened, 30 were eligible and nine took part (the target was 20 participants). At interview, participants and nurses gave valuable insights into the EPC intervention design and delivery. Although acceptable, the EPC delivery was challenging for nurses (e.g. the ability to allocate sufficient time within existing workloads) and the intervention was modified accordingly. Between December 2014 and February 2015, 8 out of 20 teams approached agreed to participate in the pilot RCT [five were randomised to the EPC arm and three were randomised to the usual-care (UC) arm]. of the 614 patients screened, 55 were eligible and 29 took part (the target was 43 participants). At baseline, the trial arms were well matched for sex and ethnicity, although the EPC arm participants were younger, from more deprived areas and had higher depression scores than the UC participants. A total of 27 out of 29 participants were followed up at 5 months. Interviews with 18 participants (12 in the EPC arm and six in the UC arm) and seven nurses who delivered EPC identified that both groups acknowledged the importance of receiving psychological support embedded within routine cardiac rehabilitation. For those experiencing/delivering EPC, the intervention was broadly acceptable, albeit challenging to deliver within existing care. Limitations: Both the feasibility and the pilot studies encountered significant challenges in recruiting patients, which limited the power of the pilot study analyses. Conclusions: Cardiac rehabilitation nurses can be trained to deliver EPC. Although valued by both patients and nurses, organisational and workload constraints were significant barriers to implementation in participating teams, suggesting that future research may require a modified approach to intervention delivery within current service arrangements. We obtained important data informing definitive research regarding participant recruitment and retention, and optimal methods of data collection.
Abstract.
Alsubaie M, Dickens C, Dunn BD, Gibson A, Ukoummunne O, Evans A, Vicary R, Gandhi M, Kuyken W (2018). Feasibility and Acceptability of Mindfulness-Based Cognitive Therapy Compared with Mindfulness-Based Stress Reduction and Treatment as Usual in People with Depression and Cardiovascular Disorders: a three-arm Randomised Controlled Trial. Mindfulness
Camacho EM, Davies LM, Hann M, Small N, Bower P, Chew-Graham C, Baguely C, Gask L, Dickens CM, Lovell K, et al (2018). Long-term clinical and cost-effectiveness of collaborative care (versus usual care) for people with mental-physical multimorbidity: Cluster-randomised trial.
British Journal of Psychiatry,
213(2), 456-463.
Abstract:
Long-term clinical and cost-effectiveness of collaborative care (versus usual care) for people with mental-physical multimorbidity: Cluster-randomised trial
Background Collaborative care can support the treatment of depression in people with long-term conditions, but long-term benefits and costs are unknown. Aims to explore the long-term (24-month) effectiveness and cost-effectiveness of collaborative care in people with mental-physical multimorbidity. Method a cluster randomised trial compared collaborative care (integrated physical and mental healthcare) with usual care for depression alongside diabetes and/or coronary heart disease. Depression symptoms were measured by the symptom checklist-depression scale (SCL-D13). The economic evaluation was from the perspective of the English National Health Service. Results 191 participants were allocated to collaborative care and 196 to usual care. At 24 months, the mean SCL-D13 score was 0.27 (95% CI, −0.48 to −0.06) lower in the collaborative care group alongside a gain of 0.14 (95% CI, 0.06-0.21) quality-adjusted life-years (QALYs). The cost per QALY gained was £13 069. Conclusions in the long term, collaborative care reduces depression and is potentially cost-effective at internationally accepted willingness-to-pay thresholds.
Abstract.
Kessler DS, MacNeill SJ, Tallon D, Lewis G, Peters TJ, Hollingworth W, Round J, Burns A, Chew-Graham CA, Anderson IM, et al (2018). Mirtazapine added to SSRIs or SNRIs for treatment resistant depression in primary care: Phase III randomised placebo controlled trial (MIR).
BMJ (Online),
363Abstract:
Mirtazapine added to SSRIs or SNRIs for treatment resistant depression in primary care: Phase III randomised placebo controlled trial (MIR)
Objective: to investigate the effectiveness of combining mirtazapine with serotonin-noradrenaline reuptake inhibitor (SNRI) or selective serotonin reuptake inhibitor (SSRI) antidepressants for treatment resistant depression in primary care. Design: Two parallel group multicentre phase III randomised placebo controlled trial. Setting: 106 general practices in four UK sites; Bristol, Exeter, Hull, and Keele/North Staffs, August 2013 to October 2015. Participants: 480 adults aged 18 or more years who scored 14 or more on the Beck depression inventory, second revision, fulfilled ICD-10 (international classification of diseases, 10th revision) criteria for depression, and had used an SSRI or SNRI for at least six weeks but were still depressed. 241 were randomised to mirtazapine and 239 to placebo, both given in addition to usual SSRI or SNRI treatment. Participants were stratified by centre and minimised by baseline Beck depression inventory score, sex, and current psychological therapy. They were followed up at 12, 24, and 52 weeks. 431 (89.8%) were included in the (primary) 12 week follow-up. Main outcome measures: Depressive symptoms at 12 weeks after randomisation, measured using the Beck depression inventory II score as a continuous variable. Secondary outcomes included measures of anxiety, quality of life, and adverse effects at 12, 24, and 52 weeks. Results: Beck depression inventory II scores at 12 weeks were lower in the mirtazapine group after adjustment for baseline scores and minimisation or stratification variables, although the confidence interval included the null (mean (SD) scores at 12 weeks: 18.0 (12.3) in the mirtazapine group, 19.7 (12.4) in the placebo group; adjusted difference between means â '1.83 (95% confidence interval â '3.92 to 0.27); P=0.09). Adverse effects were more common in the mirtazapine group and were associated with the participants stopping the trial drug. Conclusion: This study did not find evidence of a clinically important benefit for mirtazapine in addition to an SSRI or SNRI over placebo in a treatment resistant group of primary care patients with depression. This remains an area of important unmet need where evidence of effective treatment options is limited.
Abstract.
Davis KAS, Coleman JRI, Adams M, Allen N, Breen G, Cullen B, Dickens C, Fox E, Graham N, Holliday J, et al (2018). RETRACTED – Mental health in UK Biobank: development, implementation and results from an online questionnaire completed by 157 366 participants.
BJPsych Open,
4(3), 83-90.
Abstract:
RETRACTED – Mental health in UK Biobank: development, implementation and results from an online questionnaire completed by 157 366 participants
. Background
. UK Biobank is a well-characterised cohort of over 500 000 participants that offers unique opportunities to investigate multiple diseases and risk factors.
.
.
. Aims
. An online mental health questionnaire completed by UK Biobank participants was expected to expand the potential for research into mental disorders.
.
.
. Method
. An expert working group designed the questionnaire, using established measures where possible, and consulting with a patient group regarding acceptability. Case definitions were defined using operational criteria for lifetime depression, mania, anxiety disorder, psychotic-like experiences and self-harm, as well as current post-traumatic stress and alcohol use disorders.
.
.
. Results
. 157 366 completed online questionnaires were available by August 2017. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status than the general population across a range of indicators. Thirty-five per cent (55 750) of participants had at least one defined syndrome, of which lifetime depression was the most common at 24% (37 434). There was extensive comorbidity among the syndromes. Mental disorders were associated with high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
.
.
. Conclusions
. The questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed owing to selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
.
.
. Declaration of interest
. G.B. received grants from the National Institute for Health Research during the study; and support from Illumina Ltd. and the European Commission outside the submitted work. B.C. received grants from the Scottish Executive Chief Scientist Office and from the Dr Mortimer and Theresa Sackler Foundation during the study. C.S. received grants from the Medical Research Council and Wellcome Trust during the study, and is the Chief Scientist for UK Biobank. M.H. received grants from the Innovative Medicines Initiative via the RADAR-CNS programme and personal fees as an expert witness outside the submitted work.
.
Abstract.
Holt RI, Hind D, Gossage-Worrall R, Bradburn MJ, Saxon D, McCrone P, Morris TA, Etherington A, Shiers D, Barnard K, et al (2018). Structured lifestyle education to support weight loss for people with schizophrenia, schizoaffective disorder and first episode psychosis: the STEPWISE RCT.
HEALTH TECHNOLOGY ASSESSMENT,
22(65), 1-+.
Author URL.
Guthrie E, Afzal C, Blakeley C, Blakemore A, Byford R, Camacho E, Chan T, Chew-Graham C, Davies L, de Lusignan S, et al (2017). CHOICE: Choosing Health Options in Chronic Care Emergencies.
Programme Grants for Applied Research,
5(13), 1-272.
Abstract:
CHOICE: Choosing Health Options in Chronic Care Emergencies
BackgroundOver 70% of the health-care budget in England is spent on the care of people with long-term conditions (LTCs), and a major cost component is unscheduled health care. Psychological morbidity is high in people with LTCs and is associated with a range of adverse outcomes, including increased mortality, poorer physical health outcomes, increased health costs and service utilisation.ObjectivesThe aim of this programme of research was to examine the relationship between psychological morbidity and use of unscheduled care in people with LTCs, and to develop a psychosocial intervention that would have the potential to reduce unscheduled care use. We focused largely on emergency hospital admissions (EHAs) and attendances at emergency departments (EDs).DesignA three-phase mixed-methods study. Research methods included systematic reviews; a longitudinal prospective cohort study in primary care to identify people with LTCs at risk of EHA or ED admission; a replication study in primary care using routinely collected data; an exploratory and feasibility cluster randomised controlled trial in primary care; and qualitative studies to identify personal reasons for the use of unscheduled care and factors in routine consultations in primary care that may influence health-care use. People with lived experience of LTCs worked closely with the research team.SettingPrimary care. Manchester and London.ParticipantsPeople aged ≥ 18 years with at least one of four common LTCs: asthma, coronary heart disease, chronic obstructive pulmonary disease (COPD) and diabetes. Participants also included health-care staff.ResultsEvidence synthesis suggested that depression, but not anxiety, is a predictor of use of unscheduled care in patients with LTCs, and low-intensity complex interventions reduce unscheduled care use in people with asthma and COPD. The results of the prospective study were that depression, not having a partner and life stressors, in addition to prior use of unscheduled care, severity of illness and multimorbidity, were independent predictors of EHA and ED admission. Approximately half of the cost of health care for people with LTCs was accounted for by use of unscheduled care. The results of the replication study, carried out in London, broadly supported our findings for risk of ED attendances, but not EHAs. This was most likely due to low rates of detection of depression in general practitioner (GP) data sets. Qualitative work showed that patients were reluctant to use unscheduled care, deciding to do so when they perceived a serious and urgent need for care, and following previous experience that unscheduled care had successfully and unquestioningly met similar needs in the past. In general, emergency and primary care doctors did not regard unscheduled care as problematic. We found there are missed opportunities to identify and discuss psychosocial issues during routine consultations in primary care due to the ‘overmechanisation’ of routine health-care reviews. The feasibility trial examined two levels of an intervention for people with COPD: we tried to improve the way in which practices manage patients with COPD and developed a targeted psychosocial treatment for patients at risk of using unscheduled care. The former had low acceptability, whereas the latter had high acceptability. Exploratory health economic analyses suggested that the practice-level intervention would be unlikely to be cost-effective, limiting the value of detailed health economic modelling.LimitationsThe findings of this programme may not apply to all people with LTCs. It was conducted in an area of high social deprivation, which may limit the generalisability to more affluent areas. The response rate to the prospective longitudinal study was low. The feasibility trial focused solely on people with COPD.ConclusionsPrior use of unscheduled care is the most powerful predictor of unscheduled care use in people with LTCs. However, psychosocial factors, particularly depression, are important additional predictors of use of unscheduled care in patients with LTCs, independent of severity and multimorbidity. Patients and health-care practitioners are unaware that psychosocial factors influence health-care use, and such factors are rarely acknowledged or addressed in consultations or discussions about use of unscheduled care. A targeted patient intervention for people with LTCs and comorbid depression has shown high levels of acceptability when delivered in a primary care context. An intervention at the level of the GP practice showed little evidence of acceptability or cost-effectiveness.Future workThe potential benefits of case-finding for depression in patients with LTCs in primary care need to be evaluated, in addition to further evaluation of the targeted patient intervention.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
Abstract.
Winder R, Richards SH, Campbell JL, Richards DA, Dickens C, Gandhi M, Wright C, Turner K (2017). Development and refinement of a complex intervention within cardiac rehabilitation services: experiences from the CADENCE feasibility study. Pilot and Feasibility Studies, 3(1).
Alsubaie M, Abbbott R, Dunn BD, Dickens C, Keil T, Henley W, Kuyken W (2017). Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: a systematic review. Clinical Psychology Review, 55, 74-91.
Turner KM, Winder R, Campbell JL, Richards DA, Gandhi M, Dickens CM, Richards S (2017). Patients' and nurses' views on providing psychological support within cardiac rehabilitation programmes: a qualitative study.
BMJ Open,
7(9).
Abstract:
Patients' and nurses' views on providing psychological support within cardiac rehabilitation programmes: a qualitative study.
OBJECTIVE: to explore patients' and nurses' views on the feasibility and acceptability of providing psychological care within cardiac rehabilitation services. DESIGN: In-depth interviews analysed thematically. PARTICIPANTS: 18 patients and 7 cardiac nurses taking part in a pilot trial (CADENCE) of an enhanced psychological care intervention delivered within cardiac rehabilitation programmes by nurses to patients with symptoms of depression. SETTING: Cardiac services based in the South West of England and the East Midlands, UK. RESULTS: Patients and nurses viewed psychological support as central to good cardiac rehabilitation. Patients' accounts highlighted the significant and immediate adverse effect a cardiac event can have on an individual's mental well-being. They also showed that patients valued nurses attending to both their mental and physical health, and felt this was essential to their overall recovery. Nurses were committed to providing psychological support, believed it benefited patients, and advocated for this support to be delivered within cardiac rehabilitation programmes rather than within a parallel healthcare service. However, nurses were time-constrained and found it challenging to provide psychological care within their existing workloads. CONCLUSIONS: Both patients and nurses highly value psychological support being delivered within cardiac rehabilitation programmes but resource constraints raise barriers to implementation. Consideration, therefore, should be given to alternative forms of delivery which do not rely solely on nurses to enable patients to receive psychological support during cardiac rehabilitation. TRIAL REGISTRATION NUMBER: ISCTRN34701576.
Abstract.
Author URL.
Backhouse A, Richards DA, McCabe R, Watkins R, Dickens C (2017). Stakeholders perspectives on the key components of community-based interventions coordinating care in dementia: a qualitative systematic review.
BMC Health Serv Res,
17(1).
Abstract:
Stakeholders perspectives on the key components of community-based interventions coordinating care in dementia: a qualitative systematic review.
BACKGROUND: Interventions aiming to coordinate services for the community-based dementia population vary in components, organisation and implementation. In this review we aimed to investigate the views of stakeholders on the key components of community-based interventions coordinating care in dementia. METHODS: We searched four databases from inception to June 2015; Medline, the Cochrane Library, EMBASE and PsycINFO, this was aided by a search of four grey literature databases, and backward and forward citation tracking of included papers. Title and abstract screening was followed by a full text screen by two independent reviewers, and quality was assessed using the CASP appraisal tool. We then conducted thematic synthesis on extracted data. RESULTS: a total of seven papers from five independent studies were included in the review, and encompassed the views of over 100 participants from three countries. Through thematic synthesis we identified 32 initial codes that were grouped into 5 second-order themes: (1) case manager had four associated codes and described preferences for the case manager personal and professional attributes, including a sound knowledge in dementia and availability of local services; (2) communication had five associated codes and emphasized the importance stakeholders placed on multichannel communication with service users, as well as between multidisciplinary teams and across organisations; (3) intervention had 11 associated codes which focused primarily on the practicalities of implementation such as the contact type and frequency between case managers and service users, and the importance of case manager training and service evaluation; (4) resources had five associated codes which outlined stakeholder views on the required resources for coordinating interventions and potential overlap with existing resources, as well as arising issues when available resources do not meet those required for successful implementation; and (5) support had seven associated codes that reflect the importance that was placed on the support network around the case manager and the investment of professionals involved directly in care as well as the wider professional network. CONCLUSION: the synthesis of relevant qualitative studies has shown how various stakeholder groups considered dementia care coordination interventions to be acceptable, useful and appropriate for dementia care, and have clear preferences for components, implementation methods and settings of these interventions. By incorporating stakeholders' perspectives and preferences when planning and developing coordinating interventions we may increase the likelihood of successful implementation and patient benefits.
Abstract.
Author URL.
Backhouse A, Ukoumunne OC, Richards DA, McCabe R, Watkins R, Dickens C (2017). The effectiveness of community-based coordinating interventions in dementia care: a meta-analysis and subgroup analysis of intervention components.
BMC Health Serv Res,
17(1).
Abstract:
The effectiveness of community-based coordinating interventions in dementia care: a meta-analysis and subgroup analysis of intervention components.
BACKGROUND: Interventions aiming to coordinate services for the community-based dementia population vary in components, organisation and implementation. In this review we aimed to evaluate the effectiveness of community-based care coordinating interventions on health outcomes and investigate whether specific components of interventions influence their effects. METHODS: We searched four databases from inception to April 2017: Medline, the Cochrane Library, EMBASE and PsycINFO. This was aided by a search of four grey literature databases, and backward and forward citation tracking of included papers. Title and abstract screening was followed by a full text screen by two independent reviewers, and quality was assessed using the CASP appraisal tool. We then conducted meta-analyses and subgroup analyses. RESULTS: a total of 14 randomised controlled trials (RCTs) involving 10,372 participants were included in the review. Altogether we carried out 12 meta-analyses and 19 subgroup analyses. Meta-analyses found coordinating interventions showed a statistically significant improvement in both patient behaviour measured using the Neuropsychiatric Inventory (NPI) (mean difference (MD) = -9.5; 95% confidence interval (CI): -18.1 to -1.0; p = 0.03; number of studies (n) = 4; I2 = 88%) and caregiver burden (standardised mean difference (SMD) = -0.54; 95% CI: -1.01 to -0.07; p = 0.02; n = 5, I2 = 92%) compared to the control group. Subgroup analyses found interventions using a case manager with a nursing background showed a greater positive effect on caregiver quality of life than those that used case managers from other professional backgrounds (SMD = 0.94 versus 0.03, respectively; p
Abstract.
Author URL.
Bollen J, Trick L, Llewellyn D, Dickens C (2017). The effects of acute inflammation on cognitive functioning and emotional processing in humans: a systematic review of experimental studies.
Journal of Psychosomatic Research,
94, 47-55.
Abstract:
The effects of acute inflammation on cognitive functioning and emotional processing in humans: a systematic review of experimental studies
Objective the cognitive neuropsychological model of depression proposes that negative biases in the processing of emotionally salient information have a central role in the development and maintenance of depression. We have conducted a systematic review to determine whether acute experimental inflammation is associated with changes to cognitive and emotional processing that are thought to cause and maintain depression. Methods We identified experimental studies in which healthy individuals were administered an acute inflammatory challenge (bacterial endotoxin/vaccination) and standardised tests of cognitive function were performed. Results Fourteen references were identified, reporting findings from 12 independent studies on 345 participants. Methodological quality was rated strong or moderate for 11 studies. Acute experimental inflammation was triggered using a variety of agents (including endotoxin from E. coli, S. typhi, S. abortus Equi and Hepatitis B vaccine) and cognition was assessed over hours to months, using cognitive tests of i) attention/executive functioning, ii) memory and iii) social/emotional processing. Studies found mixed evidence that acute experimental inflammation caused changes to attention/executive functioning (2 of 6 studies showed improvements in attention executive function compared to control), changes in memory (3 of 5 studies; improved reaction time: reduced memory for object proximity: poorer immediate and delayed memory) and changes to social/emotional processing (4 of 5 studies; reduced perception of emotions, increased avoidance of punishment/loss experiences, and increased social disconnectedness). Conclusions Acute experimental inflammation causes negative biases in social and emotional processing that could explain observed associations between inflammation and depression.
Abstract.
Hancock J, Matthews J, Ukoumunne OC, Lang I, Somerfield D, Wenman J, Dickens C (2017). Variation in ambulance call rates for care homes in Torbay, UK.
Health and Social Care in the Community,
25(3), 932-937.
Abstract:
Variation in ambulance call rates for care homes in Torbay, UK
Emergency ambulance calls represent one of the routes of emergency hospital admissions from care homes. We aimed to describe the pattern of ambulance call rates from care homes and identify factors predicting those homes calling for an ambulance most frequently. We obtained data from South Western Ambulance Service NHS Foundation Trust on 3138 ambulance calls relating to people aged 65 and over from care homes in the Torbay region between 1 April 2012 and 31 July 2013. We supplemented this with data from the Care Quality Commission (CQC) website on home characteristics and outcomes of CQC inspections. We used descriptive statistics to identify variation in ambulance call rates for residential and nursing homes and fitted negative binomial regression models to determine if call rates were predicted by home type (nursing versus residential), the five standards in the CQC reports, dementia care status or travel time to hospital. One hundred and forty-six homes (119 residential and 27 nursing) were included in the analysis. The number of calls made ranged from 1 to 99. The median number (IQR; range) of calls per resident per year was 0.51 (0.21–0.89; 0.03–2.45). Nursing homes had a lower call rate than residential homes [adjusted rate ratio (ARR) 0.29; 95% CI: 0.22–0.40; P
Abstract.
Richards SH, Dickens C, Anderson R, Richards DA, Taylor RS, Ukoumunne OC, Kessler D, Turner K, Kuyken W, Gandhi M, et al (2016). Assessing the effectiveness of enhanced psychological care for patients with depressive symptoms attending cardiac rehabilitation compared with treatment as usual (CADENCE): study protocol for a pilot cluster randomised controlled trial.
Trials,
17Abstract:
Assessing the effectiveness of enhanced psychological care for patients with depressive symptoms attending cardiac rehabilitation compared with treatment as usual (CADENCE): study protocol for a pilot cluster randomised controlled trial.
BACKGROUND: Around 17% of people eligible for UK cardiac rehabilitation programmes following an acute coronary syndrome report moderate or severe depressive symptoms. While maximising psychological health is a core goal of cardiac rehabilitation, psychological care can be fragmented and patchy. This study tests the feasibility and acceptability of embedding enhanced psychological care, composed of two management strategies of proven effectiveness in other settings (nurse-led mental health care coordination and behavioural activation), within the cardiac rehabilitation care pathway. METHODS/DESIGN: This study tests the uncertainties associated with a large-scale evaluation by conducting an external pilot trial with a nested qualitative study. We aim to recruit and randomise eight comprehensive cardiac rehabilitation teams (clusters) to intervention (embedding enhanced psychological care into routine cardiac rehabilitation programmes) or control (routine cardiac rehabilitation programmes alone) arms. Up to 64 patients (eight per team) identified with depressive symptoms upon initial assessment by the cardiac rehabilitation team will be recruited, and study measures will be administered at baseline (before starting rehabilitation) and at 5 months and 8 months post baseline. Outcomes include depressive symptoms, cardiac mortality and morbidity, anxiety, health-related quality of life and service resource use. Trial data on cardiac team and patient recruitment, and the retention and flow of patients through treatment will be used to assess intervention feasibility and acceptability. Qualitative interviews will be undertaken to explore trial participants' and cardiac rehabilitation nurses' views and experiences of the trial methods and intervention, and to identify reasons why patients declined to take part in the trial. Outcome data will inform a sample size calculation for a definitive trial. DISCUSSION: the pilot trial and qualitative study will inform the design of a fully powered cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of the provision of enhanced psychological care within cardiac rehabilitation programmes. TRIAL REGISTRATION: ISRCTN34701576 (Registered 29 May 2014).
Abstract.
Author URL.
Panagioti M, Bower P, Kontopantelis E, Lovell K, Gilbody S, Waheed W, Dickens C, Archer J, Simon G, Ell K, et al (2016). Association Between Chronic Physical Conditions and the Effectiveness of Collaborative Care for Depression: an Individual Participant Data Meta-analysis.
JAMA Psychiatry,
73(9), 978-989.
Abstract:
Association Between Chronic Physical Conditions and the Effectiveness of Collaborative Care for Depression: an Individual Participant Data Meta-analysis.
IMPORTANCE: Collaborative care is an intensive care model involving several health care professionals working together, typically a physician, a case manager, and a mental health professional. Meta-analyses of aggregate data have shown that collaborative care is particularly effective in people with depression and comorbid chronic physical conditions. However, only participant-level analyses can rigorously test whether the treatment effect is influenced by participant characteristics, such as chronic physical conditions. OBJECTIVE: to assess whether the effectiveness of collaborative care for depression is moderated by the presence, type, and number of chronic physical conditions. DATA SOURCES: Data were obtained from MEDLINE, EMBASE, PubMed, PsycINFO, CINAHL Complete, and Cochrane Central Register of Controlled Trials, and references from relevant systematic reviews. The search and collection of eligible studies was ongoing until May 22, 2015. STUDY SELECTION: This was an update to a previous meta-analysis. Two independent reviewers were involved in the study selection process. Randomized clinical trials that compared the effectiveness of collaborative care with usual care in adults with depression and reported measured changes in depression severity symptoms at 4 to 6 months after randomization were included in the analysis. Key search terms included depression, dysthymia, anxiety, panic, phobia, obsession, compulsion, posttraumatic, care management, case management, collaborative care, enhanced care, and managed care. DATA EXTRACTION AND SYNTHESIS: Individual participant data on baseline demographics and chronic physical conditions as well as baseline and follow-up depression severity symptoms were requested from authors of the eligible studies. One-step meta-analysis of individual participant data using appropriate mixed-effects models was performed. MAIN OUTCOMES AND MEASURES: Continuous outcomes of depression severity symptoms measured using self-reported or observer-rated measures. RESULTS: Data sets from 31 randomized clinical trials including 36 independent comparisons (N = 10 962 participants) were analyzed. Individual participant data analyses found no significant interaction effects, indicating that the presence (interaction coefficient, 0.02 [95% CI, -0.10 to 0.13]), numbers (interaction coefficient, 0.01 [95% CI, -0.01 to 0.02]), and types of chronic physical conditions do not influence the treatment effect. CONCLUSIONS AND RELEVANCE: There is evidence that collaborative care is effective for people with depression alone and also for people with depression and chronic physical conditions. Existing guidance that recommends limiting collaborative care to people with depression and physical comorbidities is not supported by this individual participant data meta-analysis.
Abstract.
Author URL.
Ukoumunne OC, 1. Farrand P, Woodford J, Llewellyn D, Anderson M, Venkatasubramanian S, Adlam A, Dickens C (2016). Behavioural activation written self-help to improve mood, wellbeing and quality of life in people with dementia supported by informal carers (PROMOTE): study protocol for a single-arm feasibility study. Pilot and Feasibility Studies
Guthrie EA, Dickens C, Blakemore A, Watson J, Chew-Graham C, Lovell K, Afzal C, Kapur N, Tomenson B (2016). Depression predicts future emergency hospital admissions in primary care patients with chronic physical illness. Journal of Psychosomatic Research, 82, 54-61.
Camacho EM, Ntais D, Coventry P, Bower P, Lovell K, Chew-Graham C, Baguley C, Gask L, Dickens C, Davies LM, et al (2016). Long-term cost-effectiveness of collaborative care (vs usual care) for people with depression and comorbid diabetes or cardiovascular disease: a Markov model informed by the COINCIDE randomised controlled trial.
BMJ OPEN,
6(10).
Author URL.
Tallon D, Wiles N, Campbell J, Chew-Graham C, Dickens C, Macleod U, Peters TJ, Lewis G, Anderson IM, Gilbody S, et al (2016). Mirtazapine added to selective serotonin reuptake inhibitors for treatment-resistant depression in primary care (MIR trial): study protocol for a randomised controlled trial.
Trials,
17Abstract:
Mirtazapine added to selective serotonin reuptake inhibitors for treatment-resistant depression in primary care (MIR trial): study protocol for a randomised controlled trial.
BACKGROUND: People with depression are usually managed in primary care and antidepressants are often the first-line treatment, but only one third of patients respond fully to a single antidepressant. This paper describes the protocol for a randomised controlled trial (MIR) to investigate the extent to which the addition of the antidepressant mirtazapine is effective in reducing the symptoms of depression compared with placebo in patients who are still depressed after they have been treated with a selective serotonin reuptake inhibitor (SSRI) or serotonin and noradrenaline reuptake inhibitor (SNRI) for at least 6 weeks in primary care. METHODS/DESIGN: MIR is a two-parallel group, multi-centre, pragmatic, placebo controlled, randomised trial with allocation at the level of the individual. Eligible participants are those who: are aged 18 years or older; are currently taking an SSRI/SNRI antidepressant (for at least 6 weeks at an adequate dose); score ≥ 14 on the Beck Depression Inventory (BDI-II); have adhered to their medication; and meet ICD-10 criteria for depression (assessed using the Clinical Interview Schedule-Revised version). Participants who give written, informed consent, will be randomised to receive either oral mirtazapine or matched placebo, starting at 15 mg daily for 2 weeks and increasing to 30 mg daily thereafter, for up to 12 months (to be taken in addition to their usual antidepressant). Participants, their GPs, and the research team will all be blind to the allocation. The primary outcome will be depression symptoms at 12 weeks post randomisation, measured as a continuous variable using the BDI-II. Secondary outcomes (measured at 12, 24 and 52 weeks) include: response (reduction in depressive symptoms (BDI-II score) of at least 50% compared to baseline); remission of depression symptoms (BDI-II
Abstract.
Author URL.
Farrand P, Matthews J, Dickens C, Martin A, Woodford J (2016). Psychological interventions to improve psychological well-being in people with dementia or mild cognitive impairment: Systematic review and meta-analysis protocol. BMJ Open, 6(e009713).
Gossage-Worrall R, Holt RIG, Barnard K, Carey M, Davies M, Dickens C, Doherty Y, Edwardson C, French P, Gaughran F, et al (2016). STEPWISE - STructured lifestyle Education for People WIth SchizophrEnia: a study protocol for a randomised controlled trial.
Trials,
17(1).
Abstract:
STEPWISE - STructured lifestyle Education for People WIth SchizophrEnia: a study protocol for a randomised controlled trial
Background: People with schizophrenia are two to three times more likely to be overweight than the general population. The UK National Institute of Health and Care Excellence (NICE) recommends an annual physical health review with signposting to, or provision of, a lifestyle programme to address weight concerns and obesity. The purpose of this randomised controlled trial is to assess whether a group-based structured education programme can help people with schizophrenia to lose weight. Methods: Design: a randomised controlled trial of a group-based structured education programme. Setting: 10 UK community mental health trusts. Participants: 396 adults with schizophrenia, schizoaffective, or first-episode psychosis who are prescribed antipsychotic medication will be recruited. Participants will be overweight, obese or be concerned about their weight. Intervention: participants will be randomised to either the intervention or treatment as usual (TAU). The intervention arm will receive TAU plus four 2.5-h weekly sessions of theory-based lifestyle structured group education, with maintenance contact every 2 weeks and 'booster' sessions every 3 months. All participants will receive standardised written information about healthy eating, physical activity, alcohol and smoking. Outcomes: the primary outcome is weight (kg) change at 1 year post randomisation. Secondary outcomes, which will be assessed at 3 and 12 months, include: the proportion of participants who maintained or reduced their weight; waist circumference; body mass index; objectively measured physical activity (wrist accelerometer); self-reported diet; blood pressure; fasting plasma glucose, lipid profile and HbA1c (baseline and 1 year only); health-related quality of life (EQ-5D-5L and RAND SF-36); (adapted) brief illness perception questionnaire; the Brief Psychiatric Rating Scale; the Client Service Receipt Inventory; medication use; smoking status; adverse events; depression symptoms (Patient Health Questionnaire-9); use of weight-loss programmes; and session feedback (intervention only). Outcome assessors will be blind to trial group allocation. Qualitative interviews with a subsample of facilitators and invention-arm participants will provide data on intervention feasibility and acceptability. Assessment of intervention fidelity will also be performed. Discussion: the STEPWISE trial will provide evidence for the clinical and cost-effectiveness of a tailored intervention, which, if successful, could be implemented rapidly in the NHS. Trial registration:ISRCTN19447796, registered on 20 March 2014.
Abstract.
Trick L, Watkins E, Windeatt S, Dickens C (2016). The association of perseverative negative thinking with depression, anxiety and emotional distress in people with long term conditions: a systematic review.
Journal of Psychosomatic Research,
91, 89-101.
Abstract:
The association of perseverative negative thinking with depression, anxiety and emotional distress in people with long term conditions: a systematic review
Objective Depression is common in people with long term conditions, and is associated with worse medical outcomes. Previous research shows perseverative negative thinking (e.g. worry, rumination) predicts subsequent depression and worse medical outcomes, suggesting interventions targeting perseverative negative thinking could improve depression and medical outcomes. Previous studies recruited healthy individuals, however. This review aimed to determine the temporal relationship and strength of prospective association of perseverative negative thinking with depression, anxiety and emotional distress in people with long term conditions. Method Four electronic databases were searched for studies including standardised measures of perseverative negative thinking and depression, anxiety or emotional distress, and which presented prospective associations. Findings were narratively synthesized. Results Thirty studies were identified in a range of long term conditions. Perseverative negative thinking and subsequent depression, anxiety or emotional distress were significantly correlated in the majority of studies (bivariate r = 0.23 to r = 0.73). 25 studies controlled for confounders, and in 15 perseverative negative thinking predicted subsequent depression, anxiety or emotional distress. Results varied according to condition and study quality. Six of 7 studies found bivariate associations between depression, anxiety or emotional distress and subsequent perseverative negative thinking, though 2 studies controlling for key covariates found no association. Few studies assessed the impact of perseverative negative thinking on medical outcomes. Conclusion Strongest evidence supported perseverative negative thinking predicting subsequent depression, anxiety and emotional distress in people with long term conditions. Further prospective research is warranted to clarify the association of perseverative negative thinking with subsequent poor medical outcomes.
Abstract.
Trick L, Watkins E, Dickens C (2016). The role of perseverative negative thinking in predicting depression in people with coronary heart disease: Preliminary findings of a prospective cohort study.
JOURNAL OF PSYCHOSOMATIC RESEARCH,
85, 83-84.
Author URL.
Hudson JL, Bundy C, Coventry P, Dickens C, Wood A, Reeves D (2016). What are the combined effects of negative emotions and illness cognitions on self-care in people with type 2 diabetes? a longitudinal structural equation model.
Psychology and Health,
31(7), 873-890.
Abstract:
What are the combined effects of negative emotions and illness cognitions on self-care in people with type 2 diabetes? a longitudinal structural equation model
Objective: to explore whether negative emotions mediate the effect of diabetes cognitions on diabetes self-care and conversely whether diabetes cognitions mediate the effect of negative emotions on diabetes self-care. Design: Longitudinal observational study in adults with type 2 diabetes. Main outcome measures: Self-reported depression and anxiety (Diabetes Wellbeing Questionnaire), cognitions (Illness Perceptions Questionnaire-Revised; Beliefs about Medicines Questionnaire), and diabetes self-care (Summary of Diabetes Self-Care Activities Scale) were completed at baseline and six months. Analyses used structural equation modelling. Results: Baseline medication concerns were associated with elevated symptoms of depression and anxiety at follow-up, but emotions did not mediate medication concern’s effect on diabetes self-care. Baseline depression and anxiety symptoms were associated with specific diabetes cognitions over time, but these cognition domains did not mediate emotion’s effect on diabetes self-care. Personal control remained independent of emotions and was associated with diabetes self-care over time. Conclusions: Negative emotions did not act directly or alongside cognitions to influence diabetes self-care. The reciprocal relationship between diabetes cognitions and emotions suggests cognitive restructuring, in addition to other mood management intervention techniques would likely improve the emotional wellbeing of adults with type 2 diabetes. Likewise, personal control beliefs are likely important intervention targets for improving self-care.
Abstract.
Blakemore A, Dickens C, Anderson R, Tomenson B, Woodcock A, Guthrie E (2015). Complex interventions reduce use of urgent healthcare in adults with asthma: systematic review with meta-regression.
Respir Med,
109(2), 147-156.
Abstract:
Complex interventions reduce use of urgent healthcare in adults with asthma: systematic review with meta-regression.
INTRODUCTION: Asthma accounts for considerable healthcare expenditure, a large proportion of which is attributable to use of expensive urgent healthcare. This review examines the characteristics of complex interventions that reduce urgent healthcare use in adults with asthma. METHOD: Electronic searches of MEDLINE, EMBASE, PSYCINFO, CINAHL, the British Nursing Library and the Cochrane library, from inception to January 2013 were conducted. Studies were eligible for inclusion if they: i) included adults with asthma ii) assessed the efficacy of a complex intervention using randomised controlled trial design, and iii) included a measure of urgent healthcare utilisation at follow-up. Data on participants recruited, methods, characteristics of complex interventions and the effects of the intervention on urgent healthcare use were extracted. RESULTS: 33 independent studies were identified resulting in 39 comparisons altogether. Pooled effects indicated that interventions were associated with a reduction in urgent healthcare use (OR = 0.79, 95% CI = 0.67, 0.94). When study effects were grouped according to the components of the interventions used, significant effects were seen for interventions that included general education (OR = 0.77, 95% CI = 0.64, 0.91), skills training (OR = 0.64, 95% CI = 0.48, 0.86) and relapse prevention (OR = 0.75, 95% CI = 0.57, 0.98). In multivariate meta-regression analysis, only skills training remained significant. CONCLUSIONS: Complex interventions reduced the use of urgent healthcare in adults with asthma by 21%. Those complex interventions including skills training, education and relapse prevention may be particularly effective in reducing the use of urgent healthcare in adults with asthma.
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Dickens C (2015). Depression in People with Coronary Heart Disease: Prognostic Significance and Mechanisms.
Current Cardiology Reports,
17(10).
Abstract:
Depression in People with Coronary Heart Disease: Prognostic Significance and Mechanisms
Depression affects about 40 % of people with coronary heart disease (CHD). This group with depression and CHD have increased mortality and morbidity, worse health-related quality of life, use health services more frequently and consequently cost the health service and the national economy considerably more than their non-depressed counterparts. A number of characteristics of depression and plausible mechanisms have been proposed to explain this observed association, which could lead to improved understanding of the association and lead to new interventions to improve cardiac outcomes. This review summarises the evidence linking depression with worse cardiac outcomes, considers specific aspects of depression which may predict worse outcomes and reviews the mechanisms that could potentially explain the direct or indirect association of depression with coronary outcomes.
Abstract.
Cleare A, Pariante CM, Young AH, Anderson IM, Christmas D, Cowen PJ, Dickens C, Ferrier IN, Geddes J, Gilbody S, et al (2015). Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines.
J Psychopharmacol,
29(5), 459-525.
Abstract:
Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines.
A revision of the 2008 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken in order to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in September 2012. Key areas in treating depression were reviewed and the strength of evidence and clinical implications were considered. The guidelines were then revised after extensive feedback from participants and interested parties. A literature review is provided which identifies the quality of evidence upon which the recommendations are made. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse and stopping treatment. Significant changes since the last guidelines were published in 2008 include the availability of new antidepressant treatment options, improved evidence supporting certain augmentation strategies (drug and non-drug), management of potential long-term side effects, updated guidance for prescribing in elderly and adolescent populations and updated guidance for optimal prescribing. Suggestions for future research priorities are also made.
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Coventry P, Lovell K, Dickens C, Bower P, Chew-Graham C, McElvenny D, Hann M, Cherrington A, Garrett C, Gibbons CJ, et al (2015). Integrated primary care for patients with mental and physical multimorbidity: Cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease.
BMJ (Online),
350, 1-11.
Abstract:
Integrated primary care for patients with mental and physical multimorbidity: Cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease
Objective: to test the effectiveness of an integrated collaborative care model for people with depression and long term physical conditions. Design: Cluster randomised controlled trial. Setting: 36 general practices in the north west of England. Participants: 387 patients with a record of diabetes or heart disease, or both, who had depressive symptoms (≥ 10 on patient health questionaire-9 (PHQ-9)) for at least two weeks. Mean age was 58.5 (SD 11.7). Participants reported a mean of 6.2 (SD 3.0) long term conditions other than diabetes or heart disease; 240 (62%) were men; 360 (90%) completed the trial. Interventions: Collaborative care included patient preference for behavioural activation, cognitive restructuring, graded exposure, and/or lifestyle advice, management of drug treatment, and prevention of relapse. Up to eight sessions of psychological treatment were delivered by specially trained psychological wellbeing practitioners employed by Improving Access to Psychological Therapy services in the English National Health Service; integration of care was enhanced by two treatment sessions delivered jointly with the practice nurse. Usual care was standard clinical practice provided by general practitioners and practice nurses. Main outcome measures the primary outcome was reduction in symptoms of depression on the self reported symptom checklist-13 depression scale (SCL-D13) at four months after baseline assessment. Secondary outcomes included anxiety symptoms (generalised anxiety disorder 7), self management (health education impact questionnaire), disability (Sheehan disability scale), and global quality of life (WHOQOL-BREF). Results: 19 general practices were randomised to collaborative care and 20 to usual care; three practices withdrew from the trial before patients were recruited. 191 patients were recruited from practices allocated to collaborative care, and 196 from practices allocated to usual care. After adjustment for baseline depression score, mean depressive scores were 0.23 SCL-D13 points lower (95% confidence interval -0.41 to -0.05) in the collaborative care arm, equal to an adjusted standardised effect size of 0.30. Patients in the intervention arm also reported being better self managers, rated their care as more patient centred, and were more satisfied with their care. There were no significant differences between groups in quality of life, disease specific quality of life, self efficacy, disability, and social support. Conclusions: Collaborative care that incorporates brief low intensity psychological therapy delivered in partnership with practice nurses in primary care can reduce depression and improve self management of chronic disease in people with mental and physical multimorbidity. The size of the treatment effects were modest and were less than the prespecified effect but were achieved in a trial run in routine settings with a deprived population with high levels of mental and physical multimorbidity.
Abstract.
Coventry P, Lovell K, Dickens C, Bower P, Chew-Graham C, McElvenny D, Hann M, Cherrington A, Garrett C, Gibbons CJ, et al (2015). Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease.
BMJ-BRITISH MEDICAL JOURNAL,
350 Author URL.
Coventry P, Lovell K, Dickens C, Bower P, Chew-Graham C, McElvenny D, Hann M, Cherrington A, Garrett C, Gibbons CJ, et al (2015). Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease.
BMJ,
350Abstract:
Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease.
OBJECTIVE: to test the effectiveness of an integrated collaborative care model for people with depression and long term physical conditions. DESIGN: Cluster randomised controlled trial. SETTING: 36 general practices in the north west of England. PARTICIPANTS: 387 patients with a record of diabetes or heart disease, or both, who had depressive symptoms (≥ 10 on patient health questionaire-9 (PHQ-9)) for at least two weeks. Mean age was 58.5 (SD 11.7). Participants reported a mean of 6.2 (SD 3.0) long term conditions other than diabetes or heart disease; 240 (62%) were men; 360 (90%) completed the trial. INTERVENTIONS: Collaborative care included patient preference for behavioural activation, cognitive restructuring, graded exposure, and/or lifestyle advice, management of drug treatment, and prevention of relapse. Up to eight sessions of psychological treatment were delivered by specially trained psychological wellbeing practitioners employed by Improving Access to Psychological Therapy services in the English National Health Service; integration of care was enhanced by two treatment sessions delivered jointly with the practice nurse. Usual care was standard clinical practice provided by general practitioners and practice nurses. MAIN OUTCOME MEASURES: the primary outcome was reduction in symptoms of depression on the self reported symptom checklist-13 depression scale (SCL-D13) at four months after baseline assessment. Secondary outcomes included anxiety symptoms (generalised anxiety disorder 7), self management (health education impact questionnaire), disability (Sheehan disability scale), and global quality of life (WHOQOL-BREF). RESULTS: 19 general practices were randomised to collaborative care and 20 to usual care; three practices withdrew from the trial before patients were recruited. 191 patients were recruited from practices allocated to collaborative care, and 196 from practices allocated to usual care. After adjustment for baseline depression score, mean depressive scores were 0.23 SCL-D13 points lower (95% confidence interval -0.41 to -0.05) in the collaborative care arm, equal to an adjusted standardised effect size of 0.30. Patients in the intervention arm also reported being better self managers, rated their care as more patient centred, and were more satisfied with their care. There were no significant differences between groups in quality of life, disease specific quality of life, self efficacy, disability, and social support. CONCLUSIONS: Collaborative care that incorporates brief low intensity psychological therapy delivered in partnership with practice nurses in primary care can reduce depression and improve self management of chronic disease in people with mental and physical multimorbidity. The size of the treatment effects were modest and were less than the prespecified effect but were achieved in a trial run in routine settings with a deprived population with high levels of mental and physical multimorbidity. TRIAL REGISTRATION: ISRCTN80309252.
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Backhouse A, Dickens C, Richards D, McCabe R (2015). Key components in models of community-based interventions coordinating care in dementia: a mixed studies systematic review protocol.
Syst Rev,
4Abstract:
Key components in models of community-based interventions coordinating care in dementia: a mixed studies systematic review protocol.
BACKGROUND: Current health and social care systems are providing suboptimal and fragmented care to the growing dementia population. Interventions aiming to coordinate care services for individuals with dementia and their families are already widely used; however, the structure and implementation of these interventions vary. This mixed studies review aims to investigate the key components of effective community-based interventions that focus on coordinating care in dementia. METHODS: We will search MEDLINE, Cochrane Library, Embase and PsycINFO databases for studies of any design that look at community-based interventions that aim to coordinate dementia care through the allocation of a specified professional responsible for provision of care. Health Management Information Consortium (HMIC), Social Policy and Practice (SPP), ProQuest and International Clinical Trials Registry Platform (ICTRP) databases will be searched for grey literature. Outcomes of interest are health outcome measures that relate to the individual with dementia and/or informal caregiver, measures of resource use or process measures. Two independent reviewers will screen identified papers and extract data from eligible studies. Evidence synthesis will take place in three stages, and methods will be largely dependent on the data available. A sequential review design will be used where the qualitative evidence will be synthesised first, focusing on stakeholder's subjective views of key components. This will drive forward the quantitative stage which will identify key components of effective interventions. The final stage of the review will merge the two strands of evidence through a narrative synthesis. DISCUSSION: the results from this review will be used to develop a model for a community-based intervention coordinating care in dementia. Furthermore, the findings will help guide future work on intervention development of health and social care services for dementia. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015024618.
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Lourida I, Thompson-Coon J, Dickens CM, Soni M, Kuźma E, Kos K, Llewellyn DJ (2015). Parathyroid hormone, cognitive function and dementia: a systematic review.
PLoS One,
10(5).
Abstract:
Parathyroid hormone, cognitive function and dementia: a systematic review.
BACKGROUND: Metabolic factors are increasingly recognized to play an important role in the pathogenesis of Alzheimer's disease and dementia. Abnormal parathyroid hormone (PTH) levels play a role in neuronal calcium dysregulation, hypoperfusion and disrupted neuronal signaling. Some studies support a significant link between PTH levels and dementia whereas others do not. METHODS: We conducted a systematic review through January 2014 to evaluate the association between PTH and parathyroid conditions, cognitive function and dementia. Eleven electronic databases and citation indexes were searched including Medline, Embase and the Cochrane Library. Hand searches of selected journals, reference lists of primary studies and reviews were also conducted along with websites of key organizations. Two reviewers independently screened titles and abstracts of identified studies. Data extraction and study quality were performed by one and checked by a second reviewer using predefined criteria. A narrative synthesis was performed due to the heterogeneity of included studies. RESULTS: the twenty-seven studies identified were of low and moderate quality, and challenging to synthesize due to inadequate reporting. Findings from six observational studies were mixed but suggest a link between higher serum PTH levels and increased odds of poor cognition or dementia. Two case-control studies of hypoparathyroidism provide limited evidence for a link with poorer cognitive function. Thirteen pre-post surgery studies for primary hyperparathyroidism show mixed evidence for improvements in memory though limited agreement in other cognitive domains. There was some degree of cognitive impairment and improvement postoperatively in observational studies of secondary hyperparathyroidism but no evident pattern of associations with specific cognitive domains. CONCLUSIONS: Mixed evidence offers weak support for a link between PTH, cognition and dementia due to the paucity of high quality research in this area.
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Abbott R, Whear R, Nikolaou V, Bethel A, Coon JT, Stein K, Dickens C (2015). Tumour necrosis factor-α inhibitor therapy in chronic physical illness: a systematic review and meta-analysis of the effect on depression and anxiety.
Journal of Psychosomatic ResearchAbstract:
Tumour necrosis factor-α inhibitor therapy in chronic physical illness: a systematic review and meta-analysis of the effect on depression and anxiety
Objective: Depression is more common among individuals with chronic physical illness than in the general population. New treatments for severe and chronic inflammatory conditions which inhibit tumour necrosis factor alpha (TNF-α), a pro-inflammatory cytokine, may be able to shed some light on the role of inflammatory mediators in depression. This systematic review and meta-analysis of randomised controlled trials determined the effects of TNF-α inhibitor therapy on depression and anxiety in people with chronic physical illness. Methods: Seven databases were searched from inception to January 2014: AMED, Central, Cochrane Database of Systematic Reviews, CINAHL, Embase, MEDLINE, and PsycINFO. Articles were screened for inclusion independently by two reviewers. Data extraction and appraisal were conducted by one reviewer and checked by a second. Random-effects meta-analyses were performed. Results: Six randomised controlled trials (reported in seven articles) met eligibility criteria and were included in the final review. In total 2540 participants were enrolled across the trials, with participants presenting with rheumatoid arthritis (n = 3 trials), psoriasis (n = 2) or ankylosing spondylitis (n = 1). Meta-analyses, using standardised mean differences, showed evidence of small reductions in depression (-. 0.24; 95% CI -. 0.33 to -. 0.14; p.
Abstract.
Keyworth C, Knopp J, Roughley K, Dickens C, Bold S, Coventry P (2014). A mixed-methods pilot study of the acceptability and effectiveness of a brief meditation and mindfulness intervention for people with diabetes and coronary heart disease.
Behav Med,
40(2), 53-64.
Abstract:
A mixed-methods pilot study of the acceptability and effectiveness of a brief meditation and mindfulness intervention for people with diabetes and coronary heart disease.
Mindfulness-based interventions can successfully target negative perseverative cognitions such as worry and thought suppression, but their acceptability and effectiveness in people with long-term conditions is uncertain. We therefore pilot tested a six-week meditation and mindfulness intervention in people (n = 40) with diabetes mellitus and coronary heart disease. We used a sequential mixed-methods approach that measured change in worry and thought suppression and qualitatively explored acceptability, feasibility, and user experience with a focus group (n = 11) and in-depth interviews (n = 16). The intervention was highly acceptable, with 90% completing ≥5 sessions. Meditation and mindfulness skills led to improved sleep, greater relaxation, and more-accepting approaches to illness and illness experience. At the end of the six-week meditation course, worry, and thought suppression were significantly reduced. Positive impacts of mindfulness-based interventions on psychological health may relate to acquisition and development of meta-cognitive skills but this needs experimental confirmation.
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Coventry PA, Hudson JL, Kontopantelis E, Archer J, Richards DA, Gilbody S, Lovell K, Dickens C, Gask L, Waheed W, et al (2014). Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials.
PLoS One,
9(9).
Abstract:
Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials.
BACKGROUND: Collaborative care is a complex intervention based on chronic disease management models and is effective in the management of depression. However, there is still uncertainty about which components of collaborative care are effective. We used meta-regression to identify factors in collaborative care associated with improvement in patient outcomes (depressive symptoms) and the process of care (use of anti-depressant medication). METHODS AND FINDINGS: Systematic review with meta-regression. The Cochrane Collaboration Depression, Anxiety and Neurosis Group trials registers were searched from inception to 9th February 2012. An update was run in the CENTRAL trials database on 29th December 2013. Inclusion criteria were: randomised controlled trials of collaborative care for adults ≥18 years with a primary diagnosis of depression or mixed anxiety and depressive disorder. Random effects meta-regression was used to estimate regression coefficients with 95% confidence intervals (CIs) between study level covariates and depressive symptoms and relative risk (95% CI) and anti-depressant use. The association between anti-depressant use and improvement in depression was also explored. Seventy four trials were identified (85 comparisons, across 21,345 participants). Collaborative care that included psychological interventions predicted improvement in depression (β coefficient -0.11, 95% CI -0.20 to -0.01, p = 0.03). Systematic identification of patients (relative risk 1.43, 95% CI 1.12 to 1.81, p = 0.004) and the presence of a chronic physical condition (relative risk 1.32, 95% CI 1.05 to 1.65, p = 0.02) predicted use of anti-depressant medication. CONCLUSION: Trials of collaborative care that included psychological treatment, with or without anti-depressant medication, appeared to improve depression more than those without psychological treatment. Trials that used systematic methods to identify patients with depression and also trials that included patients with a chronic physical condition reported improved use of anti-depressant medication. However, these findings are limited by the observational nature of meta-regression, incomplete data reporting, and the use of study aggregates.
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Dickens C, Katon W, Blakemore A, Khara A, Tomenson B, Woodcock A, Fryer A, Guthrie E (2014). Complex interventions that reduce urgent care use in COPD: a systematic review with meta-regression.
Respiratory Medicine,
108(3), 426-437.
Abstract:
Complex interventions that reduce urgent care use in COPD: a systematic review with meta-regression
Context: Chronic obstructive pulmonary disease is common and accounts for considerable healthcare expenditure. A large proportion of this healthcare expenditure is attributable to the use of expensive urgent healthcare. The characteristics of interventions that reduce the use of urgent healthcare remain unclear. Objective: to examine the characteristics of complex interventions intended to reduce the use of urgent and unscheduled healthcare among people with COPD. Data sources Electronic searches of MEDLINE, EMBASE, PSYCINFO, CINAHL, the British Nursing Library and the Cochrane library, from inception to 25th January 2013 were conducted. These were supplemented by hand-searching bibliographies and citation tracing identified reviews and eligible studies. Study selection: Studies were eligible for inclusion if they: i) included adults with chronic obstructive pulmonary disease, ii) assessed the efficacy of a complex intervention using randomised controlled trial design, and iii) included a measure of urgent healthcare utilisation at follow-up. Data extraction: Data on the subjects recruited, trial methods used, the characteristics of complex interventions and the effects of the intervention on urgent healthcare utilisation were extracted from eligible studies. Results: 32 independent studies were identified. Pooled effects indicated that interventions were associated with a 32% reduction in the use of urgent healthcare (OR = 0.68, 95% CI = 0.57, 0.80). When study effects were grouped according to the components of the interventions used, significant effects were seen for interventions that included general education (OR = 0.66, 95% CI = 0.55, 0.81), Exercise (OR = 0.60, 95% CI = 0.48, 0.76) and relaxation therapy (OR = 0.48, 95% CI = 0.33, 0.70). Conclusions: Use of urgent healthcare in patients with COPD was significantly reduced by complex interventions. Complex interventions among people with COPD may reduce the use of urgent care, particularly those including education, exercise and relaxation. © 2013 Elsevier Ltd. All rights reserved.
Abstract.
Dickens C, Katon W, Blakemore A, Khara A, Tomenson B, Woodcock A, Fryer A, Guthrie E (2014). Complex interventions that reduce urgent care use in COPD: a systematic review with meta-regression. Respiratory Medicine, 108(3), 426-437.
Blakemore A, Dickens C, Guthrie E, Bower P, Kontopantelis E, Afzal C, Coventry PA (2014). Depression and anxiety predict health-related quality of life in chronic obstructive pulmonary disease: systematic review and meta-analysis.
Int J Chron Obstruct Pulmon Dis,
9, 501-512.
Abstract:
Depression and anxiety predict health-related quality of life in chronic obstructive pulmonary disease: systematic review and meta-analysis.
BACKGROUND: the causal association between depression, anxiety, and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD) is unclear. We therefore conducted a systematic review of prospective cohort studies that measured depression, anxiety, and HRQoL in COPD. METHODS: Electronic databases (Medline, Embase, Cumulative Index to Nursing and Allied Health Literature [CINAHL], British Nursing Index and Archive, PsycINFO and Cochrane database) were searched from inception to June 18, 2013. Studies were eligible for inclusion if they: used a nonexperimental prospective cohort design; included patients with a diagnosis of COPD confirmed by spirometry; and used validated measures of depression, anxiety, and HRQoL. Data were extracted and pooled using random effects models. RESULTS: Six studies were included in the systematic review; of these, three were included in the meta-analysis for depression and two were included for the meta-analysis for anxiety. Depression was significantly correlated with HRQoL at 1-year follow-up (pooled r=0.48, 95% confidence interval 0.37-0.57, P
Abstract.
Author URL.
Blakeley C, Blakemore A, Hunter C, Guthrie E, Tomenson B, Dickens C (2014). Does anxiety predict the use of urgent care by people with long term conditions? a systematic review with meta-analysis.
Journal of Psychosomatic Research,
77(3), 232-239.
Abstract:
Does anxiety predict the use of urgent care by people with long term conditions? a systematic review with meta-analysis
Objective: the role of anxiety in the use of urgent care in people with long term conditions is not fully understood. A systematic review was conducted with meta-analysis to examine the relationship between anxiety and future use of urgent healthcare among individuals with one of four long term conditions: diabetes; coronary heart disease, chronic obstructive pulmonary disease and asthma. Methods: Electronic searches of MEDLINE, EMBASE, PSYCINFO, CINAHL, the British Nursing Library and the Cochrane Library were conducted These searches were supplemented by hand-searching bibliographies, citation tracing eligible studies and asking experts within the field about relevant studies. Studies were eligible for inclusion if they: a) used a standardised measure of anxiety, b) used prospective cohort design, c) included adult patients diagnosed with coronary heart disease (CHD), asthma, diabetes or chronic obstructive pulmonary disease (COPD), d) assessed urgent healthcare use prospectively. Data regarding participants, methodology, and association between anxiety and urgent care use was extracted from studies eligible for inclusion. Odds ratios were calculated for each study and pooled using random effects models. Results: 8 independent studies were identified for inclusion in the meta-analysis, with a total of 28,823 individual patients. Pooled effects indicate that anxiety is not associated with an increase in the use of urgent care (OR. =. 1.078, p. =. 0.476), regardless of the type of service, or type of medical condition. Conclusions: Anxiety is not associated with increased use of urgent care. This finding is in contrast to similar studies which have investigated the role of depression as a risk factor for use of urgent care. © 2013.
Abstract.
Abbott RA, Whear R, Rodgers LR, Bethel A, Thompson Coon J, Kuyken W, Stein K, Dickens C (2014). Effectiveness of mindfulness-based stress reduction and mindfulness based cognitive therapy in vascular disease: a systematic review and meta-analysis of randomised controlled trials.
Journal of Psychosomatic Research,
76(5), 341-351.
Abstract:
Effectiveness of mindfulness-based stress reduction and mindfulness based cognitive therapy in vascular disease: a systematic review and meta-analysis of randomised controlled trials
Objective: to determine the effectiveness of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) on psychological and physical outcomes for people with vascular disease. Design: Systematic review and meta-analysis of randomised controlled trials. Data sources: AMED, CINAHL, EMBASE, British Nursing Index, Medline, Web of Science, PsycINFO, Cochrane Database of Systematic Reviews, Central, Social Sciences Citation Index, Social Policy and Practice, and HMIC from inception to January 2013. Review methods: Articles were screened for inclusion independently by two reviewers. Data extraction and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary. Random-effects meta-analyses were performed. Results: Nine articles (from eight original randomised controlled trials) met eligibility criteria and were included in the final review. In total, 578 participants were enrolled across the trials, with participants presenting with prehypertension/hypertension (n. = 3 trials), type 1 or 2 diabetes (n. = 2), heart disease (n. = 2) and stroke (n. = 1). Meta-analyses, using standardised mean differences, showed evidence of reductions in stress (- 0.36; 95% CI - 0.67 to - 0.09; p. = 0.01), depression (- 0.35; 95% CI - 0.53 to - 0.16; p. = 0.003) and anxiety (- 0.50; 95% CI - 0.70 to - 0.29; p. < 0.001). Effects on physical outcomes (blood pressure, albuminuria, stress hormones) were mixed. Conclusion: Whilst populations with vascular disease appear to derive a range of psychological benefits from MBSR/MBCT intervention, the effects on physical parameters of disease are not yet established. More robust studies, with longer term follow-up, are required to ascertain full effectiveness of such intervention. © 2014.
Abstract.
Hudson JL, Bundy C, Coventry PA, Dickens C (2014). Exploring the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. A systematic review with meta-analysis.
J Psychosom Res,
76(4), 265-274.
Abstract:
Exploring the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. A systematic review with meta-analysis.
OBJECTIVE: Depression and anxiety are common in diabetes and are associated with lower diabetes self-care adherence. How this occurs is unclear. Our systematic review explored the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. METHODS: Medline, Psycinfo, EMBASE, and CINAHL were searched from inception to June 2013. Data on associations between cognitive illness representations, poor emotional health, and diabetes self-care were extracted. Random effects meta-analysis was used to test the relationship between cognitive illness representations and poor emotional health. Their combined effect on diabetes self-care was narratively evaluated. RESULTS: Nine cross-sectional studies were included. Increased timeline cyclical, consequences, and seriousness beliefs were associated with poorer emotional health symptoms. Lower perceived personal control was associated with increased depression and anxiety, but not mixed anxiety and depressive symptoms. Remaining cognitive illness representation domains had mixed statistically significant and non-significant relationships across emotional states or were measured only once. Effect sizes ranged from small to large (r=±0.20 to 0.51). Two studies explored the combined effects of cognitions and emotions on diabetes self-care. Both showed that cognitive illness representations have an independent effect on diabetes self-care, but only one study found that depression has an independent effect also. CONCLUSIONS: Associations between cognitive illness representations and poor emotional health were in the expected direction - negative diabetes perceptions were associated with poorer emotional health. Few studies examined the relative effects of cognitions and emotions on diabetes self-care. Longitudinal studies are needed to clarify directional pathways.
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Author URL.
O'Bleness M, Searles VB, Dickens CM, Astling D, Albracht D, Mak ACY, Lai YYY, Lin C, Chu C, Graves T, et al (2014). Finished sequence and assembly of the DUF1220-rich 1q21 region using a haploid human genome.
BMC Genomics,
15(1).
Abstract:
Finished sequence and assembly of the DUF1220-rich 1q21 region using a haploid human genome.
BACKGROUND: Although the reference human genome sequence was declared finished in 2003, some regions of the genome remain incomplete due to their complex architecture. One such region, 1q21.1-q21.2, is of increasing interest due to its relevance to human disease and evolution. Elucidation of the exact variants behind these associations has been hampered by the repetitive nature of the region and its incomplete assembly. This region also contains 238 of the 270 human DUF1220 protein domains, which are implicated in human brain evolution and neurodevelopment. Additionally, examinations of this protein domain have been challenging due to the incomplete 1q21 build. To address these problems, a single-haplotype hydatidiform mole BAC library (CHORI-17) was used to produce the first complete sequence of the 1q21.1-q21.2 region. RESULTS: We found and addressed several inaccuracies in the GRCh37sequence of the 1q21 region on large and small scales, including genomic rearrangements and inversions, and incorrect gene copy number estimates and assemblies. The DUF1220-encoding NBPF genes required the most corrections, with 3 genes removed, 2 genes reassigned to the 1p11.2 region, 8 genes requiring assembly corrections for DUF1220 domains (~91 DUF1220 domains were misassigned), and multiple instances of nucleotide changes that reassigned the domain to a different DUF1220 subtype. These corrections resulted in an overall increase in DUF1220 copy number, yielding a haploid total of 289 copies. Approximately 20 of these new DUF1220 copies were the result of a segmental duplication from 1q21.2 to 1p11.2 that included two NBPF genes. Interestingly, this duplication may have been the catalyst for the evolutionarily important human lineage-specific chromosome 1 pericentric inversion. CONCLUSIONS: Through the hydatidiform mole genome sequencing effort, the 1q21.1-q21.2 region is complete and misassemblies involving inter- and intra-region duplications have been resolved. The availability of this single haploid sequence path will aid in the investigation of many genetic diseases linked to 1q21, including several associated with DUF1220 copy number variations. Finally, the corrected sequence identified a recent segmental duplication that added 20 additional DUF1220 copies to the human genome, and may have facilitated the chromosome 1 pericentric inversion that is among the most notable human-specific genomic landmarks.
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Author URL.
Coventry PA, Dickens C, Todd C (2014). How does mental-physical multimorbidity express itself in lived time and space? a phenomenological analysis of encounters with depression and chronic physical illness.
Soc Sci Med,
118, 108-118.
Abstract:
How does mental-physical multimorbidity express itself in lived time and space? a phenomenological analysis of encounters with depression and chronic physical illness.
Mental-physical multimorbidity (the co-existence of mental and physical ill health) is highly prevalent and associated with significant impairments and high healthcare costs. While the sociology of chronic illness has developed a mature discourse on coping with long term physical illness the impact of mental and physical health have remained analytically separated, highlighting the need for a better understanding of the day-to-day complexities encountered by people living with mental-physical multimorbidity. We used the phenomenological paradigm of the lived body to elucidate how the experience of mental-physical multimorbidity shapes people's lifeworlds. Nineteen people with chronic obstructive pulmonary disease (COPD) and depression (defined as a score ≥8 on depression scale of Hospital Anxiety and Depression Scale) were recruited from secondary NHS care and interviewed at their homes. Data were analysed phenomenologically using van Manen's lifeworld existential framework of the lived body, lived time, lived space, lived relations. Additionally, we re-analysed data (using the same framework) collected from 13 people recruited from secondary NHS care with either COPD, rheumatoid arthritis, heart disease, or type 1 or type 2 diabetes and depression. The phenomenology of mental-physical multimorbidity was articulated through embodied and emotional encounters with day-to-day life in four ways: [a] participants' perception of lived time and lived space contracted; [b] time and [c] space were experienced as liminal categories, enforcing negative mood and temporal and spatial contraction; and [d] time and space could also be customised to reinstate agency and self-determination. Mental-physical multimorbidity negatively impacts on individuals' perceptions of lived time and lived space, leading to a loss of agency, heightened uncertainty, and poor well-being. Harnessing people's capacity to modify their experience of time and space may be a novel way to support people with mental-physical multimorbidity to live well with illness.
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Author URL.
Lourida I, Soni M, Kuzma E, Thompson‐Coon J, Dickens C, Kos K, Llewellyn DJ (2014). P2‐309: DO PARATHYROID HORMONE LEVELS PLAY a ROLE IN DEMENTIA? a SYSTEMATIC REVIEW. Alzheimer's & Dementia, 10(4S_Part_15), p591-p592.
Trick L, Watkins E, Dickens C (2014). The association between perseverative negative cognitive processes and negative affect in people with long term conditions: a protocol for systematic review and meta-analysis.
Syst Rev,
3Abstract:
The association between perseverative negative cognitive processes and negative affect in people with long term conditions: a protocol for systematic review and meta-analysis.
BACKGROUND: Depression is common in people with long term conditions (LTCs) and is associated with worse medical outcomes. Understanding the mechanisms underpinning this relationship could help predict who is at increased risk of adverse medical outcomes, and lead to the development of novel interventions. Perseverative negative cognitive processes, such as worry and rumination, involve repetitive and frequent thoughts about oneself and one's concerns. These processes have been associated with negative affect, and also adverse medical outcomes. The results of prospective studies, which would allow causal inferences to be drawn, are more equivocal however. Furthermore, the majority of studies have been conducted in physically healthy individuals, and we do not know to what extent these findings will generalise to people with LTCs. METHODS/DESIGN: Electronic databases will be searched using a search strategy including controlled vocabulary and text words related to perseverative negative cognitive processes (such as worry and rumination) and negative affect (including depression and anxiety). Records will be hand-searched for terms related to LTCs. Citation and bibliography searching will be conducted, and authors of included studies will be contacted to identify unpublished studies. Studies will be included if they contain a standardised measure of the prospective association between perseverative negative cognitive processes and negative affect, or vice versa, in people with LTCs. Narrative and meta-analytic methods will be used to synthesize the data collected. DISCUSSION: This review will identify and synthesise studies of the prospective association between perseverative negative cognitive processes and negative affect among people with LTCs. The findings will help to identify whether worry and rumination could cause depression and anxiety in people with LTCs, and might indicate whether perseverative negative cognitive processes are appropriate targets for treatment.
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Author URL.
Harris S, Farrand P, Dickens C (2013). Behavioural activation interventions for depressed individuals with a chronic physical illness: a systematic review protocol.
Syst Rev,
2Abstract:
Behavioural activation interventions for depressed individuals with a chronic physical illness: a systematic review protocol.
BACKGROUND: Depression is common in people with chronic physical illness and is associated with worse medical outcomes. Cognitive behavioural therapy and problem-solving improve depression, although usually have small to moderate effects among people with chronic physical illness. Behavioural activation interventions for depression, which aim to increase positive reinforcement from the environment by encouraging individuals to increase pleasant/rewarding activities, have been reported to be equivalent to cognitive behavioural therapy. However, the effectiveness of behavioural activation interventions for depression in individuals with chronic physical illness is unclear. The aims of this systematic review are to identify the extent to which different forms of behavioural activation have been used as a treatment for depression in this population, examine the effectiveness of the interventions, and identify any adaptations which have been made specifically to the interventions for individuals with a range of chronic physical illnesses. METHODS/DESIGN: Electronic databases will be systematically searched using terms relevant to behavioural activation and depression, and the subset of studies in people with chronic physical illnesses will be identified by manual searching. References and citations of eligible studies will be searched and experts in this field will be contacted to identify additional papers. All study designs will be included in this review to allow for a more extensive identification of the extent of different forms of behavioural activation interventions. The different forms of behavioural activation and the specific chronic physical health conditions for which this intervention has been used will be reviewed narratively. For the effectiveness of the interventions, if sufficient randomised controlled trials have been undertaken the results will be meta-analysed. Non-randomised studies will be narratively synthesised and adaptations to the interventions will also be narratively reviewed. DISCUSSION: the findings will inform the design, development and subsequent evaluation of a behavioural activation intervention for depression in people with a chronic physical illness. PROSPERO registration number: CRD42013004500.
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Author URL.
Dickens C, Cherrington A, Adeyemi I, Roughley K, Bower P, Garrett C, Bundy C, Coventry P (2013). Characteristics of Psychological Interventions That Improve Depression in People with Coronary Heart Disease: a Systematic Review and Meta-Regression.
PSYCHOSOMATIC MEDICINE,
75(2), 211-221.
Author URL.
Dickens C, Katon W, Blakemore A, Khara A, Tomenson B, Woodcock A, Fryer A, Guthrie E (2013). Complex interventions that reduce urgent care use in COPD: a systematic review with meta-regression. Respiratory Medicine
Blakeley C, Blakemore A, Hunter C, Guthrie E, Tomenson B, Dickens C (2013). Does anxiety predict the use of urgent care by people with long term conditions? a systematic review with meta-analysis. Journal of Psychosomatic Research
Meurs M, Zuidersma M, Dickens C, De Jonge P (2013). Examining the relation between post myocardial infarction depression and cardiovascular prognosis using a validated prediction model for post myocardial mortality.
International Journal of Cardiology,
167(6), 2533-2538.
Abstract:
Examining the relation between post myocardial infarction depression and cardiovascular prognosis using a validated prediction model for post myocardial mortality
Background: the presence of depressive symptoms after myocardial infarction (MI) is associated with worsened cardiovascular (CV) prognosis. To date, it remains unclear to what extent the relationship between post-MI depression and prognosis is confounded by factors related to prognosis. We assessed the relationship between depression and prognosis while adjusting for a well validated risk score for mortality after a MI. Methods: Data of 494 MI patients were derived from the Depression after Myocardial Infarction study (DepreMI). Scores on the Beck Depression Inventory (BDI) (cut-off ≥ 10) were used to relate depressive symptoms (divided in somatic/affective and cognitive/affective symptoms) to the Global Registry of Acute Coronary Events (GRACE) risk score, using Pearson correlations. Cox regression analysis was performed to investigate the predictive value of depressive symptoms for prognosis after adjusting for GRACE score. Results: Overall, depressive symptoms were significantly correlated with GRACE score (r = 0.12, p = 0.008). Specifically, somatic/affective symptoms were positively correlated (r = 0.23, p < 0.001), whereas cognitive/affective symptoms tended to be negatively correlated (r = - 0.08, p = 0.097) with GRACE score. Adjusting for GRACE score did not affect the HR for recurrent CV events associated with total BDI- score (adjusted hazard ratio (HR) per point increase in BDI score 1.05 p = 0.002 95% CI 1.02-1.08 n = 463). Furthermore GRACE score attenuated the HR associated with 1 SD increase in somatic/affective depressive symptoms from 1.44 (1.20-1.72) to 1.31 (1.08-1.58). Conclusion: GRACE score was positively associated with somatic/affective depressive symptoms. GRACE score explained only partly the association between (somatic/affective) depressive symptoms and CV prognosis. © 2012 Elsevier Ireland Ltd.
Abstract.
Bird T, Mansell W, Dickens C, Tai S (2013). Is There a Core Process Across Depression and Anxiety?.
COGNITIVE THERAPY AND RESEARCH,
37(2), 307-323.
Author URL.
Jeeva F, Dickens C, Coventry P, Bundy C, Davies L (2013). Is treatment of depression cost-effective in people with diabetes? a systematic review of the economic evidence.
Int J Technol Assess Health Care,
29(4), 384-391.
Abstract:
Is treatment of depression cost-effective in people with diabetes? a systematic review of the economic evidence.
OBJECTIVES: Depression is common in diabetes and linked to a wide range of adverse outcomes. UK policy indicates that depression should be treated using conventional psychological treatments in a stepped care framework. This review aimed to identify current economic evidence of psychological treatments for depression among people with diabetes. METHOD: Electronic search strategies (conducted in MEDLINE, EMBASE, PsycINFO, CINAHL, NHS EED) combined clinical and economic search terms to identify full economic evaluations of the relevant interventions. Prespecified screening and inclusion criteria were used. Standardized data extraction and critical appraisal were conducted and the results summarized qualitatively. RESULTS: Excluding duplicates, 1,516 studies for co-morbid depression and diabetes were screened. Four economic evaluations were identified. The studies found that the interventions improved health status, reduced depression and were cost-effective compared with usual care. The studies were all U.S.-based and evaluated collaborative care programs that included psychological therapies. Critical appraisal indicated limitations with the study designs, analysis and results for all studies. CONCLUSIONS: the review highlighted the paucity of evidence in this area. The four studies indicated the potential of interventions to reduce depression and be cost-effective compared with usual care. Two studies reported costs per QALY gained of USD 267 to USD 4,317, whilst two studies reported the intervention dominated usual care, with net savings of USD 440 to USD 612 and net gains in patient free days or QALYs.
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Author URL.
Lourida I, Thompson‐Coon J, Dickens C, Soni M, Kos K, Llewellyn D (2013). P3–198: a systematic review of the relationship between parathyroid hormone levels and cognitive function and dementia. Alzheimer's & Dementia, 9(4S_Part_16), p627-p627.
Coventry PA, Bower P, Keyworth C, Kenning C, Knopp J, Garrett C, Hind D, Malpass A, Dickens C (2013). The effect of complex interventions on depression and anxiety in chronic obstructive pulmonary disease: systematic review and meta-analysis.
PLoS One,
8(4).
Abstract:
The effect of complex interventions on depression and anxiety in chronic obstructive pulmonary disease: systematic review and meta-analysis.
BACKGROUND: Depression and anxiety are very common in people with chronic obstructive pulmonary disease (COPD) and are associated with excess morbidity and mortality. Patients prefer non-drug treatments and clinical guidelines promote non-pharmacological interventions as first line therapy for depression and anxiety in people with long term conditions. However the comparative effectiveness of psychological and lifestyle interventions among COPD patients is not known. We assessed whether complex psychological and/or lifestyle interventions are effective in reducing symptoms of anxiety and depression in patients with COPD. We then determined what types of psychological and lifestyle interventions are most effective. METHODS AND FINDINGS: Systematic review of randomised controlled trials of psychological and/or lifestyle interventions for adults with COPD that measured symptoms of depression and/or anxiety. CENTRAL, Medline, Embase, PsychINFO, CINAHL, ISI Web of Science and Scopus were searched up to April 2012. Meta-analyses using random effects models were undertaken to estimate the average effect of interventions on depression and anxiety. Thirty independent comparisons from 29 randomised controlled trials (n = 2063) were included in the meta-analysis. Overall, psychological and/or lifestyle interventions were associated with small reductions in symptoms of depression (standardised mean difference -0.28, 95% confidence interval -0.41 to -0.14) and anxiety (standardised mean difference -0.23, 95% confidence interval -0.38 to -0.09). Multi-component exercise training was the only intervention subgroup associated with significant treatment effects for depression (standardised mean difference -0.47, 95% confidence interval -0.66 to -0.28), and for anxiety (standardised mean difference -0.45, 95% confidence interval -0.71 to -0.18). CONCLUSIONS: Complex psychological and/or lifestyle interventions that include an exercise component significantly improve symptoms of depression and anxiety in people with COPD. Furthermore, multi-component exercise training effectively reduces symptoms of anxiety and depression in all people with COPD regardless of severity of depression or anxiety, highlighting the importance of promoting physical activity in this population.
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Coventry PA, Lovell K, Dickens C, Bower P, Chew-Graham C, Cherrington A, Garrett C, Gibbons CJ, Baguley C, Roughley K, et al (2013). Update on the collaborative interventions for circulation and depression (COINCIDE) trial: changes to planned methodology of a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease.
Trials,
14Abstract:
Update on the collaborative interventions for circulation and depression (COINCIDE) trial: changes to planned methodology of a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease.
BACKGROUND: the COINCIDE trial aims to evaluate the effectiveness and cost-effectiveness of a collaborative care intervention for depression in people with diabetes and/or coronary heart disease attending English general practices. DESIGN: This update details changes to the cluster and patient recruitment strategy for the COINCIDE study. The original protocol was published in Trials (http://www.trialsjournal.com/content/pdf/1745-6215-13-139.pdf). Modifications were made to the recruitment targets in response to lower-than-expected patient recruitment at the first ten general practices recruited into the study. In order to boost patient numbers and retain statistical power, the number of general practices recruited was increased from 30 to 36. Follow-up period was shortened from 6 months to 4 months to ensure that patients recruited to the trial could be followed up by the end of the study. RESULTS: Patient recruitment began on the 01/05/2012 and is planned to be completed by the 30/04/2013. Recruitment for general practices was completed on 31/10/2012, by which time the target of 36 practices had been recruited. The main trial results will be published in a peer-reviewed journal. CONCLUSION: the data from the trial will provide evidence on the effectiveness and cost-effectiveness of collaborative care for depression in people with diabetes and/or coronary heart disease. TRIAL REGISTRATION NUMBER: ISRCTN80309252.
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Garrett CR, Gask LL, Hays R, Cherrington A, Bundy C, Dickens C, Waheed W, Coventry PA (2012). Accessing primary health care: a meta-ethnography of the experiences of British South Asian patients with diabetes, coronary heart disease or a mental health problem.
Chronic Illn,
8(2), 135-155.
Abstract:
Accessing primary health care: a meta-ethnography of the experiences of British South Asian patients with diabetes, coronary heart disease or a mental health problem.
OBJECTIVES: to develop an explanatory framework of the problems accessing primary care health services experienced by British South Asian patients with a long-term condition or mental health problem. METHODS: This study used meta-ethnographic methods. Published qualitative studies were identified from a structured search of six databases and themes synthesized across studies to develop a new explanatory framework. RESULTS: Initial searches identified 951 potentially relevant records from which a total of 27 articles were identified that met inclusion and exclusion criteria. Twelve of these articles were chosen on the basis of their quality and relevance. These 12 articles described themes relating to the cultural, spatial and temporal dimensions of patient experiences of accessing and using health care. Our interpretive synthesis showed that access to primary care among British South Asians with diabetes, coronary heart disease and psychological health problems is co-constructed and negotiated over time and space along the key domains of the candidacy model of access: from help-seeking to interactions at the interface to following treatment advice. In the case of each condition, British South Asians' claims to candidacy were constrained where their individual as well as broader social and cultural characteristics lacked fit with professionals' ways of working and cultural typifications. CONCLUSION: Interventions that positively affect professionals' capacity to support patient claims to candidacy are likely to help support British South Asians overcome a broad range of barriers to care for physical and mental health problems.
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Coventry PA, Lovell K, Dickens C, Bower P, Chew-Graham C, Cherrington A, Garrett C, Gibbons CJ, Baguley C, Roughley K, et al (2012). Collaborative Interventions for Circulation and Depression (COINCIDE): study protocol for a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease.
Trials,
13Abstract:
Collaborative Interventions for Circulation and Depression (COINCIDE): study protocol for a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease.
BACKGROUND: Depression is up to two to three times as common in people with long-term conditions. It negatively affects medical management of disease and self-care behaviors, and leads to poorer quality of life and high costs in primary care. Screening and treatment of depression is increasingly prioritized, but despite initiatives to improve access and quality of care, depression remains under-detected and under-treated, especially in people with long-term conditions. Collaborative care is known to positively affect the process and outcome of care for people with depression and long-term conditions, but its effectiveness outside the USA is still relatively unknown. Furthermore, collaborative care has yet to be tested in settings that resemble more naturalistic settings that include patient choice and the usual care providers. The aim of this study was to test the effectiveness of a collaborative-care intervention, for people with depression and diabetes/coronary heart disease in National Health Service (NHS) primary care, in which low-intensity psychological treatment services are delivered by the usual care provider - Increasing Access to Psychological Therapies (IAPT) services. The study also aimed to evaluate the cost-effectiveness of the intervention over 6 months, and to assess qualitatively the extent to which collaborative care was implemented in the intervention general practices. METHODS: This is a cluster randomized controlled trial of 30 general practices allocated to either collaborative care or usual care. Fifteen patients per practice will be recruited after a screening exercise to detect patients with recognized depression (≥10 on the nine-symptom Patient Health Questionnaire; PHQ-9). Patients in the collaborative-care arm with recognized depression will be offered a choice of evidence-based low-intensity psychological treatments based on cognitive and behavioral approaches. Patients will be case managed by psychological well-being practitioners employed by IAPT in partnership with a practice nurse and/or general practitioner. The primary outcome will be change in depressive symptoms at 6 months on the 90-item Symptoms Checklist (SCL-90). Secondary outcomes include change in health status, self-care behaviors, and self-efficacy. A qualitative process evaluation will be undertaken with patients and health practitioners to gauge the extent to which the collaborative-care model is implemented, and to explore sustainability beyond the clinical trial. DISCUSSION: COINCIDE will assess whether collaborative care can improve patient-centered outcomes, and evaluate access to and quality of care of co-morbid depression of varying intensity in people with diabetes/coronary heart disease. Additionally, by working with usual care providers such as IAPT, and by identifying and evaluating interventions that are effective and appropriate for routine use in the NHS, the COINCIDE trial offers opportunities to address translational gaps between research and implementation. TRIAL REGISTRATION NUMBER: ISRCTN80309252 TRIAL STATUS: Open.
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Author URL.
Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P (2012). Collaborative care for depression and anxiety problems.
Cochrane Database Syst Rev,
10Abstract:
Collaborative care for depression and anxiety problems.
BACKGROUND: Common mental health problems, such as depression and anxiety, are estimated to affect up to 15% of the UK population at any one time, and health care systems worldwide need to implement interventions to reduce the impact and burden of these conditions. Collaborative care is a complex intervention based on chronic disease management models that may be effective in the management of these common mental health problems. OBJECTIVES: to assess the effectiveness of collaborative care for patients with depression or anxiety. SEARCH METHODS: We searched the following databases to February 2012: the Cochrane Collaboration Depression, Anxiety and Neurosis Group (CCDAN) trials registers (CCDANCTR-References and CCDANCTR-Studies) which include relevant randomised controlled trials (RCTs) from MEDLINE (1950 to present), EMBASE (1974 to present), PsycINFO (1967 to present) and the Cochrane Central Register of Controlled Trials (CENTRAL, all years); the World Health Organization (WHO) trials portal (ICTRP); ClinicalTrials.gov; and CINAHL (to November 2010 only). We screened the reference lists of reports of all included studies and published systematic reviews for reports of additional studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) of collaborative care for participants of all ages with depression or anxiety. DATA COLLECTION AND ANALYSIS: Two independent researchers extracted data using a standardised data extraction sheet. Two independent researchers made 'Risk of bias' assessments using criteria from the Cochrane Collaboration. We combined continuous measures of outcome using standardised mean differences (SMDs) with 95% confidence intervals (CIs). We combined dichotomous measures using risk ratios (RRs) with 95% CIs. Sensitivity analyses tested the robustness of the results. MAIN RESULTS: We included seventy-nine RCTs (including 90 relevant comparisons) involving 24,308 participants in the review. Studies varied in terms of risk of bias.The results of primary analyses demonstrated significantly greater improvement in depression outcomes for adults with depression treated with the collaborative care model in the short-term (SMD -0.34, 95% CI -0.41 to -0.27; RR 1.32, 95% CI 1.22 to 1.43), medium-term (SMD -0.28, 95% CI -0.41 to -0.15; RR 1.31, 95% CI 1.17 to 1.48), and long-term (SMD -0.35, 95% CI -0.46 to -0.24; RR 1.29, 95% CI 1.18 to 1.41). However, these significant benefits were not demonstrated into the very long-term (RR 1.12, 95% CI 0.98 to 1.27).The results also demonstrated significantly greater improvement in anxiety outcomes for adults with anxiety treated with the collaborative care model in the short-term (SMD -0.30, 95% CI -0.44 to -0.17; RR 1.50, 95% CI 1.21 to 1.87), medium-term (SMD -0.33, 95% CI -0.47 to -0.19; RR 1.41, 95% CI 1.18 to 1.69), and long-term (SMD -0.20, 95% CI -0.34 to -0.06; RR 1.26, 95% CI 1.11 to 1.42). No comparisons examined the effects of the intervention on anxiety outcomes in the very long-term.There was evidence of benefit in secondary outcomes including medication use, mental health quality of life, and patient satisfaction, although there was less evidence of benefit in physical quality of life. AUTHORS' CONCLUSIONS: Collaborative care is associated with significant improvement in depression and anxiety outcomes compared with usual care, and represents a useful addition to clinical pathways for adult patients with depression and anxiety.
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Author URL.
Dickens C, Cherrington A, McGowan L (2012). Depression and health-related quality of life in people with coronary heart disease: a systematic review.
Eur J Cardiovasc Nurs,
11(3), 265-275.
Abstract:
Depression and health-related quality of life in people with coronary heart disease: a systematic review.
BACKGROUND: Depression affects 20% of people with coronary heart disease (CHD) and predicts worse health-related quality of life (HRQoL), but in primary studies the strength of this reported relationship has been inconsistent. AIMS AND METHODS: We conducted a systematic review to investigate the extent to which depression independently predicts subsequent physical HRQoL. We searched electronic databases (MEDLINE, PsycINFO, CINAHL and EMBASE) to identify prospective cohort studies that included CHD patients, focused on depression and subsequent physical HRQoL using standardised measures. Included studies were assessed for methodological quality. RESULTS: We identified 11 independent studies, of which nine showed a significant association between depression and subsequent physical HRQoL. There was no systematic methodological difference between those studies that did and did not show a significant association; in particular the results did not appear to be affected by the way depression or physical HRQoL was measured. Five of the 11 studies were of moderate to high methodological quality and controlled for both HRQoL and the severity of CHD at baseline. Four studies showed a significant association between depression and HRQoL. CONCLUSIONS: Depression predicts subsequent physical HRQoL and this association was not attributable to confounding effects of baseline HRQoL or the severity of the CHD. Identification of depressed CHD patients may improve targeting of resources at people at increased risk of worse physical HRQoL. Treating depression may improve subsequent physical HRQoL, though this needs to be established in future randomised controlled trials.
Abstract.
Author URL.
Dickens C, Dickens C, Katon W, Blakemore A, Khara A, Jackson J, Walker L, Guthrie E, McGowan L, Tomenson B, et al (2012). Does depression predict the use of urgent and unscheduled care by people with long term conditions? a systematic review with meta-analysis.
Journal of Psychosomatic ResearchAbstract:
Does depression predict the use of urgent and unscheduled care by people with long term conditions? a systematic review with meta-analysis
Background: Factors that drive the use of urgent healthcare among people with chronic physical illness (i.e. long term conditions-LTCs) are poorly understood. We conducted a systematic review with meta analysis to examine the strength of association between depression and subsequent use of urgent healthcare among people with LTCs. Methods: Electronic searches of MEDLINE, EMBASE, PSYCINFO, CINAHL, the British Nursing Library and the Cochrane Library 2011 were conducted, supplemented by hand-searching bibliographies, citation tracing eligible studies and asking experts about relevant studies. Studies were eligible for inclusion if they: i)used prospective cohort design, ii)included patients with diabetes, asthma, chronic obstructive pulmonary disease or coronary heart disease, iii)used a standardised measure of depression, and iv)assessed urgent healthcare utilisation prospectively. Data on the subjects recruited, methods used and the association between depression and subsequent urgent healthcare utilisation were extracted from eligible studies. Odds ratios (ORs) were calculated for each study and pooled using random effects models. Results: 16 independent studies were identified. Pooled effects indicated that depression was associated with a 49% increase in the odds of urgent healthcare utilisation (OR = 1.49, p <. 0005). This effect was not significantly affected by publication bias or inclusion of studies of low quality. Effects were much smaller and non-significant among the 3 studies that controlled for other covariates, including severity of illness (OR = 1.13, p =. 31). Conclusions: Depression was associated with increased urgent healthcare use, but not in the minority of studies that controlled for other covariates. This possibly suggests confounding, but the severity measures may themselves have been influenced by depression. Crown Copyright © 2012.
Abstract.
Dickens C, Katon W, Blakemore A, Khara A, McGowan L, Tomenson B, Jackson J, Walker L, Guthrie E (2012). Does depression predict the use of urgent and unscheduled care by people with long term conditions? a systematic review with meta-analysis.
Journal of Psychosomatic Research,
73(5), 334-342.
Abstract:
Does depression predict the use of urgent and unscheduled care by people with long term conditions? a systematic review with meta-analysis
Background: Factors that drive the use of urgent healthcare among people with chronic physical illness (i.e. long term conditions-LTCs) are poorly understood. We conducted a systematic review with meta analysis to examine the strength of association between depression and subsequent use of urgent healthcare among people with LTCs. Methods: Electronic searches of MEDLINE, EMBASE, PSYCINFO, CINAHL, the British Nursing Library and the Cochrane Library 2011 were conducted, supplemented by hand-searching bibliographies, citation tracing eligible studies and asking experts about relevant studies. Studies were eligible for inclusion if they: i)used prospective cohort design, ii)included patients with diabetes, asthma, chronic obstructive pulmonary disease or coronary heart disease, iii)used a standardised measure of depression, and iv)assessed urgent healthcare utilisation prospectively. Data on the subjects recruited, methods used and the association between depression and subsequent urgent healthcare utilisation were extracted from eligible studies. Odds ratios (ORs) were calculated for each study and pooled using random effects models. Results: 16 independent studies were identified. Pooled effects indicated that depression was associated with a 49% increase in the odds of urgent healthcare utilisation (OR = 1.49, p. < 0005). This effect was not significantly affected by publication bias or inclusion of studies of low quality. Effects were much smaller and non-significant among the 3 studies that controlled for other covariates, including severity of illness (OR = 1.13, p = 31). Conclusions: Depression was associated with increased urgent healthcare use, but not in the minority of studies that controlled for other covariates. This possibly suggests confounding, but the severity measures may themselves have been influenced by depression. © 2012.
Abstract.
Meurs M, Zuidersma M, Dickens C, de Jonge P (2012). Examining the relation between post myocardial infarction depression and cardiovascular prognosis using a validated prediction model for post myocardial mortality. International Journal of Cardiology
Bird T, Mansell W, Dickens C, Tai S (2012). Is There a Core Process Across Depression and Anxiety?. Cognitive Therapy and Research, 1-17.
Dickens C, Coventry P, Khara A, Bower P, Mansell W, Bakerly ND (2012). Perseverative negative cognitive processes are associated with depression in people with long-term conditions.
Chronic Illn,
8(2), 102-111.
Abstract:
Perseverative negative cognitive processes are associated with depression in people with long-term conditions.
BACKGROUND: Perseverative negative cognitive processes, such as worry, suppression and avoidance of undesirable thoughts, have been linked to persistence and relapse of depression. Such processes could account for poor treatment response though they have received little research attention in people with long-term conditions (LTCs). METHOD: We conducted a cross-sectional study to investigate the associations of perseverative negative cognitive processes with depression among medical outpatients with LTCs. In 190 patients, we recorded levels of depression (Hospital Anxiety and Depression Scale), worry (Penn State Worry Questionnaire), suppression (White Bear Suppression Inventory) and avoidance of undesirable thoughts (Acceptance and Action Questionnaire). Associations between these constructs were assessed using linear correlation and logistic regression. RESULTS: Both depression (32%) and anxiety (40%) were common in patients recruited. After controlling for demographic and medical confounders, subjects in the top tertile of worry, suppression and avoidance of undesirable thoughts were 20 (95% CIs, 6.6-58.3), 10 (95% CIs, 3.5-25.9) and 22 (95% CIs, 6.0-80.0) times more likely to have possible depression compared to those in the lowest tertile. CONCLUSIONS: Prospective research is required to investigate causal relationships between these constructs, and to assess the potential of psychological interventions that target these processes to improve outcomes in patients with LTCs.
Abstract.
Author URL.
Dickens C, Cherrington A, McGowan L, Taylor CB (2011). Do Cognitive and Behavioral Factors Mediate the Impact of Depression on Medical Outcomes in People with Coronary Heart Disease?.
J Cardiopulm Rehabil PrevAbstract:
Do Cognitive and Behavioral Factors Mediate the Impact of Depression on Medical Outcomes in People with Coronary Heart Disease?
PURPOSE:: Depression is common in people with coronary heart disease (CHD) and predicts worse cardiac outcomes. Cognitive and behavioral mechanisms have been proposed to explain this association, although the mediating role of these mechanisms remains unclear. We conducted a prospective cohort study to investigate whether the impact of depression on subsequent impaired health-related quality of life (HRQoL) was mediated by cognitive and behavioral pathways. METHODS:: Demographic and medical characteristics, depression (Hospital Anxiety and Depression Scale), illness cognitions (Brief Illness Perceptions Questionnaire and Cardiac Anxiety Questionnaire), awareness of somatic symptoms (Symptom Checklist-90, revised version), and health behaviors were recorded from 255 primary care patients with CHD. The Short Form-36 was completed by 201 participants 6 months later. RESULTS:: Twenty-five participants (9.8%) were depressed at baseline. Short Form-36 Physical Component Score (PCS) was significantly lower in participants who were depressed (mean PCS score = 29.8 versus 38.0, P =. 001). After controlling for demographic and medical variables, depression continued to be associated with subsequent PCS [B = -0.84(0.20), P <. 0005]. When cardiac anxiety, awareness of somatic symptoms, and negative illness perceptions were added to the regression model, depression no longer continued to make a significant independent contribution to the model [B = -0.3(0.2), P =. 16]. Maladaptive health behaviors did not fulfill criteria to mediate the relationship between depression and impaired health-related quality of life. CONCLUSIONS:: Findings indicate that the impact of depression on HRQoL could be mediated by cardiac anxiety, awareness of somatic symptoms, and negative illness perceptions, but not maladaptive health behaviors. Psychological interventions targeting these mediators have potential to improve HRQoL in people with CHD.
Abstract.
Author URL.
Dickens C, Cherrington A, McGowan L (2011). Do cognitive and behavioral factors mediate the impact of depression on medical outcomes in people with coronary heart disease?.
J Cardiopulm Rehabil Prev,
31(2), 105-110.
Abstract:
Do cognitive and behavioral factors mediate the impact of depression on medical outcomes in people with coronary heart disease?
PURPOSE: Depression is common in people with coronary heart disease (CHD) and predicts worse cardiac outcomes. Cognitive and behavioral mechanisms have been proposed to explain this association, although the mediating role of these mechanisms remains unclear. We conducted a prospective cohort study to investigate whether the impact of depression on subsequent impaired health-related quality of life (HRQoL) was mediated by cognitive and behavioral pathways. METHODS: Demographic and medical characteristics, depression (Hospital Anxiety and Depression Scale), illness cognitions (Brief Illness Perceptions Questionnaire and Cardiac Anxiety Questionnaire), awareness of somatic symptoms (Symptom Checklist-90, revised version), and health behaviors were recorded from 255 primary care patients with CHD. The Short Form-36 was completed by 201 participants 6 months later. RESULTS: Twenty-five participants (9.8%) were depressed at baseline. Short Form-36 Physical Component Score (PCS) was significantly lower in participants who were depressed (mean PCS score = 29.8 versus 38.0, P =. 001). After controlling for demographic and medical variables, depression continued to be associated with subsequent PCS [B = -0.84 (0.20), P <. 0005]. When cardiac anxiety, awareness of somatic symptoms, and negative illness perceptions were added to the regression model, depression no longer continued to make a significant independent contribution to the model [B = -0.3 (0.2), P =. 16]. Maladaptive health behaviors did not fulfill criteria to mediate the relationship between depression and impaired health-related quality of life. CONCLUSIONS: Findings indicate that the impact of depression on HRQoL could be mediated by cardiac anxiety, awareness of somatic symptoms, and negative illness perceptions, but not maladaptive health behaviors. Psychological interventions targeting these mediators have potential to improve HRQoL in people with CHD.
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Author URL.
Bower P, Macdonald W, Harkness E, Gask L, Kendrick T, Valderas JM, Dickens C, Blakeman T, Sibbald B (2011). Multimorbidity, service organization and clinical decision making in primary care: a qualitative study.
Fam Pract,
28(5), 579-587.
Abstract:
Multimorbidity, service organization and clinical decision making in primary care: a qualitative study.
BACKGROUND: Primary care professionals often manage patients with multiple long-term health conditions, but managing multimorbidity is challenging given time and resource constraints and interactions between conditions. OBJECTIVE: to explore GP and nurse perceptions of multimorbidity and the influence on service organization and clinical decision making. METHODS: a qualitative interview study with primary care professionals in practices in Greater Manchester, U.K. Interviews were conducted with 15 GPs and 10 practice nurses. RESULTS: Primary care professionals identified tensions between delivering care to meet quality targets and fulfilling the patient's agenda, tensions which are exacerbated in multimorbidity. They were aware of the inconvenience suffered by patients through attendance at multiple clinic appointments when care was structured around individual conditions. They reported difficulties managing patients with multimorbidity in limited consultation time, which led to adoption of an 'additive-sequential' decision-making model which dealt with problems in priority order until consultation resources were exhausted, when further management was deferred. Other challenges included the need for patients to co-ordinate their care, the difficulties of self-management support in multimorbidity and problems of making sense of the relationships between physical and mental health. Doctor and nurse accounts included limited consideration of multimorbidity in terms of the interactions between conditions or synergies between management of different conditions. CONCLUSIONS: Primary care professionals identify a number of challenges in care for multimorbidity and adopt a particular model of decision making to deliver care for multiple individual conditions. However, they did not describe specific decision making around managing multimorbidity per se.
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Author URL.
Jones GT, Nicholl BI, McBeth J, Davies KA, Morriss RK, Dickens C, MacFarlane GJ (2011). Role of road traffic accidents and other traumatic events in the onset of chronic widespread pain: Results from a population-based prospective study.
Arthritis Care and Research,
63(5), 696-701.
Abstract:
Role of road traffic accidents and other traumatic events in the onset of chronic widespread pain: Results from a population-based prospective study
Objective: to determine the relationship between physically traumatic events and the onset of chronic widespread pain (CWP). Methods: This was a case-control study nested within a large prospective cohort. CWP was determined, by questionnaire, as per the American College of Rheumatology fibromyalgia classification criteria. Data were also collected on psychological health, health behavior, and sleep problems. Participants without CWP were then followed up at 4 years, and (new-onset) CWP was determined in the same manner. At followup, participants were also asked to report whether they had experienced any of a series of physically traumatic events between baseline and followup. Results: a total of 2,069 individuals (46.6%) participated at followup, and 241 of these individuals (11.6%) reported CWP. More than one-third of the study population reported at least 1 physically traumatic event; although these individuals were more likely to develop CWP, this relationship was completely attenuated after adjustment for confounding (odds ratio 1.01, 95% confidence interval 0.73-1.40). However, there was some evidence to suggest that involvement in a road traffic accident, specifically, may confer an increase in the risk of CWP onset. Conclusion: This study provides support for the "at risk" phenotype hypothesis, where individuals characterized by poorer health and psychological variables may be predisposed to develop CWP following a traumatic trigger. However, although this has been seen with road traffic accidents, it is not the case with other events. Future research should examine what is peculiar about an accident, or about one's reaction to it, that confers this increase in the risk of CWP onset. © 2011, American College of Rheumatology.
Abstract.
Coventry PA, Hays R, Dickens C, Bundy C, Garrett C, Cherrington A, Chew-Graham C (2011). Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care.
BMC Fam Pract,
12Abstract:
Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care.
BACKGROUND: the risk of depression is increased in people with long term conditions (LTCs) and is associated with poorer patient outcomes for both the depressive illness and the LTC, but often remains undetected and poorly managed. The aim of this study was to identify and explore barriers to detecting and managing depression in primary care in people with two exemplar LTCs: diabetes and coronary heart disease (CHD). METHODS: Qualitative in-depth interviews were conducted with 19 healthcare professionals drawn predominately from primary care, along with 7 service users and 3 carers (n = 29). One focus group was then held with a set of 6 healthcare professionals and a set of 7 service users and 1 carer (n = 14). Interviews and the focus group were digitally recorded, transcribed verbatim, and analysed independently. The two data sets were then inspected for commonalities using a constant comparative method, leading to a final thematic framework used in this paper. RESULTS: Barriers to detecting and managing depression in people with LTCs in primary care exist: i) when practitioners in partnership with patients conceptualise depression as a common and understandable response to the losses associated with LTCs - depression in the presence of LTCs is normalised, militating against its recognition and treatment; ii) where highly performanced managed consultations under the terms of the Quality and Outcomes Framework encourage reductionist approaches to case-finding in people with CHD and diabetes, and iii) where there is uncertainty among practitioners about how to negotiate labels for depression in people with LTCs in ways that might facilitate shared understanding and future management. CONCLUSION: Depression was often normalised in the presence of LTCs, obviating rather than facilitating further assessment and management. Furthermore, structural constraints imposed by the QOF encouraged reductionist approaches to case-finding for depression in consultations for CHD and diabetes. Future work might focus on how interventions that draw on the principles of the chronic care model, such as collaborative care, could support primary care practitioners to better recognise and manage depression in patients with LTCs.
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Author URL.
Poole L, Dickens C, Steptoe A (2011). The puzzle of depression and acute coronary syndrome: Reviewing the role of acute inflammation.
Journal of Psychosomatic Research,
71(2), 61-68.
Abstract:
The puzzle of depression and acute coronary syndrome: Reviewing the role of acute inflammation
The relationship between depression and coronary heart disease is well-established, but causal mechanisms are poorly understood. The aim of this review is to stimulate different ways of viewing the relationship between depression and adverse outcomes following acute coronary syndrome (ACS) and coronary artery bypass graft (CABG) surgery patients. We present an argument for depression in ACS and CABG patients being a qualitatively distinct form from that observed in psychiatric populations. This is based on three features: (1) depression developing after cardiac events has been linked in many studies to poorer outcomes than recurrent depression; (2) somatic symptoms of depression following cardiac events are particularly cardiotoxic; (3) depression following an ACS does not respond well to antidepressant treatments. We propose that inflammation is a common causal process responsible in part both for the development of depressive symptoms and for adverse cardiac outcomes, and we draw parallels with inflammation-induced sickness behaviour. Clinical implications of our observations are discussed along with suggestions for further work to advance the field. © 2010 Elsevier Inc.
Abstract.
Ismail K, Maissi E, Thomas S, Chalder T, Schmidt U, Bartlett J, Patel A, Dickens C, Creed F, Treasure J, et al (2010). A randomised controlled trial of cognitive behaviour therapy and motivational interviewing for people with type 1 diabetes mellitus with persistent sub-optimal glycaemic control: a diabetes and psychological therapies (ADaPT) study.
Health Technology Assessment,
14(22), 1-127.
Abstract:
A randomised controlled trial of cognitive behaviour therapy and motivational interviewing for people with type 1 diabetes mellitus with persistent sub-optimal glycaemic control: a diabetes and psychological therapies (ADaPT) study
Objectives: to determine whether (i) motivational enhancement therapy (MET) + cognitive behaviour therapy (CBT) compared with usual care, (ii) MET compared with usual care, (iii) or MET + CBT compared with MET was more effective in improving glycaemic control when delivered by general nurses with additional training in these techniques. Design: a three-arm parallel randomised controlled trial as the gold standard design to test the effectiveness of psychological treatments. Setting: the recruiting centres were diabetes clinics in seven acute trusts in south-east London and Greater Manchester. Participants: Adults (18-65 years) with a confirmed diagnosis of type 1 diabetes for a minimum duration of 2 years and a current glycated (or glycosylated) haemoglobin (HbA1c) value between 8.2% and 15.0%. Interventions: the control arm consisted of usual diabetes care which varied between the hospitals, but constituted at least three monthly appointments to diabetes clinic. The two treatments arms consisted of usual care with MET and usual care with MET + CBT. Main outcome measures: the primary outcome was HbA1c at 12 months from randomisation. Secondary outcome measures were 1-year costs measured by the Client Service Receipt Inventory at baseline, 6 months and 12 months; quality of life-years [quality-adjusted life-years (QALYs)] measured by the SF-36 (Short Form-36 Health Survey Questionnaire) and EQ-5D (European Quality of Life-5 Dimensions) at aseline and 12 months. Results: One thousand six hundred and fifty-nine people with type 1 diabetes were screened and 344 were randomised to MET + CBT (n = 106), MET (n = 117) and to usual care (n = 121). The 12-month follow-up rate for HbA1c was 88% (n = 305). The adjusted mean 12-month HbA1c was 0.45% lower in those treated with MET + CBT [95% confidence interval (CI) 0.16% to 0.79%, p = 0.008] than for usual care; 0.16% lower in those treated with MET (95% CI 0.20% to 0.51%, p = 0.38) than for usual care; and 0.30% lower with MET + CBT than with MET (95% CI -0.07% to 0.66%, p = 0.11). The higher the HbA1c, and the younger the participant at baseline, the greater was the reduction in HbA1c. The interventions had no effect on secondary outcomes such as depression and quality of life. The economic evaluation was inconclusive. Both interventions were associated with increased health care costs than for usual care alone. There was no significant difference in social costs. Cost effectiveness ratios, up to one year, varied considerably according to whether QALY estimates were based on EQ-5D or SF-36 and whether imputed or complete data were used in the analyses. Conclusions: a combination of MET and CBT may beuseful for patients with persistent sub-optimal diabetic control. MET alone appears less effective than usual care. Economic evaluation was inconclusive. Trial registration: Current Controlled Trials ISRCTN77044517.
Abstract.
Dickens C, Cherrington A, Garrett C, Bower P, Bundy C, Gask L, Coventry P (2010). Characteristics of psychosocial interventions that improve depression in people with coronary heart disease: a systematic review with meta-regression.
JOURNAL OF PSYCHOSOMATIC RESEARCH,
68(6), 619-619.
Author URL.
Dickens C, McGowan L, Tomenson B, Cotter L, Heagerty A, Creed F (2009). Depression that starts after myocardial infarction is predictive of subsequent cardiac mortality.
PSYCHOLOGY & HEALTH,
24, 29-29.
Author URL.
Davies KA, Macfarlane GJ, McBeth J, Morriss R, Dickens C (2009). Insecure attachment style is associated with chronic widespread pain.
Pain,
143(3), 200-205.
Abstract:
Insecure attachment style is associated with chronic widespread pain.
Individuals with "insecure" adult attachment styles have been shown to experience more pain than people with secure attachment, though results of previous studies have been inconsistent. We performed a cross-sectional study on a large population-based sample to investigate whether, compared to pain free individuals, subjects with chronic widespread pain were more likely to report insecure adult attachment style. Subjects in a population-based cross-sectional study completed a self-rated assessment of adult attachment style. Attachment style was categorised as secure (i.e. normal attachment style); or preoccupied, dismissing or fearful (insecure attachment styles). Subjects completed a pain questionnaire from which three groups were identified: pain free; chronic widespread pain; and other pain. Subjects rated their pain intensity and pain-related disability on an 11 point Likert scale. Subjects (2509) returned a completed questionnaire (median age 49.9 years (IQR 41.2-50.0); 59.2% female). Subjects with CWP were more likely to report a preoccupied (RRR 2.6; 95%CI 1.8-3.7), dismissing (RRR 1.9; 95%CI 1.2-3.1) or fearful attachment style (RRR 1.4; 95%CI 1.1-1.8) than those free of pain. Among CWP subjects, insecure attachment style was associated with number of pain sites (Dismissing: RRR 2.8; 95%CI 1.2-2.3, Preoccupied: RRR=1.8, 95%CI 0.98-3.5) and degree of pain-related disability (Preoccupied: RRR=2.1, 95%CI 1.0-4.1), but not pain intensity. These findings suggest that treatment strategies based on knowledge of attachment style, possibly using support and education, may alleviate distress and disability in people at risk of, or affected by, chronic widespread pain.
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Author URL.
Nicholl BI, Macfarlane GJ, Davies KA, Morriss R, Dickens C, McBeth J (2009). Premorbid psychosocial factors are associated with poor health-related quality of life in subjects with new onset of chronic widespread pain - results from the EPIFUND study.
Pain,
141(1-2), 119-126.
Abstract:
Premorbid psychosocial factors are associated with poor health-related quality of life in subjects with new onset of chronic widespread pain - results from the EPIFUND study.
Chronic widespread pain (CWP) is associated with poor health-related quality of life (HRQoL). It is unclear whether pain itself is the cause of poor HRQoL or other factors play a role. We hypothesised that new onset of CWP was associated with poor physical and mental HRQoL but that psychosocial risk markers for CWP onset would explain this relationship. A prospective population-based survey measured pain and psychosocial status at baseline. Subjects free of CWP at baseline were followed up 15 months later, when pain status, threatening life events and HRQoL (SF-12) were assessed. The risk associated with the new onset of CWP and reporting poor SF12-MCS and SF12-PCS was quantified using multinomial logistic regression (relative risk ratios (RRRs) with 95% confidence intervals (95% CI)), adjusted for age and gender. 3000 subjects (77%) free of CWP at baseline participated at follow-up. 2650 subjects (88%) provided full SF-12 and pain data and formed the cohort for this analysis. 9.4% of subjects (n=248) reported new CWP. New CWP was associated with an increased risk of having the poorest SF12-MCS (RRR=2.3; 95% CI 1.6-3.2) and SF12-PCS (RRR=8.0; 95% CI 5.4-11.8) scores. After adjusting for baseline psychosocial status, the relationship between CWP onset and SF12-MCS was attenuated (RRR=1.2; 95% CI 0.8-1.8), although the association with SF12-PCS remained (RRR=4.8% CI 3.1-7.47). New onset of CWP is associated with poor mental and physical HRQoL. However, the relationship with mental HRQoL is explained by psychosocial risk markers.
Abstract.
Author URL.
Davies KA, Silman AJ, Macfarlane GJ, Nicholl BI, Dickens C, Morriss R, Ray D, McBeth J (2009). The association between neighbourhood socio-economic status and the onset of chronic widespread pain: results from the EPIFUND study.
Eur J Pain,
13(6), 635-640.
Abstract:
The association between neighbourhood socio-economic status and the onset of chronic widespread pain: results from the EPIFUND study.
BACKGROUND: Cross-sectional studies have reported an inverse relationship between socio-economic status and the prevalence of chronic widespread pain (CWP). However, the extent to which this relationship is explained by psychological factors is unknown. The aim of this study was to examine the hypothesis that socio-economic status predicts the onset of CWP but that this relationship would be explained by psychological factors. METHODS: Subjects from three diverse socio-economic areas were recruited into a population-based prospective survey of pain. Subjects completed a questionnaire at baseline that assessed pain status and psychological factors and occupation. Fifteen months later subjects completed a follow-up questionnaire which assessed pain status. RESULTS: a total of 3489 subjects were free of CWP at baseline and eligible for follow-up, of whom 2782 (79.7%) participated. of those, 281 (10%) subjects were classified as having new CWP. Logistic regression analysis revealed that compared to subjects from the most affluent socio-economic area, those from the moderate and least affluent areas were respectively, 1.47 (95% CI: 1.08-2.01) and 1.35 (95% CI: 1.00-1.82) times more likely to have new CWP. However, in a stepwise multivariate logistic regression analysis, controlling for psychological factors, the relationship between new onset CWP and socio-economic status was no longer evident. CONCLUSIONS: This study has demonstrated that socio-economic status is related to new onset CWP, but the association is explained by psychological factors. Understanding the factors underlying the association between socio-economic status and pain should help to design intervention strategies which may reduce the burden of chronic pain in identified high risk population groups.
Abstract.
Author URL.
Jones EA, McBeth J, Nicholl B, Morriss RK, Dickens C, Jones GT, Macfarlane GJ (2009). What characterizes persons who do not report musculoskeletal pain? Results from a 4-year population-based longitudinal study (The Epifund Study).
Journal of Rheumatology,
36(5), 1071-1077.
Abstract:
What characterizes persons who do not report musculoskeletal pain? Results from a 4-year population-based longitudinal study (The Epifund Study)
Objective. To identify and characterize persons in the population who do not report musculoskeletal pain. Methods. This was a population-based 4-year prospective longitudinal study by postal questionnaire. Population sample recruited from general practice registers in North-West England followed up at 15 months and 4 years. Results. of respondents, 17.4% [95% confidence interval (CI) 16.1%-19.7%] reported no pain in the previous month at all 3 measurement intervals over 4 years. They were characterized by low levels of psychological distress [relative risk (RR) low vs high levels of psychological distress 2.3; 95% CI 1.7-2.9], low levels of depression (2.7; 95% CI 2.0-3.6), low levels of anxiety (2.1; 95% CI 1.6-2.7), low health anxiety (1.6; 95% CI 1.2-2.1), and low illness behavior scores (5.8; 95% CI 4.0-8.3), good quality sleep (3.4; 95% CI 2.6-4.4), no somatic symptoms (RR 0 vs 3 or more, 3.1; 95% CI 1.6-6.3) and no adverse life events in the 6 months prior to baseline data collection (RR 0 vs 3 or more, 3.2; 95% CI 1.6-6.2). On multivariable analysis, good quality sleep, low illness behavior, low psychological distress, and absence of recent adverse life events remained statistically independent predictors of musculoskeletal health. In total, 46% of persons who had all 4 of these characteristics consistently reported being free of pain, compared to only 5% of those who had none. Conclusion. In a general population sample, over a period of 4 years, only around 1 in 6 persons do not report musculoskeletal pain. These persons report low levels of psychological distress and high quality sleep, both of which are potentially modifiable risk factors for the targeting of interventional or preventive strategies. Copyright © 2009. All rights reserved.
Abstract.
Duddu V, Husain N, Dickens C (2008). Medically unexplained presentations and quality of life: a study of a predominantly South Asian primary care population in England.
J Psychosom Res,
65(4), 311-317.
Abstract:
Medically unexplained presentations and quality of life: a study of a predominantly South Asian primary care population in England.
Primary care subjects from a predominantly South Asian inner-city setting in Manchester, UK, were studied. We aimed to determine whether medically unexplained symptoms (MUS) are associated with worse health-related quality of life than medically explained symptoms (MES), after controlling for differences in sociodemographic variables, number of somatic symptoms, and levels of anxiety and depression. One hundred nineteen subjects attending general practice completed questionnaires to assess somatic symptoms, anxiety, depression, and quality of life. Doctors' records were later studied to ascertain whether the presentation was medically explained. Thirty-nine subjects (33%) had medically unexplained presentations. Compared to patients with MES, those with MUS had significantly more somatic symptoms (6.9 vs. 4.3, P
Abstract.
Author URL.
Ismail K, Thomas SM, Maissi E, Chalder T, Schmidt U, Bartlett J, Patel A, Dickens CM, Creed F, Treasure J, et al (2008). Motivational enhancement therapy with and without cognitive behavior therapy to treat type 1 diabetes: a randomized trial. Annals of Internal Medicine, 149(10), 708-719.
Dickens C, McGowan L, Percival C, Tomenson B, Cotter L, Heagerty A, Creed F (2008). Negative illness perceptions are associated with new-onset depression following myocardial infarction.
Gen Hosp Psychiatry,
30(5), 414-420.
Abstract:
Negative illness perceptions are associated with new-onset depression following myocardial infarction.
OBJECTIVE: to test the hypothesis that negative perceptions about heart disease at the time of the myocardial infarction (MI) were associated with the onset of new episodes of depression following MI. METHOD: We recruited 269 subjects admitted following first MI and monitored their depression status over the subsequent 12 months. At baseline, we recorded demographic information, family and personal history of cardiac disease and severity of MI; subjective health beliefs were assessed using the Illness Perceptions Questionnaire (IPQ). We assessed depression at baseline, 6 and 12 months following MI using a standardised questionnaire, validated in this population against a semistructured research interview. RESULTS: in the days following MI, patients who subsequently developed depression were more likely to anticipate that their heart disease would last a long time (P=.012) and was unlikely to be cured (P=.038). Controlling for potential confounding variables, scores on the IPQ remained associated with subsequent depression (P =. 036), with anticipation that heart disease would last a long time [odds ratio (OR)=2.7, P=.013] and that heart disease could be cured (OR=0.45, P=.048) showing strongest association. CONCLUSIONS: Negative perceptions about heart disease in the days following admission to hospital with first MI are associated with the development of subsequent new episodes of depression.
Abstract.
Author URL.
Dickens C, McGowan L, Percival C, Tomenson B, Cotter L, Heagerty A, Creed F (2008). New onset depression following myocardial infarction predicts cardiac mortality.
Psychosom Med,
70(4), 450-455.
Abstract:
New onset depression following myocardial infarction predicts cardiac mortality.
OBJECTIVE: Studies investigating the effects of depression on mortality following myocardial infarction (MI) have produced heterogeneous findings. We report on a study investigating whether the timing of the onset of depression, with regard to the MI, affected its impact on subsequent cardiac mortality. METHODS: Five hundred and eighty-eight subjects admitted following MI underwent assessments of cardiac status, cardiac risk factors, and noncardiac illness. We identified separately subjects who were depressed before their MI (pre-MI depression) and those who developed depression in the 12 months after MI (new-onset depression), using a standardized questionnaire and a research interview. Patients dying of cardiac cause were identified during 8-year follow-up using information from death certificates. RESULTS: Multivariate predictors of cardiac death during follow-up included: greater age (hazards ratio (HR) = 1.06, p =. 007), previous angina (HR = 4.15, p <. 0005), high Killip Class (HR = 2.21, p =. 013), prescription of beta-blockers on discharge (HR = 0.37, p =. 02), and new-onset depression (HR = 2.33, p =. 038). Pre-MI depression did not convey any additional risk of cardiac mortality. CONCLUSION: We have shown increased cardiac mortality in patients who develop depression after suffering MI. Further observational studies need to separate pre- and post-MI depression if we are to determine underlying mechanisms by which depression is associated with mortality following MI.
Abstract.
Author URL.
Keeley P, Creed F, Tomenson B, Todd C, Borglin G, Dickens C (2008). Psychosocial predictors of health-related quality of life and health service utilisation in people with chronic low back pain.
Pain,
135(1-2), 142-150.
Abstract:
Psychosocial predictors of health-related quality of life and health service utilisation in people with chronic low back pain.
Psychological and social factors have been shown, separately, to predict outcome in individuals with chronic low back pain. Few previous studies, however, have integrated both psychological and social factors, using prospective study of clinic populations of low back pain patients, to identify which are the most important targets for treatment. One hundred and eight patients with chronic low back pain, newly referred to an orthopaedic outpatient clinic, completed assessments of demographic characteristics, details of back pain, measures of anxiety and depression (Hospital Anxiety and Depression Scale, HADS), fearful beliefs about pain (Fear Avoidance Beliefs Questionnaire), social stresses (Life Events and Difficulties Schedule) and physical aspects of health-related quality of life [SF-36 Physical Component summary Score scale (PCS)]. Six months later subjects completed the SF-36 PCS and the number of healthcare contacts during follow-up was recorded. Independent predictors of SF-36 PCS at 6-month follow-up were duration of pain [(standardised regression coefficient (beta)=-0.18, p=0.04), HADS score (beta)=-0.27, p=0.003] and back pain related social difficulties (beta=-0.42, p
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Davies KA, Macfarlane GJ, Nicholl BI, Dickens C, Morriss R, Ray D, McBeth J (2008). Restorative sleep predicts the resolution of chronic widespread pain: results from the EPIFUND study.
Rheumatology (Oxford),
47(12), 1809-1813.
Abstract:
Restorative sleep predicts the resolution of chronic widespread pain: results from the EPIFUND study.
OBJECTIVES: Poor sleep is associated with chronic widespread pain (CWP). Conversely, good-quality sleep may play a role in the resolution of pain symptoms. Sleep is a multidimensional construct, comprising a number of diverse components. The aims of the current study were to examine the hypotheses that: (i) good sleep quality would predict the resolution of CWP, (ii) restorative sleep would predict the resolution of CWP and (iii) that these relationships would be independent of confounding psychological factors. METHODS: Subjects in a population-based prospective study completed a pain questionnaire at baseline from which subjects with CWP were identified. Baseline sleep was measured using the Estimation of Sleep Problems Scale which measures sleep onset, maintenance, early wakening and restorative sleep. The questionnaire also contained scales examining psychosocial status. Subjects were followed up 15 months later and pain status was assessed. RESULTS: a total of 1061 subjects reported CWP at baseline of whom 679 (75% of eligible subjects) responded at follow-up. of those, a total of 300 (44%) no longer satisfied criteria for CWP. Univariate analysis revealed that three of the four sleep components were associated with the resolution of CWP: rapid sleep onset, odds ratio (OR) = 1.7, 95% CI 1.2, 2.5; absence of early wakening, OR = 1.6, 95% CI 1.1, 2.4; and restorative sleep, OR = 2.7, 95% CI 1.5, 4.8. After adjusting for the effect of psychosocial factors, which may have confounded the relationship, only restorative sleep (OR = 2.0, 95% CI 1.02, 3.8) was associated. CONCLUSIONS: Self-reported restorative sleep was independently associated with the resolution of CWP and return to musculoskeletal health.
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Dickens C, Creed F (2007). Authors' reply [9]. British Journal of Psychiatry, 190(MAR.).
Fletcher J, Bower PJ, Gilbody S, Lovell K, Richards D, Gask L (2007). Collaborative care for depression and anxiety problems in primary care. Cochrane Database of Systematic Reviews(2).
Dickens C, Creed F (2007). Depression and anxiety after myocardial infarction - Reply.
BRITISH JOURNAL OF PSYCHIATRY,
190, 273-273.
Author URL.
Dickens C, McGowan L, Percival C, Tomenson B, Cotter L, Heagerty A, Creed F (2007). Depression is a risk factor for mortality after myocardial infarction: fact or artifact?.
J Am Coll Cardiol,
49(18), 1834-1840.
Abstract:
Depression is a risk factor for mortality after myocardial infarction: fact or artifact?
OBJECTIVES: This study sought to investigate the long-term impact of depression on cardiac mortality after myocardial infarction (MI) and to assess whether the timing of depression influences the findings. BACKGROUND: Previous studies have shown that depression increases the risk of cardiac death after MI, although some studies with robust methodology have failed to show this effect. Clinical trials of depression treatments have failed to improve mortality. Until the relationship between depression and post-MI mortality is understood fully, clinical trials aimed at reducing mortality by treating depression remain premature. METHODS: We recruited 588 subjects after MI and followed up their cases for up to 8 years. Patients underwent detailed assessments of cardiac status, conventional cardiac risk factors, and noncardiac illness at baseline. Depression was assessed for the period immediately preceding MI and at 12 months after MI, using a standardized questionnaire and a research interview. At follow-up, the mortality status, cause, and date of death were recorded for 587 subjects using population records. RESULTS: Multivariate predictors of cardiac death included older age (hazard ratio [HR] = 1.04, p = 0.007), previous angina (HR = 1.8, p = 0.03), previous MIs (HR = 1.6, p = 0.004), Killip class (HR = 1.8, p = 0.005), beta-blockers (HR = 0.5, p = 0.023), and angiotensin-converting enzyme inhibitors (HR = 0.6, p = 0.047) prescribed on discharge. Depression was not associated with cardiac mortality, whether detected immediately before MI (p = 0.48), 12 months after MI (p = 0.27), or at both time points (p = 0.97). CONCLUSIONS: the association between depression and post-MI mortality is complex, possibly being limited to depression immediately after MI. Defining the window when intervention for depression might benefit survival is crucial for the design of future trials.
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McBeth J, Silman AJ, Gupta A, Chiu YH, Ray D, Morriss R, Dickens C, King Y, Macfarlane GJ (2007). Moderation of psychosocial risk factors through dysfunction of the hypothalamic-pituitary-adrenal stress axis in the onset of chronic widespread musculoskeletal pain: findings of a population-based prospective cohort study.
Arthritis Rheum,
56(1), 360-371.
Abstract:
Moderation of psychosocial risk factors through dysfunction of the hypothalamic-pituitary-adrenal stress axis in the onset of chronic widespread musculoskeletal pain: findings of a population-based prospective cohort study.
OBJECTIVE: to test the hypothesis that abnormalities in the hypothalamic-pituitary-adrenal (HPA) stress-response system would act as an effect moderator between HPA function and the onset of chronic widespread pain (CWP). METHODS: We conducted a population-based prospective cohort study. Current pain and psychosocial status were ascertained in 11,000 subjects. of the 768 eligible subjects free of CWP but at future risk based on their psychosocial profile, 463 were randomly selected, and 267 (57.7%) consented to assessment of their HPA axis function. Diurnal function was measured by assessing levels of salivary cortisol in the morning (9:00 AM) and evening (10:00 PM). Serum cortisol levels were measured after an overnight low-dose (0.25 mg) dexamethasone suppression test and a potentially stressful clinical examination. All subjects were followed up 15 months later to identify cases of new-onset CWP. RESULTS: a total of 241 subjects (94.9%) completed the followup study, and 28 (11.6%) reported the new onset of CWP. High levels of cortisol post-dexamethasone (odds ratio [OR] 3.53, 95% confidence interval [95% CI] 1.17-10.65), low levels in morning saliva (OR 1.43, 95% CI 0.52-3.94), and high levels in evening saliva (OR 2.32, 95% CI 0.64-8.42) were all associated with CWP. These 3 factors were found to be independent and additive predictors of CWP (OR for all 3 factors 8.5, 95% CI 1.5-47.9) in analyses controlling for age, sex, depression, sleep disturbance, recent traumatic life events, and pain status. One or more of these 3 HPA factors identified 26 (92.9%) cases of new-onset CWP. CONCLUSION: Among a group of psychologically at-risk subjects, dysfunction of the HPA axis helps to distinguish those who will and will not develop new-onset CWP.
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Gupta A, McBeth J, Macfarlane GJ, Morriss R, Dickens C, Ray D, Chiu YH, Silman AJ (2007). Pressure pain thresholds and tender point counts as predictors of new chronic widespread pain in somatising subjects.
Ann Rheum Dis,
66(4), 517-521.
Abstract:
Pressure pain thresholds and tender point counts as predictors of new chronic widespread pain in somatising subjects.
BACKGROUND: Tender points are a general measure of distress both in the community and in clinic subjects. It has been suggested that multiple tender points should be regarded as the early stages of somatisation of distress. Similarly, recent evidence suggests that chronic widespread pain (CWP) is one manifestation of the somatisation of distress. OBJECTIVE: Given that a high tender point count and CWP are clinical hallmarks of the fibromyalgia syndrome, it was hypothesised that in somatising subjects, a high tender point count or a low pain threshold would predict the development of CWP in the future. METHODS: in this population-based prospective study, 245 adults aged 25-65 years, free of CWP, were identified on the basis of a detailed questionnaire on pain and a psychosocial questionnaire comprising the Somatic Symptom Checklist and the Illness Behaviour subscale of the Illness Attitude Scales. These subjects took part in a pain threshold examination with a Fischer pressure algometer. Tender point counts were computed by including all areas with a pain threshold
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Gupta A, Silman AJ, Ray D, Morriss R, Dickens C, MacFarlane GJ, Chiu YH, Nicholl B, McBeth J (2007). The role of psychosocial factors in predicting the onset of chronic widespread pain: results from a prospective population-based study.
Rheumatology (Oxford),
46(4), 666-671.
Abstract:
The role of psychosocial factors in predicting the onset of chronic widespread pain: results from a prospective population-based study.
OBJECTIVE: Chronic widespread pain (CWP) is strongly associated with psychosocial distress both in a clinical setting and in the community. The aim of this study was to determine the contribution of measures of psychosocial distress, health-seeking behaviour, sleep problems and traumatic life events to the development of new cases of CWP in the community. METHODS: in a population-based prospective study, 3171 adults aged 25-65 yrs free of CWP were followed-up 15 months later to identify those with new CWP. Baseline data were available on their scores from a number of psychological scales including Illness Attitude Scales (IAS), Somatic Symptom Checklist (SSC), Hospital Anxiety & Depression Scale, Sleep Problems Scale, and Life Events Inventory. RESULTS: 324 subjects [10%, 95% confidence interval (CI) 9.2, 11.3] developed new CWP at follow-up. After adjustment for age and sex, three factors independently predicted the development of CWP: scoring three or more on the SSC [odds ratio (OR) 1.8, 95% CI 1.1, 3.1], scoring eight or more on the Illness Behaviour subscale of the IAS (OR 3.3, 95% CI 2.3, 4.8), and nine or more on the Sleep Problem Scale (OR 2.7, 95% CI 1.6, 3.2). Subjects exposed to all three factors were at 12 times the odds of new CWP than those with low scores on all scales. CONCLUSION: Subjects are at substantial increased odds of developing CWP if they display features of somatization, health-seeking behaviour and poor sleep. Psychosocial distress has a strong aetiological influence on CWP.
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Dickens C, Tomenson B, Creed F (2007). Throw the window out the door - Reply.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY,
50(15), 1520-1520.
Author URL.
Knight KM, McGowan L, Dickens C, Bundy C (2006). A systematic review of motivational interviewing in physical health care settings.
Br J Health Psychol,
11(Pt 2), 319-332.
Abstract:
A systematic review of motivational interviewing in physical health care settings.
PURPOSE: Motivational interviewing (MI), a method of augmenting an individual's motivation to change problematic behaviours, is a patient-centred counselling style that seeks to help patients resolve ambivalence about behaviour change. MI has successfully been used in the field of addictions and has recently received increased interest as a means of promoting treatment adherence in physical health care settings. This systematic review is aimed to evaluate the effectiveness of MI interventions in physical health care settings. METHODS: Electronic databases were searched for articles specifying the use of 'motivational interviewing' in physical health care settings between 1966 and April 2004. Fifty-one relevant abstracts were yielded and data was extracted from eight relevant selected studies. RESULTS: Eight studies were identified in the fields of diabetes, asthma, hypertension, hyperlipidaemia, and heart disease. The majority of studies found positive results for effects of MI on psychological, physiological, and life-style change outcomes. Problems with research in this area include: small sample sizes, lack of power, use of disparate multiple outcomes, inadequate validation of questionnaires, poorly-defined therapy and training. CONCLUSIONS: While MI has high face validity across a number of domains in physical health care settings, the general quality of trials in this area is inadequate and therefore recommendations for its dissemination in this area cannot yet be made. More research into MI applied to health behaviour change is urgently required.
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Neves AC, Dickens C, Xavier M (2006). Comorbidity between hepatitis C and depression: Epidemiological and etiopathogenic aspects.
Acta Medica Portuguesa,
19(1), 21-28.
Abstract:
Comorbidity between hepatitis C and depression: Epidemiological and etiopathogenic aspects
Neuropsychiatric symptoms are commonly associated with chronic hepatitis C virus infection (HCV). The aim of this review of the literature was to evaluate the prevalence of depression in patients with hepatitis C, as well as the proposed etiopathogenic models. A review of the literature was undertaken using the complete search strategy devised by the Cochrane Collaboration Review Group for Depression, Anxiety and Neurosis. All studies but one have shown that major depression in chronic HCV patients is significantly more common than in the general population (reported rates from 5.7% and 45%), being related with illness perception, functional disability, impaired quality of life, fatigue severity, and the presence of psychiatric comorbidity. The mechanism by which depression is related to Hepatitis C is still poorly understood. Authors address some possible mechanisms, such as the psychological impact of the knowledge that one has been infected with HCV and the direct effects of the virus itself on the Central Nervous System (eg. cytoquines).
Abstract.
Dickens CM, Mcgowan L, Percival C, Tomenson B, Cotter L, Heagerty A, Creed FH (2006). Contribution of depression and anxiety to impaired health-related quality of life following first myocardial infarction.
BRITISH JOURNAL OF PSYCHIATRY,
189, 367-372.
Author URL.
Dickens CM, McGowan L, Percival C, Tomenson B, Cotter L, Heagerty A, Creed FH (2006). Contribution of depression and anxiety to impaired health-related quality of life following first myocardial infarction.
Br J Psychiatry,
189, 367-372.
Abstract:
Contribution of depression and anxiety to impaired health-related quality of life following first myocardial infarction.
BACKGROUND: the extent to which depression impairs health-related quality of life (HRQoL) in the physically ill has not been clearly established. AIMS: to quantify the adverse influence of depression and anxiety, assessed at the time of first myocardial infarction and 6 months later, on the physical aspect of HRQoL 12 months after the infarction. METHOD: in all, 260 in-patients, admitted following first myocardial infarction, completed the Hospital Anxiety and Depression Scale and the Medical Outcomes Study SF-36 assessment before discharge and at 6- and 12-month follow-up. RESULTS: Depression and anxiety 6 months after myocardial infarction predicted subsequent impairment in the physical aspects of HRQoL (attributable adjusted R(2)=9%, P
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Dickens C, McGowan L, Percival C, Douglas J, Tomenson B, Cotter L, Heagerty A, Creed F (2005). Association between depressive episode before first myocardial infarction and worse cardiac failure following infarction.
Psychosomatics,
46(6), 523-528.
Abstract:
Association between depressive episode before first myocardial infarction and worse cardiac failure following infarction.
Depression following myocardial infarction is associated with a higher mortality rate. The authors studied 314 patients admitted to the hospital with a first myocardial infarction to assess whether cardiac failure after the infarction, which is also linked to a higher mortality rate, was predicted by psychosocial characteristics present before the myocardial infarction. One-fifth (20.7%) of the subjects met the ICD-10 criteria for depressive episode in the 1 month before the attack. Variables independently associated with worse cardiac failure after the myocardial infarction were greater age, a history of angina preceding the infarction, and a previous depressive episode. The impact of depression on postinfarction outcome may result from the influence of preinfarction depression on the degree of cardiac failure.
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Dickens C (2005). Commentary on Who is at risk of post-MI depressive symptoms. Journal of Psychosomatic Research, 58(5), 433-434.
McBeth J, Chiu YH, Silman AJ, Ray D, Morriss R, Dickens C, Gupta A, Macfarlane GJ (2005). Hypothalamic-pituitary-adrenal stress axis function and the relationship with chronic widespread pain and its antecedents.
Arthritis Res Ther,
7(5), R992-R1000.
Abstract:
Hypothalamic-pituitary-adrenal stress axis function and the relationship with chronic widespread pain and its antecedents.
In clinic studies, altered hypothalamic-pituitary-adrenal (HPA) axis function has been associated with fibromyalgia, a syndrome characterised by chronic widespread body pain. These results may be explained by the associated high rates of psychological distress and somatisation. We address the hypothesis that the latter, rather than the pain, might explain the HPA results. A population study ascertained pain and psychological status in subjects aged 25 to 65 years. Random samples were selected from the following three groups: satisfying criteria for chronic widespread pain; free of chronic widespread pain but with strong evidence of somatisation ('at risk'); and a reference group. HPA axis function was assessed from measuring early morning and evening salivary cortisol levels, and serum cortisol after physical (pain pressure threshold exam) and chemical (overnight 0.25 mg dexamethasone suppression test) stressors. The relationship between HPA function with pain and the various psychosocial scales assessed was modelled using appropriate regression analyses, adjusted for age and gender. In all 131 persons with chronic widespread pain (participation rate 74%), 267 'at risk' (58%) and 56 controls (70%) were studied. Those in the chronic widespread pain and 'at risk' groups were, respectively, 3.1 (95% CI (1.3, 7.3)) and 1.8 (0.8, 4.0) times more likely to have a saliva cortisol score in the lowest third. None of the psychosocial factors measured were, however, associated with saliva cortisol scores. Further, those in the chronic widespread pain (1.9 (0.8, 4.7)) and 'at risk' (1.6 (0.7, 3.6)) groups were also more likely to have the highest serum cortisol scores. High post-stress serum cortisol was related to high levels of psychological distress (p = 0.05, 95% CI (0.02, 0.08)). After adjusting for levels of psychological distress, the association between chronic widespread pain and post-stress cortisol scores remained, albeit slightly attenuated. This is the first population study to demonstrate that those with established, and those psychologically at risk of, chronic widespread pain demonstrate abnormalities of HPA axis function, which are more marked in the former group. Although some aspects of the altered function are related to the psychosocial factors measured, we conclude that the occurrence of HPA abnormality in persons with chronic widespread pain is not fully explained by the accompanying psychological stress.
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Chiu YH, Silman AJ, Macfarlane GJ, Ray D, Gupta A, Dickens C, Morriss R, McBeth J (2005). Poor sleep and depression are independently associated with a reduced pain threshold. Results of a population based study.
Pain,
115(3), 316-321.
Abstract:
Poor sleep and depression are independently associated with a reduced pain threshold. Results of a population based study.
To determine the relative contributions of psychological factors and sleep disturbance to reduced pain threshold we conducted a cross-sectional two-phase population-based study. A total of 424 subjects were recruited, stratified by pain and distress status. Subjects completed a postal questionnaire that asked about current pain and covered aspects of psychological status and sleep disturbance. Samples of subjects stratified by the extent of bodily pain they reported and psychological status were invited to participate in an examination of pain threshold. The association between psychological status, sleep disturbance and a low pain threshold was examined using ordinal regression. High levels of psychological distress (OR=1.6, 95% CI (1.02, 2.5)), disturbed sleep (OR=2.2, 95% CI (1.4, 3.5)) and high scores on the HAD depression scale (OR=2.1, 95% CI (1.3, 3.2)) were all associated with having a low pain threshold. In multivariate analysis disturbed sleep and depression remained independently associated with a low pain threshold. These relationships persisted after adjustment for pain status. This study had demonstrated that depression and poor sleep are associated with a reduced pain threshold.
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Fletcher J, Lovell K, Bower P, Campbell M, Dickens C (2005). Process and outcome of a non-guided self-help manual for anxiety and depression in primary care: a pilot study.
Behavioural and Cognitive Psychotherapy,
33(3), 319-331.
Abstract:
Process and outcome of a non-guided self-help manual for anxiety and depression in primary care: a pilot study
Self-help interventions in mental health are increasingly seen as one way of overcoming problems with access to psychological therapy, but there is insufficient evidence of effectiveness in routine care settings. This paper investigates the process and outcome of a non-guided self-help manual for anxiety and depression compared to a waiting list control in a primary care setting. Patients with mild to moderate mental health problems were recruited from routine GP referrals to the local Primary Care Mental Health Team. Thirty patients were randomly assigned to either non-guided self-help or a waiting list control group. Patients completed outcome measures at baseline, 6 weeks and 12 weeks. Intention to treat analysis found no significant differences between the two groups on measures of anxiety or depression at 12 weeks. Between 40% to 50% of patients in both groups were no longer clinical cases at the end of the trial. However, there was a high level of satisfaction with the self-help manual. Within the limitations of the small sample size, the study does not support the hypothesis that non-guided self-help is superior to waiting list control in the treatment of anxiety and/or depression in primary care. © 2005 British Association for Behavioural and Cognitive Psychotherapies.
Abstract.
McBeth J, Chiu YH, Ray D, Morriss RK, Dickens C, Gupta A, Silman AJ, Macfarlane GJ (2004). HYPOTHALAMIC-PITUITARY-ADRENAL STRESS AXIS FUNCTION - THE RELATIONSHIP WITH CHRONIC WIDESPREAD PAIN AND ITS ANTECEDENTS: a POPULATION-BASED STUDY.
RHEUMATOLOGY,
43, 7-7.
Author URL.
Dickens CM, McGowan L, Percival C, Douglas J, Tomenson B, Cotter L, Heagerty A, Creed FH (2004). Lack of a close confidant, but not depression, predicts further cardiac events after myocardial infarction.
Heart,
90(5), 518-522.
Abstract:
Lack of a close confidant, but not depression, predicts further cardiac events after myocardial infarction.
OBJECTIVE: to assess the role of depression and lack of social support before myocardial infarction (MI) in determining outcome in a large representative sample of patients admitted after MI in the UK. DESIGN: Prospective cohort design. PATIENTS: 1034 consecutive patients were screened 3-4 days after MI. MAIN OUTCOME MEASURES: Mortality and further cardiac events over one year after an MI. RESULTS: at 12 months' follow up mortality and further cardiac events were assessed in 583 of 654 eligible patients (90% response); 140 of 589 for whom baseline data were collected (23.8%) were depressed before their MI. Patients who were depressed before their MI were not more likely to die (mortality 5.2% v 5.0% of non-depressed patients) or suffer further cardiac events (cardiac events rate 20.7% v 20.3% of non-depressed patients). After controlling for demographic factors and severity of MI, the absence of a close confidant predicted further cardiac events (hazard ratio 0.57, p = 0.022). CONCLUSION: Lack of a close confidant but not depression before MI was associated with adverse outcome after MI in this sample. This association may be mediated by unhealthy behaviours and lack of compliance with medical recommendations, but it is also compatible with difficulties in early life leading to heart disease.
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Paschalides C, Wearden AJ, Dunkerley R, Bundy C, Davies R, Dickens CM (2004). The associations of anxiety, depression and personal illness representations with glycaemic control and health-related quality of life in patients with type 2 diabetes mellitus.
J Psychosom Res,
57(6), 557-564.
Abstract:
The associations of anxiety, depression and personal illness representations with glycaemic control and health-related quality of life in patients with type 2 diabetes mellitus.
OBJECTIVE: This study examined the interrelationships of anxiety, depression and personal illness representations with glycaemic control and health-related quality of life in adults with Type 2 diabetes. METHODS: One hundred eighty-four consecutive patients with Type 2 diabetes mellitus completed the Illness Perception Questionnaire (IPQ), the Well-Being Scale (WBQ) and the Short Form 36 Health Survey Questionnaire (SF-36). Demographic characteristics, details of diabetes status (duration of diabetes, treatments and complications) and glycosylated haemoglobin (HbA1c) were recorded. RESULTS: Depression was correlated with greater perceived symptom load (r =. 48, P <. 01), worse anticipated consequences (r = -.41, P <. 01) and perceived lack of control of diabetes (r =. 28, P <. 01). After controlling for demographic and illness characteristics, personal illness representations relating to symptom load and anticipated consequences were independently associated with the SF-36 physical functioning score, contributing an additional 15% to the variance. WBQ depression and anxiety scores, along with IPQ control and consequences, were independently associated with SF-36 mental function score, contributing a further 51% to the variance after controlling for demographic and illness details. Neither IPQ nor WBQ scales were associated with HbA1c after controlling for demographic and medical illness details. CONCLUSION: Anxiety, depression and negative beliefs about illness influence physical and mental functioning, but not metabolic control in patients with diabetes.
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McGowan L, Dickens C, Percival C, Douglas J, Tomenson B, Creed F (2004). The relationship between vital exhaustion, depression and comorbid illnesses in patients following first myocardial infarction.
J Psychosom Res,
57(2), 183-188.
Abstract:
The relationship between vital exhaustion, depression and comorbid illnesses in patients following first myocardial infarction.
OBJECTIVE: Vital exhaustion and depression are both independent risk factors for cardiovascular disease, yet the relationship between these highly similar dimensions remains unclear. We have examined the association between depression and vital exhaustion and investigated the extent to which any association is the result of comorbid illnesses. METHODS: Three hundred and five consecutive patients were examined on average 3.6 days following hospital admission with first myocardial infarction (MI). The Maastricht Questionnaire (MQ; vital exhaustion) was administered together with the Hospital Anxiety and Depression Scale (HADS), and details of comorbid physical illness were recorded. The factor structure of the MQ was explored using factor analysis. RESULTS: Depression and vital exhaustion were highly correlated (r=.61, P
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Dickens CM, Percival C, McGowan L, Douglas J, Tomenson B, Cotter L, Heagerty A, Creed FH (2004). The risk factors for depression in first myocardial infarction patients.
Psychol Med,
34(6), 1083-1092.
Abstract:
The risk factors for depression in first myocardial infarction patients.
BACKGROUND: Depression affects outcome following myocardial infarction but the risk factors for such depression have been little studied. This study considered whether the causes of depression occurring before and after myocardial infarction were similar to those of depression in the general population. METHOD: Consecutive patients admitted to hospital following their first myocardial infarction were interviewed with the Schedule for Clinical Assessment in Neuropsychiatry to detect psychiatric disorders and the Life Events and Difficulties Schedule to assess recent stress. Participants completed the Hospital Anxiety and Depression Scale (HADS) at entry to the study and 1 year later and the risk factors associated with a high score at both times were assessed. RESULTS: of 314 (88% of eligible) patients who were recruited, 199 (63%) were male and 63 (20%) had depressive disorders. Logistic regression identified the following as independently associated with depressive disorder that had been present for at least I month before the myocardial infarction: younger age, female sex, past psychiatric history, social isolation, having marked non-health difficulties and lack of a close confidant. At follow-up 269/298 (90%) responded; of 189 participants not depressed at first assessment, 39 (21%) became depressed by the 1 year follow-up. Logistic regression identified frequent angina as the only significant predictor of raised HADS scores at 12 months. CONCLUSIONS: Depression developing during the year following myocardial infarction does not have the same risk factors as that which precedes myocardial infarction. Further clarification of the mechanisms linking depression to poor outcome may require separation consideration of pre- and post-myocardial infarction depression, and its risk factors.
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Smith EM, Gomm SA, Dickens CM (2003). Assessing the independent contribution to quality of life from anxiety and depression in patients with advanced cancer.
Palliat Med,
17(6), 509-513.
Abstract:
Assessing the independent contribution to quality of life from anxiety and depression in patients with advanced cancer.
BACKGROUND: the aim of palliative care services is to ensure the best quality of life for patients and their carers. Depression is common amongst palliative care patients and has been shown to adversely affect quality of life. This study aimed to examine the independent contribution of depression to quality of life. OBJECTIVE: to investigate the hypothesis that a) illness severity, pain, anxiety and depression are all associated with impaired health-related quality of life and b) once the effects of illness severity have been adjusted for, there is further independent contribution to quality of life from anxiety and depression. METHOD: Consecutive patients with advanced cancer under the care of palliative care services were screened. Sixty-eight patients were evaluated for levels of anxiety and depression, severity of illness, pain severity and health-related quality of life. RESULTS: Thirty-three males and 35 females were recruited and had an age range of 41-93 years (median 71). Seventeen (25%) of patients were anxious [anxiety score > or = 11 on the Hospital Anxiety and Depression Scale (HADS)], 15 (22%) were depressed (HADS depression score > or = 11). After controlling for the effects of pain and illness severity, anxiety and depression were independently associated with global health status, emotional and cognitive functioning, and fatigue. Anxiety further contributed significantly towards social functioning, nausea and vomiting. CONCLUSIONS: This study has confirmed that pain, anxiety and depression were associated with impaired quality of life. Anxiety and depression contributed independently towards various dimensions of quality of life. Longitudinal studies are required to examine the direction of the causal association between pain and depression in patients receiving palliative care.
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Dickens C, Jackson J, Tomenson B, Hay E, Creed F (2003). Association of depression and rheumatoid arthritis.
Psychosomatics,
44(3), 209-215.
Abstract:
Association of depression and rheumatoid arthritis.
This study assessed the relative strength of the association of physical characteristics and social stresses with a diagnosis of depression in patients with rheumatoid arthritis. Depression and social difficulties were assessed in 74 patients with rheumatoid arthritis by using standardized research interviews. Rheumatoid arthritis activity, damage related to rheumatoid arthritis, and subjective functional disability were assessed with well-validated methods. Twenty-nine patients (39.2%) were depressed. Compared to nondepressed patients, depressed patients had more marked social difficulties related to rheumatoid arthritis (72.4% versus 46.7%, respectively) and more marked social difficulties independent of rheumatoid arthritis (55.2% versus 31.1%, respectively). With logistic regression, social difficulties, independent of rheumatoid arthritis, was the only variable significantly associated with depression. Demographic characteristics and rheumatoid arthritis were not associated with a diagnosis of depression. Recognition by clinicians of the importance of social stresses, independent of disease state, should lead to more appropriate and specific psychological and social treatment of depression in rheumatoid arthritis.
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Chiu YH, McBeth J, Morriss R, Dickens C, MacFarlane GJ, Silman AJ (2003). FEATURES OF SOMATISATION ARE ASSOCIATED WITH LOW PAIN THRESHOLD: RESULTS FROM a POPULATION BASED STUDY.
RHEUMATOLOGY,
42, 15-15.
Author URL.
Dickens C, McGowan L, Dale S (2003). Impact of depression on experimental pain perception: a systematic review of the literature with meta-analysis.
Psychosom Med,
65(3), 369-375.
Abstract:
Impact of depression on experimental pain perception: a systematic review of the literature with meta-analysis.
OBJECTIVE: This systematic review and meta-analysis was performed to examine the impact of depression on the perception of experimental pain stimuli. METHODS: CD-ROM databases and bibliographies were searched to identify studies comparing the psychophysical responses to experimental pain stimuli of depressed subjects with that of healthy controls. Effect sizes (Cohen's d) and probabilities were combined across studies; positive effect sizes indicated higher thresholds in depressed groups. RESULTS: Six methodologically rigorous, independent studies were found comparing psychophysical responses to experimental pain stimuli in depressed subjects and healthy controls. Pain perception threshold was higher in depressed subjects (6 studies, d = 0.38, p =.001). This finding was not the result of publication bias. Absolute sensory perception threshold was much higher in depressed subjects (2 studies, d = 0.68, p =.002), though the findings for pain tolerance (2 studies) were too heterogeneous to enable us to combine results. CONCLUSIONS: Depressed subjects are less likely to perceive a sensory stimulus as being painful compared with nondepressed controls. The influence of depression on attention to the pain stimulus may account for this effect. More studies are required to enable us to determine the impact of depression on absolute sensory perception threshold and pain tolerance. Furthermore, more studies would enable the examination of depression on the perception of different modalities.
Abstract.
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Dickens C (2002). Commentary. Advances in Psychiatric Treatment, 8(4), 305-306.
Dickens C, McGowan L, Clark-Carter D, Creed F (2002). Depression in rheumatoid arthritis: a systematic review of the literature with meta-analysis.
Psychosom Med,
64(1), 52-60.
Abstract:
Depression in rheumatoid arthritis: a systematic review of the literature with meta-analysis.
OBJECTIVE: This systematic review and meta-analysis examined the strength of association between rheumatoid arthritis and depression. In addition, we investigated the extent to which sociodemographic characteristics, level of pain, and method of assessing depression might affect the degree of depression. METHODS: CD-ROM databases and bibliographies were searched to identify all studies comparing depression in patients with rheumatoid arthritis and control subjects using standardized assessments. Effect sizes (Pearson's r) and probabilities were combined across studies. We examined the extent to which the association between rheumatoid arthritis and depression could be attributed to level of pain (using contrasts), sociodemographic differences between groups (combining methodologically restricted studies), and methods of assessing depression (examining heterogeneity across studies). RESULTS: Twelve independent studies comparing depression in patients with rheumatoid arthritis with depression in healthy control subjects were found. Effect sizes for depression were small to moderate (r =.21, p
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Dickens C, Jayson M, Creed F (2002). Psychological correlates of pain behavior in patients with chronic low back pain.
Psychosomatics,
43(1), 42-48.
Abstract:
Psychological correlates of pain behavior in patients with chronic low back pain.
Pain behaviors that are excessive for the degree of known physical disease are common in patients with chronic low back pain and are frequently assumed to arise from a comorbid depressive illness. Although some studies have confirmed an association between depression and excessive pain behavior, methodologic problems (such as the use of depression ratings that also recorded symptoms attributable to physical disease) make interpretation of this finding difficult. We recruited 54 consecutive patients with chronic (>6 months) low back pain from a hospital clinic. Subjects completed self-rated assessments of anxiety and depression (Hospital Anxiety and Depression Scale) designed to be minimally affected by physical symptoms, along with assessments of disability (ODQ), pain (visual analogue scale), pain behavior (Waddell checklist), and physical impairment. Seventeen subjects (31%) exhibited excessive pain behavior. Overall, they were no more depressed or anxious than the remainder, although men with excessive pain behavior showed a trend toward being more depressed. Patients with excessive pain behavior were more disabled (self-rated and observer-rated), reported greater pain, and were more likely to be female and to have pain of shorter duration. Pain behavior did not correlate with anxiety or depression, but correlated with measures of disability and pain intensity. Factor analysis revealed that physical disability, pain intensity, and pain behavior loaded heavily on the first factor. Anxiety and depression loaded together on a separate factor. We conclude that pain behaviors were not related to anxiety or depression in our group, although gender differences between groups could have contributed to our negative findings. Pain behaviors may influence other physical measures. Further studies are required to investigate the relation between depression and pain behavior while controlling for gender differences.
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Dickens C (2002). The pain-depression relationship - Dr. Dickens replies.
PSYCHOSOMATICS,
43(4), 341-342.
Author URL.
Fishbain DA, Dickens C (2002). The pain-depression relationship [7] (multiple letters). Psychosomatics, 43(4), 341-342.
Dickens C, Creed F (2001). The burden of depression in patients with rheumatoid arthritis. Rheumatology, 40(12), 1327-1330.
Dickens C, Creed F (2000). Depression as a predictor of outcome following myocardial infarction.
Cardiovascular Reviews and Reports,
21(9), 481-487.
Abstract:
Depression as a predictor of outcome following myocardial infarction
Depression occurs in up to 19% of patients following myocardial infarction. This has been shown to be associated with increased mortality (odds ratio up to 6.6), more frequent angina (odds ratio up to 2.3), and subsequent cardiac events (odds ratio 4.3). Depression is also associated with rehospitalization, increased health care costs, and worsened quality of life. In addition, both anxiety and social stresses have been linked with poor outcome following myocardial infarction. Mechanisms by which psychological factors may influence outcome are speculative at present. Some researchers propose that changes in sympathetic tone associated with depression may increase the probability of arrhythmias in the vulnerable myocardium. Alternative hypotheses suggest that behavioral factors such as smoking are important. Identification of patients likely to be suffering from depression is possible for nonpsychiatrists using brief, standardized questionnaires. Cardiologists, like other physicians, need to incorporate assessment of mood and treat patients with concurrent depression in order to improve quality of life following myocardial infarction. © 2000 by Cardiovascular Reviews and Reports, Inc.
Abstract.
Ash G, Dickens CM, Creed FH, Jayson MIV, Tomenson B (2000). The effects of dothiepin on subjects with rheumatoid arthritis and depression (multiple letters) [3].
Rheumatology,
39(12), 1425-1427.
Abstract:
The effects of dothiepin on subjects with rheumatoid arthritis and depression (multiple letters) [3]
Background. The relative importance of direct analgesic and antidepressant effects of antidepressant drugs in rheumatoid arthritis (RA) is not clear. Method. Forty-eight female out-patients with RA, with depression and/or anxiety, were entered into a double-blind, placebo-controlled study of dothiepin in doses up to 150 mg daily to assess the effects on mood [Hospital Anxiety and Depression (HAD) scale and Hamilton Rating Scale (HRS) for Depression], pain [visual analogue scale (VAS)] and disability [Health Assessment Questionnaire (HAQ)]. Results. Repeated measures multivariate analysis of variance revealed that treatment had a significant effect on pain (Fd.f. 1,39=5.7, P=0.02). There were further interaction effects between treatment and time on pain (Fd.f. 3,117=3.3, P=0.03), disability (Fd.f. 3,117=4.2, P=0.008) and duration of early morning stiffness (Fd.f. 3,117=3.3, P=0.03). Depression (HRS) was considerably reduced in both the dothiepin and placebo groups, and there was no significant difference between groups. Post hoc analyses using analysis of covariance revealed that, in the dothiepin group, pain was significantly reduced by week 4 and remained so at week 12. Disability scores and duration of early morning stiffness were consistently lower in the dothiepin group, although differences failed to reach statistical significance at any follow-up assessment. In the group as a whole, reductions in pain were highly significantly correlated with reductions in HAD depression (r=0.63, P
Abstract.
Ash G, Dickens CM, Creed FH (2000). The effects of dothiepin on subjects with rheumatoid arthritis and depression - Reply.
RHEUMATOLOGY,
39(12), 1426-1427.
Author URL.
Dickens C, Jayson M, Sutton C, Creed F (2000). The relationship between pain and depression in a trial using paroxetine in sufferers of chronic low back pain.
Psychosomatics,
41(6), 490-499.
Abstract:
The relationship between pain and depression in a trial using paroxetine in sufferers of chronic low back pain.
Previous studies have shown a positive association between pain and depression, though evidence supporting a direct link between these two variables is less robust. Using a placebo-controlled trial, the authors examined the analgesic and antidepressant efficacy of paroxetine (20 mg) in chronic low back pain sufferers. The authors examined the associations among pain, depression, disability, and illness attitudes. Paroxetine showed no effects on pain or depression compared with placebo; however, subjects randomized to paroxetine were more likely to reduce concomitant analgesic medication. The cross-sectional association of depression and pain at baseline (r = 0.2, P = 0.02) was weaker than the association between depression and disability (r = 0.3, P = 0.004). Similarly, the association of change in depression scores with change in pain (r = 0.25, P = 0.016) was weaker than change between depression and disability (r = 0.49, P
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Murphy H, Dickens C, Creed F, Bernstein R (1999). Depression, illness perception and coping in rheumatoid arthritis.
J Psychosom Res,
46(2), 155-164.
Abstract:
Depression, illness perception and coping in rheumatoid arthritis.
This study aimed to establish the relationship between depression, illness perception, coping strategies, and adverse childhood events in rheumatoid arthritis patients. Sixty-two out-patients with rheumatoid arthritis (RA) completed the Hospital Anxiety and Depression Scale, Illness Perception Questionnaire, London Coping with Rheumatoid Arthritis Questionnaire, and Childhood Development Questionnaire, and underwent a clinical assessment of their physical state. Depressed patients were more disabled than the nondepressed, had a more negative view of their illness, and used more negative coping strategies. There was no association between depression and childhood adversity. Once disability was controlled for, there continued to be a significant correlation between depression and: (i) viewing the consequences of the illness negatively (Spearman's correlation coefficient [r]=0.37, p=0.003); and (ii) the perceived ability to control the illness (r= -0.26, p=0.04). The relationship between depression and negative coping strategies became insignificant. This study indicates the close relationship between depression and a negative view of the illness.
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Author URL.
Ash G, Dickens CM, Creed FH, Jayson MIV, Tomenson B (1999). The effects of dothiepin on subjects with rheumatoid arthritis and depression.
Rheumatology,
38(10), 959-967.
Abstract:
The effects of dothiepin on subjects with rheumatoid arthritis and depression
Background. The relative importance of direct analgesic and antidepressant effects of antidepressant drugs in rheumatoid arthritis (RA) is not clear. Method. Forty-eight female out-patients with RA, with depression and/or anxiety, were entered into a double-blind, placebo-controlled study of dothiepin in doses up to 150 mg daily to assess the effects on mood [Hospital Anxiety and Depression (HAD) scale and Hamilton Rating Scale (HRS) for Depression], pain [visual analogue scale (VAS)] and disability [Health Assessment Questionnaire (HAQ)]. Results. Repeated measures multivariate analysis of variance revealed that treatment had a significant effect on pain (F(d.f. 1,39) = 5.7, P = 0.02). There were further interaction effects between treatment and time on pain (F(d.f. 3,117) = 3.3, P = 0.03), disability (F(d.f. 3,117) = 4.2, P = 0.008) and duration of early morning stiffness (F(d.f. 3,117) = 3.3, P = 0.03). Depression (HRS) was considerably reduced in both the dothiepin and placebo groups, and there was no significant difference between groups. Post hoc analyses using analysis of covariance revealed that, in the dothiepin group, pain was significantly reduced by week 4 and remained so at week 12. Disability scores and duration of early morning stiffness were consistently lower in the dothiepin group, although differences failed to reach statistical significance at any follow-up assessment. In the group as a whole, reductions in pain were highly significantly correlated with reductions in HAD depression (r = 0.63, P < 0.0005), HAD anxiety (r = 0.46, P = 0.001) and HRS depression (r = 0.37, P = 0.01). Conclusion. Dothiepin is effective in relieving pain, disability and reducing the duration of early morning stiffness in out-patients with RA. Although there is a general association between pain reduction and improved anxiety and depression, the analgesic effect of dothiepin is independent of its antidepressant effect. Individual variation is considerable and further research should try to identify mechanisms of interaction between the antidepressant and analgesic effects of treatment in different patient groups.
Abstract.
Dickens C, Jayson M, Creed F (1998). Treating depression in chronic low back pain sufferers.
PSYCHOSOMATIC MEDICINE,
60(1), 130-130.
Author URL.
Zeidler M, Johnstone EC, Bamber RWK, Dickens CM, Fisher CJ, Francis AF, Goldbeck R, Higgo R, Johnson-Sabine EC, Lodge GJ, et al (1997). New variant Creutzfeldt-Jakob disease: Psychiatric features.
Lancet,
350(9082), 908-910.
Abstract:
New variant Creutzfeldt-Jakob disease: Psychiatric features
Background. An apparently new variant of Creutzfeldt-Jakob disease (CJD), new variant CJD (nvCJD), was identified in the UK in 1996. There have now been 21 cases of nvCJD in the UK and one in France. Psychiatric symptoms are prominent in the initial presentation in these cases. Methods. Cases of nvCJD are identified mainly by direct referral from neurologists and neuropathologists. Detailed clinical information was obtained by review of case notes and interviewing patients' relatives. We report the psychiatric features of the first 14 cases on nvCJD in the UK. Psychiatric notes were examined in all 13 of these cases who were seen by a psychiatrist. Results. Eight cases were women. All 14 cases had early psychiatric features and in nine, the first symptom was psychiatric. 13 cases were seen by a psychiatrist and the majority were diagnosed as suffering from depression or depression secondary to organic disease. Two cases suffered from first-rank symptoms suggestive of psychotic illness and transient delusions and auditory or visual hallucinations occurred in the majority. All cases were referred to a neurologist as the illness evolved and neurological signs developed. Interpretation. Psychiatric symptoms are a consistent early clinical feature in nvCJD. Analysis of the psychiatric symptoms does not suggest specific features that readily allow distinction from more common psychiatric disorders, although the occurrence of associated persistent sensory symptoms may raise the possibility of this diagnosis. Neurological signs, including ataxia, involuntary movements and cognitive impairment developed in all cases and the evolution of increasing neurological deficits is likely to remain critical to the clinical diagnosis of nvCJD.
Abstract.
APPLEBY L, DICKENS C (1993). MOTHERING SKILLS OF WOMEN WITH MENTAL-ILLNESS.
BRITISH MEDICAL JOURNAL,
306(6874), 348-349.
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DICKENS CM, HESELTINE D, WALTON S, BENNETT JR (1990). THE ESOPHAGUS IN LICHEN-PLANUS - AN ENDOSCOPIC STUDY.
BRITISH MEDICAL JOURNAL,
300(6717), 84-84.
Author URL.
Dickens CM, Heseltine D, Walton S, Bennett JR (1990). The oesophagus in lichen planus: an endoscopic study.
BMJ,
300(6717).
Author URL.
DICKENS C, WALTON S, KECZKES K (1989). OIL GRANULOMA OF THE PENIS - AN UNUSUAL ARTIFACT.
CLINICAL AND EXPERIMENTAL DERMATOLOGY,
14(4), 332-332.
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