Carl Walker

Prevalence of common mental disorders in general practice attendees across Europe.

BACKGROUND There is evidence that the prevalence of common mental disorders varies across Europe. AIMS To compare prevalence of common mental disorders in general practice attendees in six European countries. METHOD Unselected attendees to general practices in the UK, Spain, Portugal, Slovenia, Estonia and The Netherlands were assessed for major depression, panic syndrome and other anxiety syndrome. Prevalence of DSM-IV major depression, other anxiety syndrome and panic syndrome was compared between the UK and other countries after taking account of differences in demographic factors and practice consultation rates. RESULTS Prevalence was estimated in 2,344 men and 4,865 women. The highest prevalence for all disorders occurred in the UK and Spain, and lowest in Slovenia and The Netherlands. Men aged 30-50 and women aged 18-30 had the highest prevalence of major depression; men aged 40-60 had the highest prevalence of anxiety, and men and women aged 40-50 had the highest prevalence of panic syndrome. Demographic factors accounted for the variance between the UK and Spain but otherwise had little impact on the significance of observed country differences. CONCLUSIONS These results add to the evidence for real differences between European countries in prevalence of psychological disorders and show that the burden of care on general practitioners varies markedly between countries.

Development and Validation of an International Risk Prediction Algorithm for Episodes of Major Depression in General Practice Attendees The PredictD Study

CONTEXT Strategies for prevention of depression are hindered by lack of evidence about the combined predictive effect of known risk factors. OBJECTIVES To develop a risk algorithm for onset of major depression. DESIGN Cohort of adult general practice attendees followed up at 6 and 12 months. We measured 39 known risk factors to construct a risk model for onset of major depression using stepwise logistic regression. We corrected the model for overfitting and tested it in an external population. SETTING General practices in 6 European countries and in Chile. PARTICIPANTS In Europe and Chile, 10 045 attendees were recruited April 2003 to February 2005. The algorithm was developed in 5216 European attendees who were not depressed at recruitment and had follow-up data on depression status. It was tested in 1732 patients in Chile who were not depressed at recruitment. Main Outcome Measure DSM-IV major depression. RESULTS Sixty-six percent of people approached participated, of whom 89.5% participated again at 6 months and 85.9%, at 12 months. Nine of the 10 factors in the risk algorithm were age, sex, educational level achieved, results of lifetime screen for depression, family history of psychological difficulties, physical health and mental health subscale scores on the Short Form 12, unsupported difficulties in paid or unpaid work, and experiences of discrimination. Country was the tenth factor. The algorithms average C index across countries was 0.790 (95% confidence interval [CI], 0.767-0.813). Effect size for difference in predicted log odds of depression between European attendees who became depressed and those who did not was 1.28 (95% CI, 1.17-1.40). Application of the algorithm in Chilean attendees resulted in a C index of 0.710 (95% CI, 0.670-0.749). CONCLUSION This first risk algorithm for onset of major depression functions as well as similar risk algorithms for cardiovascular events and may be useful in prevention of depression.

Prediction of depression in European general practice attendees: the PREDICT study

BackgroundPrevention of depression must address multiple risk factors. Estimating overall risk across a range of putative risk factors is fundamental to prevention of depression. However, we lack reliable and valid methods of risk estimation. This protocol paper introduces PREDICT, an international research study to address this risk estimation.Methods/designThis is a prospective study in which consecutive general practice attendees in six European countries are recruited and followed up after six and 12 months. Prevalence of depression is assessed at baseline and each follow-up point. Consecutive attendees between April 2003 and September 2004 who were aged 18 to 75 were asked to take part. The possibility of a depressive episode was assessed using the Depression Section of the Composite International Diagnostic Interview. A selection of presumed risk factors was based on our previous work and a systematic review of the literature. It was necessary to evaluate the test-retest reliability of a number of risk factor questions that were developed specifically, or adapted, for the PREDICT study. In a separate reliability study conducted between January and November 2003, consecutive general practice attendees in the six participating European countries completed the risk factor items on two occasions, two weeks apart. The overall response rate at entry to the study was 69%. We exceeded our expected recruitment rate, achieving a total of 10,048 people in all. Reliability coefficients were generally good to excellent.DiscussionResponse rate to follow-up in all countries was uniformly high, which suggests that prediction will be based on almost a full cohort. The results of our reliability analysis are encouraging and suggest that data collected during the course of PREDICT will have a satisfactory level of stability. The development of a multi-factor risk score for depression will lay the foundation for future research on risk reduction in primary care. Our data will also provide the necessary evidence base on which to develop and evaluate interventions to reduce the prevalence of depression.

Measuring spiritual belief: development and standardization of a Beliefs and Values Scale

BACKGROUND Higher levels of religious involvement are modestly associated with better health, after taking account of other influences, such as age, sex and social support. However, little account is taken of spiritual beliefs that are not tied to personal or public religious practice. Our objective was to develop a standardized measure of spirituality for use in clinical research. METHOD We characterized the core components of spirituality using narrative data from a purposive sample of people, some of whom were near the end of their lives. These data were developed into statements in a scale to measure strength of spiritual beliefs and its reliability, validity and factor structure were evaluated in order to reach a final version. RESULTS Thirty-nine people took part in the qualitative study to define the nature of spirituality in their lives. These data were used to construct a 47-item instrument that was evaluated in 372 people recruited in medical and non-medical settings. Analysis of these statements led to a 24-item version that was evaluated in a further sample of 284 people recruited in similar settings. The final 20-item questionnaire performed with high test-retest and internal reliability and measures spirituality across a broad religious and non-religious perspective. CONCLUSIONS A measure of spiritual belief that is not limited to religious thought, may contribute to research in psychiatry and medicine.

Heavy Episodic Drinking in Europe: A Cross Section Study in Primary Care in Six European Countries

AIMS We examined the prevalence of heavy episodic drinking in general practice attenders who were non-hazardous drinkers, the associated risk factors and the outcome over 6 months. METHODS Consecutive attenders aged 18-75 were recruited from the UK, Spain, Slovenia, Estonia, the Netherlands and Portugal and followed up after 6 months. Data were collected on alcohol use using the Alcohol Use Disorder Identification test (at recruitment and 6 months) and risk factors for heavy episodic alcohol use at recruitment. RESULTS The prevalence of heavy episodic drinking in non-hazardous drinkers was 4.5% across Europe [lowest in Portugal (1.5%); highest Netherlands (8.4%)]. It was less frequent in Spain, Slovenia, Estonia and Portugal compared with the UK and Netherlands. It was higher in men [odd ratio (OR) 4.4, 95% confidence interval (CI) 3.3, 5.9], people between 18 and 29 years of age, those employed (OR 1.8, 95% CI 1.3, 2.6) and those using recreational drugs (OR 2.1, 95% CI 1.4, 3.3). It was lower in people with existing DSMIV major depression (OR 0.54, 95% CI 0.31, 0.96). Heavy episodic drinkers were more likely to become hazardous drinkers at 6 months (male: OR 7.2, 95% CI 4.1, 12.7; female: OR 9.4, 95% CI 4.3, 20.6). CONCLUSION Women and men in the UK, men in the Netherlands and younger people in all countries are at the greatest risk of exhibiting heavy episodic drinking behaviours even in the absence of hazardous alcohol use. There is hence an urgent need for general practitioners to consider early detection and management of heavy episodic drinking behaviour in this population.

“Responsibilizing” a Healthy Britain: Personal Debt, Employment, and Welfare

Growing evidence suggests that experiences of financial strain and over-indebtedness can contribute to problems of physical and mental health. This article contends that there is a need to carefully examine recent neoliberally informed symbolic and material transformations in the practices and experiences of employment, welfare, and subjectivity in order to provide an appropriately sophisticated analysis of experiences of debt and mental health. An illusion of economic growth has been based on increasing levels of often traumatic personal debt and a low-wage labor force compelled into increasingly problematic practices of employment. In recent years, a concerted neoliberal assault on subjectivity, modes of employment, minimum incomes, and practices of welfare governance has effectively constituted new forms of poverty and personal sustenance through deregulated sub-prime credit markets. The variable and multifunctional nature of personal debt has provided a substrate for neoliberal public policy by systematically reinforcing the development of a low-wage labor market and by representing a means through which to transfer collective risk into private responsibility. This article suggests that traditional ways of knowing and acting upon the mental and physical health difficulties associated with problems of debt and material deprivation fail to adequately acknowledge the political and economic role of personal debt growth.

Paediatric eczema and psychosocial morbidity: how does eczema interact with parents’ illness beliefs?

Background  Thus far there has been relatively little work on childrens illness representations regarding eczema and how these relate to parental conceptualizations of their childs psychosocial health. This is important because the challenge of raising a child with a serious illness can affect many facets of a parents everyday life and the behaviour of parents can be closely related to the health of the child.

Different shades of meaning: illness beliefs among vitiligo sufferers

Vitiligo is a pigmentory disorder of uncertain etiology, involving the destruction of cutaneous melanocytes. This study explores the beliefs held by vitiligo sufferers about their condition in the absence of an established medical explanation. All vitiligo patients had been formally diagnosed by a dermatologist or GP. Participants completed the Illness Perception Questionnaire (IPQ) in order to measure illness beliefs. Participants also completed a questionnaire requesting demographic information. Questionnaires were sent to 1,937 members of the UK Vitiligo Society, of whom 922 (48%) returned usable questionnaires. The results suggest distinct differences in the consequences of vitiligo and differences in internal and external causal attributions with respect to race and gender status. The findings have implications for how we approach counselling and medical therapy for this patient group. Further implications are discussed and suggestions for future research are made.

The Illness Perception Questionnaire as a reliable assessment tool: Cognitive representations of vitiligo

Vitiligo is an episodic condition with uncertain aetiology, therefore the labeling and, in turn, beliefs about the nature of the condition are less likely to be based on substantive medical knowledge and more on cognitive representations which the patients develop. As such, a reliable measure of these representations could be very useful in understanding how vitiligo patients interpret their condition. The present study examines the internal consistency of the Illness Perception Questionnaire (IPQ; Weinman et al. , 1996) sub-scales with respect to its usefulness as a reliable measure of these cognitive representations of illness among vitiligo patients. Nine hundred and twenty-two usable questionnaires were returned from UK Vitiligo Society members and a reliability analysis was carried out on SPSS for Windows for each of the four sub-scales and the symptom scale. The symptom scale and every sub-scale showed high internal consistency when completed by vitiligo patients. Results suggest that the IPQ is a reliable assessment tool for the cognitive representations of illness of vitiligo patients. The questionnaire could be very useful for health care professionals. The IPQ would also allow the investigation of sociodemographic variance with respect to vitiligo populations.

Return-to-work support for employees with mental health problems: Identifying and responding to key challenges of sick leave

Introduction This research explored return-to-work and sick leave experiences of workers with mental health issues in contact with acute or community mental health services. Method Using a critical realist methodology with a comparative case study and collaborative design, 21 employed participants recovering from mental health problems participated in semi-structured interviews. Data were analysed using inductive and deductive thematic and constant comparative analysis. Findings While on sick leave, despite a range of challenges, participants treasured their work identities. They were sustained by positive and troubled by negative memories of work. People missed the routine of work and felt isolated. To varying degrees of success, they searched for alternative activities to fill this gap and promote recovery. Conclusion The need for sick leave was not disputed, but an important discovery was its iatrogenic (‘side-’) effects, whereby isolation and reduced activity levels could exacerbate mental health problems. Negative impacts of sick leave need to be mitigated by support to maintain worker identity and orientation and by opportunities and encouragement to sustain routine, activities and social contacts. A new concept of ‘occupational capital’ emerged, comprising accessible external opportunities and supports for occupational participation, and internal capacities and skills required to access these.