Claire Cartwright

The prevalence of voice-hearers in the general population: A literature review

Background. It is increasingly understood that voice-hearing is neither a rare phenomenon experienced only by ‘psychiatric patients’ nor a meaningless symptom of a ‘mental illness’. Aims. To estimate the prevalence of voice-hearing in the adult general population. Methods. PsycINFO and relevant literature reviews were searched for studies of the prevalence of verbal auditory hallucinations among adults. Results. Seventeen surveys, from nine countries, were identified. Comparisons across studies were problematic due to differences in definitions, methodologies, and cultural factors. Prevalence ranged from 0.6% to 84%, with an interquartile range (excluding the highest and lowest quartiles) of 3.1%–19.5%, and a median of 13.2%. Conclusions. Differences in prevalence can be attributed in part to differences in definitions and methodologies, but also to true variations based on gender, ethnicity and environmental context. The findings support the current movement away from pathological models of unusual experiences and towards understanding voice-hearing as occurring on a continuum in the general population, and having meaning in relation to the voice-hearers life experiences.

Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants

In the context of rapidly increasing antidepressant use internationally, and recent reviews raising concerns about efficacy and adverse effects, this study aimed to survey the largest sample of AD recipients to date. An online questionnaire about experiences with, and beliefs about, antidepressants was completed by 1829 adults who had been prescribed antidepressants in the last five years (53% were first prescribed them between 2000 and 2009, and 52% reported taking them for more than three years). Eight of the 20 adverse effects studied were reported by over half the participants; most frequently Sexual Difficulties (62%) and Feeling Emotionally Numb (60%). Percentages for other effects included: Feeling Not Like Myself - 52%, Reduction In Positive Feelings - 42%, Caring Less About Others - 39%, Suicidality - 39% and Withdrawal Effects - 55%. Total Adverse Effect scores were related to younger age, lower education and income, and type of antidepressant, but not to level of depression prior to taking antidepressants. The adverse effects of antidepressants may be more frequent than previously reported, and include emotional and interpersonal effects.

Young adults’ narratives of relational development with stepfathers:

Young adults (N = 25) who grew up in stepfamilies in New Zealand took part in narrative interviews on relationships development with their stepfathers. Initially interview data were analyzed using thematic analysis that indicated the importance of perceptions of the stepfather’s personal qualities; warmth and support; discipline issues; and perceptions of his impact on the family. In addition, a narrative analysis examined five types of stories, which ranged from Continuous Positive Regard to Continuous Struggle. Positive stepfather—stepchild relationships were characterized by stepfather warmth and support, and stepchild acceptance. Boundary-related discipline issues underlay many stepfather—stepchild difficulties. Implications for stepfather roles, stepfamily parental alliance, and relationships with stepchildren are discussed.

Preparing to repartner and live in a stepfamily: An exploratory investigation

Abstract Little is known about the courtship period of stepfamily couples. This current study is an exploratory investigation of the preparation couples undertake prior to stepfamily living. Ninety- nine stepfamily adults living in New Zealand completed an online questionnaire about the courtship period. The results suggest that couples are motivated to repartner by needs for an intimate relationship and associated benefits, although economic and resource issues precipitated cohabitation for some. Many participants had awareness of potential stepfamily challenges. However, the majority did not talk to partners about parenting issues, or how to manage the change for children, supporting earlier findings that stepfamily couples avoid communicating about difficult issues. The results also suggest that many children received little preparation or communication about the decision to repartner and live in a stepfamily.

Into the unknown: the experiences of individuals living with multiple sclerosis.

This article examines the narratives of 16 individuals diagnosed with multiple sclerosis (MS). Before diagnosis, the participants had experienced disparate and transient symptoms. Diagnosis itself involved numerous tests and health practitioners, varied responses to the diagnosis, an inability to assimilate information about the disease, and a view of MS as being the lesser of two evils. Immediately after diagnosis, participants revealed concerns about the unpredictable progression of the disease. Patient narratives reflected both negative and positive aspects of living with a chronic illness, such as shifting roles, discrimination, reevaluation of priorities, reinvestment in the family, and positive lifestyle changes. All aspects of the narratives revealed fear and anxiety in relation to the unknown.

Long-term antidepressant use: patient perspectives of benefits and adverse effects

Long-term antidepressant treatment has increased and there is evidence of adverse effects; however, little is known about patients’ experiences and views of this form of treatment. This study used mixed methods to examine patients’ views and experiences of long-term antidepressant treatment, including benefits and concerns. Data from 180 patients, who were long-term users of antidepressants (3–15 years), were extracted from an anonymous online survey of patients’ experiences of antidepressants in New Zealand. Participants had completed rating scales about the effectiveness of antidepressants, levels of depression before and during antidepressant use, quality of life, and perceived adverse effects. Two open-ended questions allowed participants to comment on personal experiences. The majority (89.4%) reported that antidepressants had improved their depression although 30% reported moderate-to-severe depression on antidepressants. Common adverse effects included withdrawal effects (73.5%), sexual problems (71.8%), and weight gain (65.3%). Adverse emotional effects, such as feeling emotionally numb (64.5%) and addicted (43%), were also common. While the majority of patients were pleased with the benefits of antidepressant treatment, many were concerned about these adverse effects. Some expressed a need for more information about long-term risks and increased information and support to discontinue.

Beliefs of people taking antidepressants about the causes of their own depression

BACKGROUND The beliefs of people receiving treatment about the causes of their own mental health problems are researched less often than the causal beliefs of the public, but have important implications for relationships with prescribers, treatment choices and recovery. METHOD An online survey on a range of beliefs about depression, and experiences with antidepressants, was completed by 1829 New Zealand adults prescribed anti-depressants in the preceding five years, 97.4% of whom proceeded to take antidepressants. RESULTS Six of 17 beliefs about the causes of their own depression were endorsed by more than half the sample: chemical imbalance, family stress, work stress, heredity, relationship problems and distressing events in childhood. There were some marked differences in content, structure and level of conviction of beliefs about one׳s own depression and the sample׳s previously published beliefs about depression in general. There were also significant differences between the beliefs of demographic groupings. Regression analyses revealed that self-reported effectiveness of the antidepressants was positively associated with bio-genetic causal beliefs. The quality of the relationship with the prescribing doctor was positively related to a belief in chemical imbalance as a cause and negatively related to a belief in unemployment as a cause. LIMITATIONS The convenience sample may have been biased towards a favourable view of bio-genetic explanations, since 83% reported that the medication reduced their depression. CONCLUSIONS People experiencing depression hold complex, multifactorial and idiosyncratic sets of beliefs about the causes of their own depression, apparently based at least in part on their own life experiences and circumstances. Exploring those beliefs may enhance the doctor-patient relationship and selection of appropriate treatment modality.

Understanding the non-pharmacological correlates of self-reported efficacy of antidepressants

To explore the non‐pharmacological correlates of the perceived effectiveness of antidepressants (ADs), thereby enhancing understanding of the mechanisms involved in recovery from depression while taking ADs.

‘In my life antidepressants have been…’: a qualitative analysis of users’ diverse experiences with antidepressants

BackgroundWhile mental health professionals have focused on concerns about whether antidepressants work on a neurochemical level it is important to understand the meaning this medication holds in the lives of people who use it. This study explores diversity in the experience of antidepressant users.MethodsOne thousand seven hundred forty-seven New Zealand antidepressant users responded to an open-ended question about their experience of antidepressants. This was analysed using content and thematic analysis.ResultsThere was considerable diversity in participants’ responses including positive (54 %), negative (16 %) and mixed (28 %) experiences with antidepressants. Those with positive experiences saw antidepressants as a necessary treatment for a ‘disease’, a life saver, a way of meeting social obligations, dealing with difficult circumstances or a stepping stone to further help. Negative themes described antidepressants as being ineffective, having unbearable side effects, undermining emotional authenticity, masking real problems and reducing the experience of control. Mixed experience themes showed how participants weighed up the unpleasant side effects against the benefits, felt calmer but less like themselves, struggled to find the one or dosage and felt stuck with continuing on antidepressants when they wished to stop.ConclusionsMental health professions need to recognize that antidepressants are not a ‘one size fits all’ solution.

Are older people prescribed antidepressants on the basis of fewer symptoms of depression, and for longer periods of time? A survey of 1825 New Zealanders.

To determine whether older people are prescribed antidepressants at lower levels of depression and with fewer symptoms, and whether they are more likely to engage in chronic usage than younger adults.