Jane Hutton

Self-help interventions for symptoms of depression, anxiety and psychological distress in patients with physical illnesses: A systematic review and meta-analysis

Psychological distress, depression and anxiety are common in most physical diseases, and self-help interventions, if effective, might be an important approach to improve outcomes as they are inexpensive to provide to large numbers of patients. The primary aim of this review was to assess randomised controlled trials examining the impact of self-help interventions on symptoms of depression, anxiety and psychological distress in patients with physical illness. Systematic searches of electronic databases resulted in twenty-five eligible studies for meta-analysis (n=4211). The results of the primary meta-analyses revealed a significant improvement in depression symptoms, in favour of the intervention group (SMD=-0.13, 95% CI: -0.25, -0.02, p=0.02, I(2)=50%). There were no significant differences in symptoms of anxiety (SMD=-0.10, 95% CI: -0.24, 0.05, p=0.20, I(2)=63%) or psychological distress (SMD=-0.14, 95% CI: -0.40, 0.12, p=0.30, I(2)=72%) between intervention and control conditions. Several subgroup and sensitivity analyses improved effect sizes, suggesting that optimal mental health outcomes may be obtained in patients without neurological conditions, and with interventions based on a therapeutic model (such as cognitive behavioural therapy), and with stress management components. This review demonstrates that with appropriate design and implementation, self-help interventions may potentially improve symptoms of depression in patients with physical conditions.

Embedding integrated mental health assessment and management in general hospital settings: feasibility, acceptability and the prevalence of common mental disorder

OBJECTIVE To assess the feasibility and acceptability of routine web-based screening in general hospital settings, and describe the level of common mental disorder. METHOD A service development platform to integrate mental and physical healthcare was implemented in six specialties (rheumatology, limb reconstruction, hepatitis C, psoriasis, adult congenital heart disease (ACHD), chronic pain) across three general hospitals in London, UK. Under service conditions, patients completed a web-based questionnaire comprising mental and physical patient-reported outcome measures, whilst waiting for their appointment. Feasibility was quantified as the proportion of patients who completed the questionnaire. Acceptability was quantified as the proportion of patients declining screening, and the proportion requiring assistance completing the questionnaire. The prevalence of probable depression and anxiety was expressed as the percentage of cases determined by the Patient Health Questionnaire-9 and Generalised Anxiety Disorder Questionnaire-7. RESULTS The proportion of patients screened varied widely across specialties (40.1-98.2%). The decline rate was low (0.6-9.7%) and the minority required assistance (11.7-40.4%). The prevalence of probable depression ranged from 60.9% in chronic pain to 6.6% in ACHD. The prevalence of probable anxiety ranged from 25.1% in rheumatology to 11.4% in ACHD. CONCLUSION Web-based screening is acceptable to patients and can be effectively embedded in routine practice. General hospital patients are at increased risk of common mental disorder, and routine screening may help identify need, inform care and monitor outcomes.

A qualitative study of men's experience of myocardial infarction

Abstract The majority of people experiencing myocardial infarction and attending cardiac rehabilitation are male and the outcome of rehabilitation is better for men. However, there is a lack of qualitative exploration of how men experience myocardial infarction and cardiac rehabilitation, which this study aims to address. Ten men who had recently had a myocardial infarction were interviewed using a semi-structured format, which covered events around the infarction, its impact on various aspects of life, ways of dealing with these experiences and experience of cardiac rehabilitation and other medical services. In this paper, the themes which emerged from Interpretive Phenomenological Analysis of the interview transcipts will be described and discussed in relation to the existing literature, and particularly to White et al.s (in press) study of women who had had a myocardial infarction. These themes relate to views of the self, the illness and the future, ways of coping and experiences of rehabilitation. Implications for services and future research will be discussed.