Jeannette Lynch

Attention processes in chronic fatigue syndrome: attentional bias for health-related threat and the role of attentional control.

Cognitive behavioural models of chronic fatigue syndrome (CFS) propose that attention processes, specifically, enhanced selective attention to health-threat related cues, may play an important role in symptom maintenance. The current study investigated attentional bias towards health-threat stimuli in CFS. It also examined whether individuals with CFS have impaired executive attention, and whether this was related to attentional bias. 27 participants with CFS and 35 healthy controls completed a Visual Probe Task measuring attentional bias, and an Attention Network Test measuring executive attention, alerting and orienting. Participants also completed self-report measures of CFS and mood symptoms. Compared to the control group, the CFS group showed greater attentional bias for health-threat words than pictures; and the CFS group was significantly impaired in executive attention. Furthermore, CFS individuals with poor executive attention showed greater attentional bias to health-threat related words, compared not only to controls but also to CFS individuals with good executive attention. Thus, this study revealed a significant relationship between attentional bias and executive attention in CFS: attentional bias to threat was primarily evident in those with impaired executive attention control. Taking account of individual differences in executive attention control in current intervention models may be beneficial for CFS.

Are patient beliefs important in determining adherence to treatment and outcome for depression? Development of the beliefs about depression questionnaire

BACKGROUND Depressive disorders are prevalent and costly but there is a lack of evidence on how to best select treatments for mild to moderate depression in primary care. Illness beliefs have been shown to influence the outcome from physical illness and our previous retrospective study suggested that beliefs may influence the duration of antidepressant medication. The development of a short questionnaire to measure beliefs will allow exploration of the relationship between beliefs, adherence to treatment and outcome for depression. METHODS A questionnaire was designed based on Leventhals Common Sense Model of illness beliefs (CSM). Data from previous qualitative and quantitative studies as well as formal inventories were used to inform the content of individual items. The questionnaire was mailed to primary care patients with a recorded history of depression in the previous 2 years. Data were analysed by principal component analysis to determine underlying multidimensional structure and derive a shortened questionnaire. RESULTS Three hundred and thirty-four respondents completed the questionnaire. Fifteen components (subscales) were derived which corresponded to aspects of the CSM dimensions for cause, control/cure, consequences and timeline. The identity dimension was retained as one subscale. Reliability coefficients determined the items which best represented each subscale; 52 items were retained to derive a new shortened questionnaire. Convergent construct validity was demonstrated by comparison with the generic brief illness perception questionnaire (BIPQ) and divergent construct validity was shown by comparison with the Hospital Anxiety and Depression scale (HADs). LIMITATIONS The study was adequately powered, but the response rate means that response bias cannot be excluded. CONCLUSIONS Beliefs about depression are multi-faceted, but fit the dimensions of the CSM. The derived shortened questionnaire will be used to determine whether beliefs about depression are predictive of outcome in a future prospective study.

Do patients׳ illness beliefs predict depression measures at six months in primary care; a longitudinal study

BACKGROUND Depressive disorders are prevalent and costly but there is a lack of evidence on how best to select treatments for mild to moderate depression in primary care. Illness beliefs have been shown to affect the outcome from physical illness, but there is limited information on the beliefs of patients who are depressed. AIMS To measure patients׳ beliefs about depression at baseline and determine whether these relate to depression severity at six months. METHODS Primary care patients with a recently diagnosed episode of depression completed the Beliefs about Depression Questionnaire and depression severity scores at baseline. The primary outcome was the change in depression severity score on the Hospital Anxiety and Depression Scale after six months. RESULTS 227/292 (78%) participants completed follow-up questionnaires. Initial severity of depression at baseline, and particular beliefs about the causes, consequences and timeline of depression predicted poorer outcomes, whereas a belief in using exercise or keeping busy to treat depression predicted improved outcomes. Prescription of antidepressants did not appear to mediate these relationships. LIMITATIONS This was an initial study using a new validated questionnaire and it cannot be predicted whether these results are representative or would be reproduced in other populations. Although participants were primary care patients whose GP (General Practitioner) had coded as having a new incident episode of depression in the preceding six months, 43% of participants stated they had been depressed for more than a year. Sufficient participants were recruited to ensure the study was adequately powered but participation rate was 30%, raising the possibility of response bias. CONCLUSIONS AND CLINICAL RELEVANCE Illness beliefs may help to predict outcomes in depression and therefore assessing and addressing patients׳ beliefs about their depression may enhance treatment.