Jed Boardman

The prevalence of depression in two districts of Uganda

Little information is available on the prevalence of depression in Uganda. Given the recent political history of Uganda, depression may be common. The aim was to estimate the point prevalence of probable clinical depressive disorder among the general population in two contrasting districts of Uganda. Translated versions (in Madi and Lusoga) of the 13-item Beck Depression Inventory (BDI) were administered to a systematic sample of adult residents in the Adjumani and Bugiri districts of Uganda. The overall prevalence of probably clinically significant depression (BDI score of 20–39) was 17.4%. Significantly higher rates were found in women and in Adjumani District. Depression is common in Uganda and particularly in the more troubled and less socially cohesive district of Adjumani.

Understanding General Health Questionnaire (GHQ-28) score and its threshold

AbstractBackgroundThe finding of variation in the optimal threshold of the General Health Questionnaire (GHQ) across different settings has proved difficult to explain. This analysis aimed to examine the optimal threshold of the GHQ, its variability and relationship with prevalence of psychiatric disorder.MethodsA cross–sectional two–phase epidemiological survey was used in a study of non–psychotic psychiatric disorder of General Practice consulters. A total of 1670 consecutive patients were screened using the GHQ–28 and the GP encounter form, and 336 were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). The total prevalence of the psychiatric disorders was estimated using three different methods and was calculated in the rural and urban practices and among those attending the General Practitioners and Practice Nurses.ResultsThe frequency distribution of the GHQ score for the whole sample of respondents was skewed resulting in the biased mean GHQ score. The mean values for different sample categories were found to be higher than the median values indicating that the median GHQ score may be a better parameter to describe the score distribution than the mean. The median value of the GHQ score showed a strong correlation with the prevalence estimated by the three different methods.ConclusionsThe median of GHQ score gives a better estimate for the cut–off score than the mean. The median score may be used as an estimate for the optimal threshold, in settings where the sensitivity and specificity are not known or where an estimate of the prevalence from a questionnaire survey is required. Alternative methods are preferable when screening for individual cases or in the context of a two–phase design.

In-patient and residential alternatives to standard acute psychiatric wards in England

BACKGROUND Acute psychiatric wards have been the focus of widespread dissatisfaction. Residential alternatives have attracted much interest, but little research, over the past 50 years. AIMS Our aims were to identify all in-patient and residential alternatives to standard acute psychiatric wards in England, to develop a typology of such services and to describe their distribution and clinical populations. METHOD National cross-sectional survey of alternatives to standard acute in-patient care. RESULTS We found 131 services intended as alternatives. Most were hospital-based and situated in deprived areas, and about half were established after 2000. Several clusters with distinctive characteristics were identified, ranging from general acute wards applying innovative therapeutic models, through clinical crisis houses that are highly integrated with local health systems, to more radical voluntary sector alternatives. Most people using the alternatives had a previous history of admission, but only a few community-based services accepted compulsory admissions. CONCLUSIONS Alternatives to standard acute psychiatric wards represent an important, but previously undocumented and unevaluated, sector of the mental health economy. Further evidence is needed to assess whether they can improve the quality of acute in-patient care.

Reluctance to seek help and the perception of anxiety and depression in the United kingdom: a pilot vignette study.

We investigated if reluctance to seek help could be explained by how people perceive an illness. Participants were members of the general public who had experienced mental health problems, for which approximately half had sought professional help. We asked them to rate the problems of 2 vignette characters using the Brief Illness Perception Questionnaire (BIPQ). Participants who had sought help were more likely to see the problems of the vignette characters as having more serious consequences and to understand their problems better, compared with those who had not sought help. The depression vignette character was seen as having a problem that was more serious but less amenable to treatment compared with the anxiety vignette character. Compared with men, women were likely to be more aware of the consequences and chronicity of depression. We conclude illness perceptions may help explain reluctance to seek help and discuss implications for encouraging consultation.

Sexual problems in schizophrenia: prevalence and characteristics. A cross sectional survey

ObjectiveTo determine the prevalence and characteristics of psychosexual problems in people with schizophrenia, and to compare the subjects’ and researcher’s perceptions of the presence of these problems.MethodsCross-sectional survey of 137 people with established schizophrenia or schizoaffective disorder, aged 18–65 in one geographical area of southeast England, using a semi-structured interview format.ResultsA total of 74% of men and 82% of women reported at least one ICD-10 defined sexual problem. Arousal problems were associated with physical health problems in men. Orgasm problems were more common in people in relationships. The researcher was about three times more likely to record a sexual problem than the respondents were to report one.ConclusionsPeople with schizophrenia report sexual dysfunction that is similar in nature but which occurs at a higher rate than is reported in the general population. There are gender differences and differences in the perception of psychosexual problems between those with schizophrenia and the researcher.

Prevalence of Suicide Ideation in Two Districts of Uganda

ABSTRACT Suicide ideation is common in all communities but research on suicidal behavior in Sub-Saharan Africa is scarce. The aim of this study was to determine the prevalence of self-reported suicidal ideation in two contrasting districts of Uganda. The method employed was a systematic sample of 939 respondents residing in Adjumani and Bugiri districts, using the Beck Scale for Suicide Ideation (BSS). Results indicated a higher rate of suicidal ideation in females, the unemployed and in Adjumani district. Consistent with other international studies, high rates of suicidal ideation were found in the Ugandan population. The higher prevalence of suicide ideation in the Adjumani District appears to be a symptom of psychosocial distress related to many years of social and political turmoil and the poor socio-economic conditions. In-depth observational studies are needed to fully understand the process of suicide ideation in Uganda.

Are self-referrers just the worried well? : A cross-sectional study of self-referrers to community psycho-educational Stress and Self-Confidence workshops

Reluctance to seek formal help has been seen as a major problem in trying to reduce the prevalence of anxiety and depression. The aims of this study were to assess the psychiatric status of those self-referring to psycho-educational Stress and Self-Confidence community workshops using a cognitive behavioural therapy (CBT) approach. Cross-sectional analysis of 196 people who referred themselves to community workshops was carried out using the Clinical Interview Schedule (CIS-R) psychiatric interview and the Beck Depression Inventory (BDI) and Spielberger Trait Anxiety Inventory (STAI-T) scale self-report assessments. Over 70% of all self-referrers had an ICD-10 diagnosis. Those without diagnoses had experienced recurrent significant psychological problems and 29.7% had never consulted their General Practitioner (GP) for anxiety/depression problems. Total CIS-R scores and white ethnic group best predicted previous GP consultation. Setting up a self-referral system can enable those with diagnosable psychiatric problems, who may otherwise be reluctant to seek help, to come forward. This may have significant public mental health implications.

Difficulties in implementing supported employment for people with severe mental health problems

People with severe mental health problems have low rates of open employment. Despite good evidence for the effectiveness of Individual Placement and Support (IPS), these schemes are not widely implemented. Their implementation is hampered by clinician and societal attitudes and the effect of organisational context on implementing IPS schemes with sufficient fidelity.

The predictive power and psychometric properties of the General Health Questionnaire (GHQ-28)

Background: The General Health Questionnaire (GHQ) is a well known screening instrument, but little is known about its psychometric properties. Aims: The study aimed to evaluate the predictive power of GHQ-28 and compare alternative methods of enhancing its discriminatory power. We examined the detailed sensitivity and specificity of individual items of the GHQ-28 to understand its psychometric properties, and suggested the combination of items that best predict cases with high discriminatory power. Method: The data obtained in a study of non-psychotic psychiatric disorder in two-phase study of General Practice consulters was analysed. A total of 1670 consecutive patients aged 16 – 65 years were screened using the GHQ-28 and 336 were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). Cases of non-psychotic psychiatric disorder were defined at interview using DSM-IV and Bedford College criteria. The diagnostic outcomes were dichotomized as cases and non-cases, and were combined with the GHQ data for the logistic regression. The regression was used to select individual GHQ items that exhibit high predictive power. Based on ROC analysis, the performance of the combination of the selected items with high predictive power was compared to the performance of the full 28-item version and the use of stratum-specific likelihood ratios (SSLR). Results: GHQ items reflecting depression have high specificity while items reflecting somatic symptoms that are non-specific to psychological problems, have high sensitivity. From the GHQ-28 items, eight items were selected using the logistic regression. Five items were selected because of their high sensitivity or specificity values. The remaining three items were selected because they enhance other significant items. Using an area under ROC curve to indicate the level of predictive power, the results showed that by removing the 20 insignificant individual items, the predictive power was increased slightly from 81.6% to 84.4%. When compared to SSLR, both tests seemed to perform better than SSLR. Conclusion: The study has shown an alternative analysis to evaluate the GHQs validity. This approach to the GHQ psychometric properties may provide a simple way to enhance and preserve the high predictive power of GHQ. The computational scheme could be easily applied to other screening instruments to assess their validity.

The prediction of in-patient length of stay for acute psychiatric admissions

Many factors are known to influence length of stay on psychiatric wards. Korner returns were used to ascertain length of stay for all psychiatric admissions for patients aged 16-64 years to acute wards in North Staffordshire 1987-1993. Predictor variables were derived from Korner returns or obtained from the 1991 Census data. Fitting a Cox‘s regression model showed that females, older patients, those with psychotic diagnoses, elective admissions, weekday admissions and admissions from relatively affluent areas had longer lengths of stay. The study demonstrates that survival techniques can be used to model length of stay on acute psychiatric wards. The predictor variables used in the study are readily available and the derived models may have value in service planning, audit and resource allocation and may be relevant to individual patient management.Many factors are known to influence length of stay on psychiatric wards. Korner returns were used to ascertain length of stay for all psychiatric admissions for patients aged 16-64 years to acute wards in North Staffordshire 1987-1993. Predictor variables were derived from Korner returns or obtained from the 1991 Census data. Fitting a Cox‘s regression model showed that females, older patients, those with psychotic diagnoses, elective admissions, weekday admissions and admissions from relatively affluent areas had longer lengths of stay. The study demonstrates that survival techniques can be used to model length of stay on acute psychiatric wards. The predictor variables used in the study are readily available and the derived models may have value in service planning, audit and resource allocation and may be relevant to individual patient management.