Rowena Merritt

Long term outcome of primary care depression

We conducted a follow up over 23 years of depressed patients originally presenting to general practice in 1981 and studied in detail at that time. Aims were to assess the long term course and outcome of depression in primary care. Patterns of recovery and recurrence of major depressive episodes, together with other aspects of course, treatment and current state, were assessed at interview. 78% (129) of the original sample were traced to current general practice and outcome data obtained on 54. One third had a prior history of depression. Interview data were obtained on 37 patients. Time to recovery from baseline averaged 10.3 months. The recurrence rate was 64% (23). Most participants suffered at least 2 further episodes that were frequently chronic lasting 2 years on average. Time before first recurrence appeared considerably longer than in comparable psychiatric inpatient samples. No participants were continuously ill. Although loss to follow up limits our conclusions, the course of primary care depression appears worse than suggested by previous, shorter follow ups. Our data suggest that long term risk of a recurrence may be high, but with recurrence delayed.

A cluster randomized controlled trial to assess the effectiveness of an intervention to educate students about depression.

BACKGROUND Depression is an important cause of disability worldwide, with many people experiencing their first depressive episode before the age of 18. University students are particularly vulnerable to depression. Depression can be treated successfully in most patients. However, for treatment to be successful, depressed people need to recognize their symptoms as illness, present to medical care, and be aware that effective treatment is available. A thoughtful health campaign might therefore increase the likelihood of successful treatment. METHOD A cluster randomized controlled trial was conducted to determine the effectiveness of an educational intervention. A total of 3313 undergraduate students participated in the study. The intervention consisted of postcards and posters on depression and its treatment. The primary outcome was student awareness that depression can be treated effectively. Secondary outcomes included the proportion of students reading the postcards, recognition of symptoms and knowledge of treatments. RESULTS The postcards were read by 69% of students. Less than half of participants reported that depression could be treated effectively, and there was no evidence of a difference between the intervention and control groups [341 (49.1%) v. 379 (49.7%), difference -0.7, p=0.8, 95% confidence interval (CI) -5.1 to 3.7]. However, intervention group participants were more likely than control group participants to recognize depressive symptoms and to report that antidepressants are not addictive. CONCLUSIONS Many university students lack knowledge about depression and its treatment. Simple and cheap media, such as postcards and posters, might help to improve awareness in areas where current knowledge is low.

Neurological disorders and violence: a systematic review and meta-analysis with a focus on epilepsy and traumatic brain injury.

The objectives of this study were to systematically review and meta-analyze the research literature on the association of common neurological disorders and violence. Keywords relating to neurological disorders and violence were searched between 1966 and August 2008. Case–control and cohort studies were selected. Odds ratios of violence risk in particular disorders compared with controls were combined using fixed-effects meta-analysis with the data presented in forest plots. Sensitivity analyses were conducted to identify possible differences in risk estimates across surveys. Information on risk factors for violence was extracted if replicated in more than one study. Nine studies were identified that compared the risk of violence in epilepsy or traumatic brain injury compared with unaffected controls. For the epilepsy studies, the overall pooled odds ratio for violent outcomes was 0.67 [95% confidence interval (CI) 0.46–0.96]. For traumatic brain injury, the odds ratio was 1.66 (95% CI 1.12–2.31). An additional 11 case–control studies investigated factors associated with violence in epilepsy and traumatic brain injury. It was not possible to meta-analyze these data. Comorbid psychopathology was associated with violence. Data on other neurological conditions was limited and unreplicated. In conclusion, although the evidence was limited and methodological quality varied, epilepsy and traumatic brain injury appeared to differ in their risk of violence compared with control populations. Longitudinal studies are required to replicate this review’s provisional findings that epilepsy is inversely associated with violence and that brain injury modestly increases the risk, and further research is needed to provide information on a broader range of risk factors.

A comparison of levels of burden in Indian and white parents with a son or daughter with schizophrenia

Background: Caregiver burden in mental illness is believed to differ between ethnic groups, but few studies have examined this in schizophrenia in the UK. Aim: To measure burden in British North Indian Sikh and white British parents with a son or daughter with established schizophrenia managed in outpatient care. Method: A cross-cultural cohort study measuring family factors, patient psychopathology and levels of burden and distress. Results: Overall levels of burden were low with no significant differences between the groups. Burden subscale scores showed Indian parents were more affected by psychotic behaviours than white parents. The groups also differed on several sociodemographic variables. Conclusion: In stabilized community patients, the overall extent of burden experienced by both Indian and white parents is low and comparable. However, Indian parents were more burdened by psychotic behaviours. This may be a result of co-residence as Indian patients are more likely to live with their families. Social and economic factors in the country of residence and levels of acculturation may also influence levels of burden and the illness behaviours found most bothersome by parents.

What Next for Social Marketing - Developing ‘Superman’ or a Sustainable System?

Social marketing is being increasingly used within the UK health system to address a range of health inequality issues. The Department of Health for England plans to increase the use of social marketing at both national and local levels. However, this can only be achieved if the correct resources are in place. Currently we have a shortage of skilled social marketing practitioners within the UK. The Department of Health is therefore looking to academia to help increase capacity and skills to fill this gap. Presently, capacity and capability within the academic system are limited. This article is aimed at promoting debate about how academic capacity is grown within the UK. It also aims to reflect the main challenges we are facing in the UK, which may or may not be reflected in other countries.

Underage Drinking and Antisocial Behavior: Research to Inform a U.K. Behavioral Intervention

This study aimed to identify and describe the motivators for underage, curbside drinking leading to antisocial behavior and to use these insights to develop a suitable intervention to tackle this. A cross-sectional study was conducted with youths and key stakeholders. “Street drinking” was identified as the most common recreational activity for youths and was motivated by a lack of appropriate leisure services, peer pressure and behavior, and the local accessibility of alcohol. Antisocial behavior was a major theme associated with street drinking. Few studies have examined the root causes of youth drinking and antisocial behavior. Our findings show that deprivation, social bonds, and the symbolic capital attached to alcohol along with its relative cost and availability enhance its appeal to the young, and provide some illumination to the relationship between these related problems.

Evaluating the Value for Money of Interventions to Support Behavior Change for Better Health (Behavior Change Evaluation Tools)

This article reports the development of tools for use by local commissioning teams, based in English Local Authorities (Local Government Councils), to evaluate the value for money of their behavior change investments. The national program was guided by a panel of senior advisers and included consultations with experts in the field, as the basis for the design of the methodology. Evaluation tools were then developed applying evidence provided by the National Institute for Health and Clinical Excellence, the World Health Organization, Health England (a national group set up to advise on public health policy), and other sources. As data were often incomplete, provision was made to update the tools as further evidence emerges. The tools, which are now available online at http://www.thensmc.com/resources/vfm, cover: smoking cessation, alcohol harm reduction, obesity reduction, comprising, weight loss, diet and increased activity, breast feeding continuation, and participation in bowel cancer screening. The use of these tools by local teams has proved valuable in demonstrating the relative value for money of local interventions and the importance of further developments of this kind.

Bostin Value An Intervention to Increase Fruit and Vegetable Consumption in a Deprived Neighborhood of Dudley, United Kingdom

“Bostin Value” was a pilot scheme aiming to improve fruit and vegetable consumption in a deprived neighborhood in the borough of Dudley, England. Research identified the need to address both supply and demand to encourage the target audience (parents/carers of young children) to consume more fruit and vegetables along with their children. Bostin Value improved supply through commissioning a local greengrocer to sell fresh fruit and vegetables twice a week at a local primary school. Promotions were used to encourage sales, including a loyalty card system, money off vouchers, and recipe cards. To increase demand, educational sessions were run at the school to improve parent’s skills in cooking seasonal produce. Children at the school received tasting workshops to encourage them to try a variety of fruit and vegetables. Results saw the mean portions of fruit consumed weekly by parents significantly increase from 2.4 portions in April 2009 to 3.1 in July 2010. This was mirrored in children whose weekly portions increased from 2.6 to 3.7. The mean number of different fruits and vegetables tasted by children also increased significantly.

Measuring the Societal Impact of Behavior Choices

Social marketing has a key role to play in helping to shape the choices people make and supporting the decisions and actions that determine their health and well-being. These choices have a broad impact on society, affecting not only the quality of life of individuals and communities and the cost of public services, but also the performance of business and the economy. In this article we discuss how the impact of behavior choices and the interventions that support them can be evaluated. We briefly set out the problems of measuring the cost effectiveness of behavior choice interventions and propose an approach to these challenges. The article illustrates how a pragmatic, layered framework for evaluating cost effectiveness can be developed and applied in five fields in which positive behavior choices can prevent illness (alcohol misuse, smoking, obesity, coronary vascular disease, and mental health). The review identifies the value of a quality adjusted life year in each of these fields and uses these estimates to generate “return on investment” for typical projects, at different levels in society (individual and family, health and care services, other public sector, private sector, and wider society). Finally we propose a consensus conference to develop and apply such a framework.

Sources of parental burden in a UK sample of first-generation North Indian Punjabi Sikhs and their white British counterparts

Objective: The correlates of parental burden in schizophrenia may differ between ethnic groups, but few studies have examined this in a UK setting. Our aim was to identify the correlates of burden in a UK sample of first-generation North Indian Punjabi Sikh parents and their white British counterparts. Method: Test the association of burden with a series of clinical, social and service use variables and control for potential confounding factors in a model predicting drivers of burden in a combined sample of the above. Results: The strongest correlates of burden were patient symptoms and parental distress. Differences in correlates of burden between the groups emerged when individual components of service use and parental social network were tested. The group comparisons also revealed differences in expressed emotion (EE) and social networks. Conclusion: The similarities in sources of burden between the groups could be explained by a commonality of sociocultural and economic experience, resulting from the successful acculturation and affluence of this British Sikh group. The differences between the groups may be related to enduring cultural factors such as kin support, since larger family groups were associated with low burden in the British Sikh group. The nature of EE in this British Sikh group may explain why it was not associated with burden in this sample.