Sharon See Tai

A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people

BackgroundLesbian, gay and bisexual (LGB) people may be at higher risk of mental disorders than heterosexual people.MethodWe conducted a systematic review and meta-analysis of the prevalence of mental disorder, substance misuse, suicide, suicidal ideation and deliberate self harm in LGB people. We searched Medline, Embase, PsycInfo, Cinahl, the Cochrane Library Database, the Web of Knowledge, the Applied Social Sciences Index and Abstracts, the International Bibliography of the Social Sciences, Sociological Abstracts, the Campbell Collaboration and grey literature databases for articles published January 1966 to April 2005. We also used Google and Google Scholar and contacted authors where necessary. We searched all terms related to homosexual, lesbian and bisexual people and all terms related to mental disorders, suicide, and deliberate self harm. We included papers on population based studies which contained concurrent heterosexual comparison groups and valid definition of sexual orientation and mental health outcomes.ResultsOf 13706 papers identified, 476 were initially selected and 28 (25 studies) met inclusion criteria. Only one study met all our four quality criteria and seven met three of these criteria. Data was extracted on 214,344 heterosexual and 11,971 non heterosexual people. Meta-analyses revealed a two fold excess in suicide attempts in lesbian, gay and bisexual people [pooled risk ratio for lifetime risk 2.47 (CI 1.87, 3.28)]. The risk for depression and anxiety disorders (over a period of 12 months or a lifetime) on meta-analyses were at least 1.5 times higher in lesbian, gay and bisexual people (RR range 1.54–2.58) and alcohol and other substance dependence over 12 months was also 1.5 times higher (RR range 1.51–4.00). Results were similar in both sexes but meta analyses revealed that lesbian and bisexual women were particularly at risk of substance dependence (alcohol 12 months: RR 4.00, CI 2.85, 5.61; drug dependence: RR 3.50, CI 1.87, 6.53; any substance use disorder RR 3.42, CI 1.97–5.92), while lifetime prevalence of suicide attempt was especially high in gay and bisexual men (RR 4.28, CI 2.32, 7.88).ConclusionLGB people are at higher risk of mental disorder, suicidal ideation, substance misuse, and deliberate self harm than heterosexual people.

A multidisciplinary approach for improving services in primary care : randomised controlled trial of screening for haemoglobin disorders

Abstract Objective: To investigate the feasibility of improving screening for carriers of haemoglobin disorders in general practice by using a nurse facilitator to work with primary care teams and the relevant haematology laboratories; to identify problems in communication between all those involved in delivering the service, and to implement solutions. Design: Two year, practice based randomised controlled trial. Setting: North London area where 29% of residents and 43% of births are in ethnic groups at risk for haemoglobin disorders. Subjects: 26 of the 93 practices using the services of the areas haematology laboratory agreed to take part and were randomly divided into control and intervention practices. Main outcome measure: Change in number of requests for screening tests for haemoglobin disorders made by control and intervention practices in baseline and intervention years. Results: The number of screening tests requested varied from 0-150 in the 93 practices in the baseline year. Study practices tended to have made a moderate number of requests (10-50) during this period. During the intervention year intervention practices made 292 more requests (99% increase) and control practices made 74 fewer requests (23% decrease; P=0.001 for difference in median change). Four practices, three of which were singlehanded, accounted for 75% of the increase. The number of requests from intervention practices, adjusted for baseline requests, was 3.2 times higher than control practices (P<0.0001). Conclusion: General practitioners and practice nurses are willing to undertake a new genetic screening service (or expand an existing one) if they are persuaded that it benefits the health of a significant proportion of their practice population. They need appropriate tools (for example, information materials for carriers and groups at risk), and the laboratory must be sensitive to their needs. Preconceptional carrier screening and counselling need to be coupled with antenatal screening.

Care of schizophrenia in general practice.

Patients, methods, and results Thirteen of the 16 London general practices fulfilling required validation standards of the VAMP (value added medical products) computer research bank between April and September 1990 participated.2 A search of the computerised records identified 212 patients with a diagnosis of schizophrenia; 90% of a one in two random sample were given a lifetime diagnosis of schizophrenia according to broad diagnostic criteria.2 Each was age matched (within a five year band) and sex matched with two patients in the same practice. The first was randomly selected from a pool of patients with chronic physical diseases (epilepsy, diabetes, rheumatoid arthritis, and multiple sclerosis) and in the second from the practice register. Information for the preceding four years was collected from the practice records. All consultations were counted and coded as physical or mental according to the presenting complaints; the number of disease specific assessments for patients with schizophrenia and chronic physical diseases was recorded. Entries in the notes pertaining to housing, employment, finances, or social outlets were counted and classed as social entries for all three groups of patients. The number of letters from hospital consultants was recorded. Prescriptions issued by the surgery without direct patient contact were classed as repeat prescriptions. Variables examined in the analysis were divided around the median of the respective control groups observations. Disease specific assessments and letters from hospital consultants were not relevant for the controls selected from the practice register. As these controls had few psychiatric consultations and repeat prescriptions binary variables were created corresponding to none or at least one such event. These variables were then analysed by conditional logistic regression3 for matched case-control studies with the EGRET statistical package. The aim of the regression was to determine factors predicting membership of the schizophrenia group (table). Mental health consultations strongly predicted that a patient belonged to the schizophrenia group. Social entries were also associated with this group. Physical consultations were more strongly associated with being in the physical disease group, as were repeat prescriptions and disease specific assessments. The total consultation rate was not a significant predictor of membership of the schizophrenia group in the comparison with the physical disease group, but in the comparison with the other control group, frequent consultations (above the median of this control group) indicated that patients were 11 times more likely to belong to the schizophrenia group.