Victoria Mason

The psychological impact of exposure to floods

A number of studies have shown a range of symptoms resulting from exposure to natural disasters such as flooding. Among these consequences, individuals may experience symptoms of post-traumatic stress disorder (PTSD), depression and anxiety. The aim of this study was to examine the psychological impact of flooding in the UK. A cross-sectional survey was used to investigate the psychological symptoms associated with the aftermath of the flood amongst adults living in the affected communities. A questionnaire battery including the Harvard Trauma Questionnaire (trauma and symptoms associated with PTSD), Hopkins Symptom Checklist (anxiety and depression), Coping Strategies Questionnaire and a range of questions addressing sociodemographic characteristics and factors relating to the flood was administered to households in flood-affected areas. Four hundred and forty four completed questionnaires were returned. 27.9% of participants met criteria for symptoms associated with PTSD, 24.5% for anxiety and 35.1% for depression. Females had higher mean scores on PTSD, anxiety and depression than males. Most frequently reported coping strategies were rational, detached and avoidant, with the least frequent being emotional coping. Having to vacate home following flood, previous experience of flooding and poor health were associated with greater psychological distress. Detached coping appeared to be related to less distress. Although it is not possible to determine whether the symptoms were a direct consequence of the flood, symptoms of distress are a significant issue amongst communities affected by environmental events warranting further attention to prevent chronic distress.

Accepting low back pain: is it related to a good quality of life?

Objectives Whether individuals with chronic low back pain (CLBP) are willing to accept their pain, is of interest to pain management, but how far is the acceptance of pain related to a good quality of life (QoL)? Recently available measures now enable this question to be investigated; these are (1) the Chronic Pain Acceptance Questionnaire (CPAQ) and a revised version, here described as a short-form (SF-CPAQ), and (2) the World Health Organization Quality of Life Assessment (WHOQOL)-Pain, which is composed of the generic WHOQOL-100 profile (25 facets in 6 domains), and 4 additional facets within a specific pain and discomfort module (PDM). Method Eighty-six CLBP outpatients (62.8% female, mean age 54.3 y, mean pain duration 69.4 mo) completed the CPAQ and WHOQOL-Pain, mailed 2 weeks before a pain clinic appointment. Results General QoL was positively associated with overall acceptance of pain (CPAQ: r=0.376, P=0.003; SF-CPAQ: r=0.582, P<0.001), and with activity engagement (r=0.455, P<0.001) and pain willingness (r=0.493, P<0.001) specifically. Lower reports of pain were also associated with a better QoL (r=−0.349, P=0.002). Pain level was important in explaining QoL relating to the physical and social domains and pain-related facets assessed by the PDM. Overall, acceptance contributed to explain QoL in the level of independence and environment domains and for pain-related QoL assessed by the PDM. However, pain and acceptance only made a modest contribution to explaining psychologic and social dimensions of QoL. Discussion The results indicate that present pain level and whether or not pain is accepted play an important role in the QoL of patients with chronic pain. Additionally, the results provide construct validity for the WHOQOL-Pain and SF-CPAQ measures, especially dimensions of pain willingness and activities engagement. The findings have implications for the way health care is delivered, particularly for the role of acceptance-based treatments for individuals with CLBP.

Polymorphism of the 5-HT transporter and response to antidepressants: randomised controlled trial.

BACKGROUND Antidepressants exhibit a variety of pharmacological actions including inhibition of the serotonin and noradrenaline transporters. We wished to investigate whether genetic variation could be used to target or personalise treatment, in a comparison of selective serotonin reuptake inhibitors (SSRIs) with noradrenaline reuptake inhibitors (NARIs). AIMS To test the hypothesis that patients homozygous for the long (insertion) polymorphism of the serotonin transporter (5-HTTLPR) have an increased response to SSRI antidepressants but not to NARI antidepressants. METHOD In an individually randomised, parallel-group controlled trial, people meeting criteria for a depressive episode who were referred by their general practitioner were randomised to receive either citalopram (an SSRI) or reboxetine (an NARI). Randomisation was by means of a remote automated system accessed by telephone. The main outcome was depressive symptoms, measured by Beck Depression Inventory (BDI) total score 6 weeks after randomisation. The trial was registered with the International Standard Randomised Controlled Trials Number registry (ISRCTN31345163). RESULTS Altogether 298 participants were randomised to receive citalopram and 303 were randomised to reboxetine. At 6 weeks follow-up, complete data were available for 258 participants taking citalopram and 262 taking reboxetine. We found no evidence to support an influence of 5-HTTLPR on outcome following antidepressant treatment. The interaction term for BDI score at 6 weeks was 0.50 (95% CI -2.04 to 3.03, P = 0.70), which indicated that responses to the SSRI and NARI were similar irrespective of 5-HTTLPR genotype. CONCLUSIONS It is unlikely that the 5-HTTLPR polymorphism alone will be clinically useful in predicting response to antidepressants in people with depression.

GENetic and clinical Predictors Of treatment response in Depression: the GenPod randomised trial protocol

BackgroundThe most effective pharmacological treatments for depression inhibit the transporters that reuptake serotonin (Selective Serotonin Reuptake Inhibitors – SSRIs) and noradrenaline (Noradrenaline Reuptake Inhibitors – NaRIs) into the presynaptic terminal. There is evidence to suggest that noradrenaline and serotonin enhancing drugs work through separate mechanisms to produce their clinical antidepressant action. Although most of the current evidence suggests there is little difference in overall efficacy between SSRIs and NaRIs, there are patients who respond to one class of compounds and not another. This suggests that treatment response could be predicted by genetic and/or clinical characteristics.Firstly, this study aims to investigate the influence of a polymorphism (SLC6A4) in the 5HT transporter in altering response to SSRI medication. Secondly, the study will investigate whether those with more severe depression have a better response to NaRIs than SSRIs.Methods/designThe GenPod trial is a multi-centre randomised controlled trial. GPs referred patients aged between 18–74 years presenting with a new episode of depression, who did not have any medical contraindications to antidepressant medication and who had no history of psychosis or alcohol/substance abuse. Patients were interviewed to ascertain their suitability for the study. Eligible participants (with a primary diagnosis of depression according to ICD10 criteria and a Beck Depression Inventory (BDI) score > 14) were randomised to receive one of two antidepressant treatments, either the SSRI Citalopram or the NaRI Reboxetine, stratified according to severity. The final number randomised to the trial was 601. Follow-up assessments took place at 2, 6 and 12 weeks following randomisation. Primary outcome was measured at 6 weeks by the BDI. Outcomes will be analysed on an intention-to-treat basis and will use multiple regression models to compare treatments.DiscussionThe results of the trial will provide information about targeting antidepressant treatment for individual patients; in turn this may increase prescribing efficacy, thereby speeding recovery and reducing the cost to the NHS. It will also help to understand the different roles that noradrenaline and serotonin might play in the biology of depression.The trial is expected to report in the autumn of 2008.Trial RegistrationISRCTN 31345163

Severity of depression and response to antidepressants: GENPOD randomised controlled trial

BACKGROUND Antidepressant prescribing is widespread. Nonetheless, response to antidepressants is variable. If it was possible to predict response to medication and thus tailor treatment accordingly, this would not only improve patient outcomes but may also have economic benefits. AIMS To test the hypothesis that individuals with more severe depression would benefit more from noradrenaline reuptake inhibitors (NARIs) than selective serotonin reuptake inhibitors (SSRIs) compared with individuals with less severe depression. METHOD Individuals recruited from UK primary care who met ICD-10 criteria for a depressive episode and scored 15 or more on the Beck Depression Inventory (BDI) were randomised to either an SSRI (citalopram 20 mg daily) or a NARI (reboxetine 4 mg twice daily). Randomisation was by means of a remote automated telephone system. The main outcome was depressive symptoms measured by the BDI total score 6 weeks after randomisation. ( TRIAL REGISTRATION ISRCTN31345163.) RESULTS In total, 601 participants were randomised (citalopram: n = 298, reboxetine: n = 303). Ninety-one per cent were followed up at 6 weeks (citalopram: n = 274, reboxetine: n = 272). There was little evidence to support an interaction between treatment and severity of depression (interaction term: 0.02, 95% CI -0.59 to 0.62, P = 0.96). Adjustment for potential confounders (age, gender, employment status, history of depression, number of life events and social support) did not affect the findings (interaction term: 0.06, 95% CI -0.54 to 0.66, P = 0.85). CONCLUSIONS Treatment with NARIs does not confer any advantage over SSRI treatment for outcome in those with more severe depressive illness presenting in primary care.

Assessing the properties of the WHOQOL-Pain: quality of life of chronic low back pain patients during treatment

ObjectivesAssessing subjective, patient-reported outcomes such as quality of life (QoL) is essential to health care research. This study aimed to assess the properties of a QoL measure relating to pain and discomfort: the WHOQOL-Pain. MethodChronic low back pain patients (n=133) completed the WHOQOL-Pain, SF-12, and short-form McGill Pain Questionnaire before treatment started and again 2-4 weeks later. Of these, 76 received a lumbar epidural steroid injection, and 57 were waiting to receive treatment. ResultsOverall, there was no significant difference in effect of either epidural injections or no treatment on bringing about an improvement to QoL overtime. Moderate effect sizes were found for 5 facets including pain relief and uncertainty. Small effect sizes were found for 7 facets including vulnerability, fear and worry, anger and frustration. Larger effect sizes were found for those reporting the most improvement in pain. The waiting group reported no significant changes to QoL but small changes for uncertainty. Three of the four new facets were sensitive to change and test-retest reliability (stability) was confirmed in three. DiscussionAlthough this study was not designed to test treatment effectiveness, the WHOQOL-Pain enables patients to report changes to important aspects of QoL during many diverse interventions for relieving pain.

Quality is in the eye of the beholder? An evaluation of impact factors and perception of journal prestige in the UK

A number of proxy measures have been used as indicators of journal quality. The most recent and commonly employed are journal impact factors. These measures are somewhat controversial, although they are frequently referred to in establishing the impact of published journal articles. Within psychology, little is known about the relationship between the ‘objective’ impact factors of journals and the ‘subjective’ ratings of prestige and perceived publishing difficulty amongst academics. In order to address this, a cross-sectional web-based survey was conducted in the UK to investigate research activity and academics’ views of journals within three fields of psychology; cognitive, health and social. Impact factors for each journal were correlated with individual academic’s perceptions of prestige and publishing difficulty for each journal. A number of variables pertaining to the individual academic and their place of work were assessed as predictors of these correlation values, including age, gender, institution type, and a measure of departmental research activity. The implications of these findings are discussed in relation to perceptions of journal prestige and publishing difficulty, higher education in general and the assessment of research activity within academic institutions.

Surgeons' Experience of Learning Psychological Skills: A Preliminary Evaluation of a Psychological Skills Training Course

INTRODUCTION A range of human factors have been shown to impact on surgical performance although little is known about the impact of training on the views of surgeons towards these factors or how receptive surgeons are to such training. SUBJECTS AND METHODS This was an observational pilot study using a short questionnaire designed to elicit views of surgeons towards a range of human factors prior to, and immediately following, a course designed to address human factors in surgical performance. Focus groups were also conducted before and immediately after the course to elicit views. RESULTS Of all the human factors assessed, decision-making was rated on a visual analogue scale as having the biggest impact on performance both before and after the course. In general, views of human factors changed following the course, most notably an increase in the extent to which work stress, interpersonal difficulties and personality were believed to affect performance. Three themes emerged from the focus groups: (i) personal professional development; (ii) the relationship between trainer and trainee; and (iii) the changing perspective. CONCLUSIONS Surgeons from a range of specialties are receptive to training on the impact of human factors on performance and this study has shown that views may change following a course designed to address this. Further training to address the theory-practice gap is warranted in addition to an evaluation of its effectiveness.

The quality of life of people in chronic pain: Developing a pain and discomfort module for use with the WHOQOL

This article reports the development of a pain and discomfort module (PDM) designed to assess the full impact of quality of life (QoL) relating to chronic pain, which could be used with the generic World Health Organisation Quality of Life Assessment (WHOQOL). First, cognitive interviewing was completed with nine participants with chronic pain, for 108 items representing 10 pain-specific facets of QoL. Sixty-eight QoL items and 16 importance questions on pain were relevant, comprehensive, comprehensible and acceptable to users, and were confirmed to assess their purported concepts. Secondly, these items were pilot tested using a cross-sectional survey of 216 people with chronic pain, to investigate the preliminary psychometric properties of the PDM, and reduce its items statistically. All new facets were important to those with chronic pain. Sixteen items within four facets of pain relief, anger and frustration, vulnerability/fear/worry, and uncertainty were retained, and demonstrated acceptable to good internal consistency reliability (α = 0.77–0.85). The PDM is a self-administered, multidimensional subjective assessment of pain-related QoL, with potential to evaluate pain-relieving interventions, identify sufferers needs, and for survey use.