Willem Kuyken

The World Health Organization Quality of Life assessment (WHOQOL) : Development and general psychometric properties

This paper reports on the field testing, empirical derivation and psychometric properties of the World Health Organisation Quality of Life assessment (the WHOQOL). The steps are presented from the development of the initial pilot version of the instrument to the field trial version, the so-called WHOQOL-100. The instrument has been developed collaboratively in a number of centres in diverse cultural settings over several years; data are presented on the performance of the instrument in 15 different settings worldwide.

Mindfulness-Based Cognitive Therapy to Prevent Relapse in Recurrent Depression

For people at risk of depressive relapse, mindfulness-based cognitive therapy (MBCT) has an additive benefit to usual care (H. F. Coelho, P. H. Canter, & E. Ernst, 2007). This study asked if, among patients with recurrent depression who are treated with antidepressant medication (ADM), MBCT is comparable to treatment with maintenance ADM (m-ADM) in (a) depressive relapse prevention, (b) key secondary outcomes, and (c) cost effectiveness. The study design was a parallel 2-group randomized controlled trial comparing those on m-ADM (N = 62) with those receiving MBCT plus support to taper/discontinue antidepressants (N = 61). Relapse/recurrence rates over 15-month follow-ups in MBCT were 47%, compared with 60% in the m-ADM group (hazard ratio = 0.63; 95% confidence interval: 0.39 to 1.04). MBCT was more effective than m-ADM in reducing residual depressive symptoms and psychiatric comorbidity and in improving quality of life in the physical and psychological domains. There was no difference in average annual cost between the 2 groups. Rates of ADM usage in the MBCT group was significantly reduced, and 46 patients (75%) completely discontinued their ADM. For patients treated with ADM, MBCT may provide an alternative approach for relapse prevention.

Quality of Life Assessment: International Perspectives

The Development of Cross-Cultural Quality of Life Assessment Instruments.- Translation of Health Status Instruments.- Cross-Cultural Validation of Quality of Life Measures.- Ensuring International Equivalence of Quality of Life Measures: Problems and Approaches to Solutions.- The Development of the WHO Quality of Life Assessment Instrument (The WHOQOL).- Perspectives on Quality of Life.- The Relationship Between Health Economics and Health-Related Quality of Life.- The PCASEE Model: An Approach to Subjective Well-Being.- Quality of Life Assessment in Cancer.- Quality of Life Assessment in SWOG Cancer Clinical Trials: Translating and Validating a Spanish Questionnaire.- Quality of Life Assessment in Cancer Patients in India: Cross-Cultural Issues.- Measuring the Quality of Life in Breast Cancer.- Quality of Life Assessment in Specific Populations.- The Experiences and Quality of Life of Informal Caregivers.- Quality of Life Assessment in Arthritis.- The Assessment of Quality of Life in Refugees.- Quality of Life in Hypertensives and Normotensives in Israel: Introducing a Self-Structured Subjective Measure.- Subjective Quality of Life Assessment in Therapeutic Trials: Presentation of a New Instrument in France (SQLP: Subjective Quality for Life Profile) and First Results.

Autobiographical memory functioning in depression and reports of early abuse.

The authors investigated the memory functioning of depressed women patients with and without a reported history of child physical or sexual abuse using J. M. G. Williams and K. Broadbents (1986) Autobiographical Memory Test. Whereas latency to recall autobiographical memories was not related to reports of abuse, patients who reported childhood sexual abuse produced more overgeneral memories to positive and negative cues. In addition, patients reporting high levels of avoidance of spontaneous memories of childhood physical or sexual abuse in the past week retrieved more overgeneral memories to positive and negative cues.

Translation of Health Status Instruments

Methods and instruments to measure the various facets of health status range from ways of calculating mortality and morbidity statistics at regional, national and global levels (e.g., WHO 1991; World Bank 1993) to interview and questionnaire methods for assessing diseases and physical symptoms (e.g., CIDI and SCAN; Pull and Wittchen, 1991), as well as a wealth of instruments for the assessment of impairment, disability, handicap and psychological functioning (see McDowell and Newell 1987; Bowling 1991; WHO 1993a; Walker and Rosser 1993). Most health status measures and psychological tests are used only in the setting in which they were developed. Some are translated into other languages and used without attention to the adaptation that is necessary to ensure their usefulness in another culture or language. A very small number of instruments are produced in equivalent versions in different languages, before assessing the instruments’ validity and reliability that are a prerequisite for the use of instruments in a new culture. We shall argue that both properly conducted translation of existing health status instruments and the development of equivalent versions of an instrument in different languages was time consuming and difficult tasks, yet necessities for comparative study.

Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial

BACKGROUND Only a third of patients with depression respond fully to antidepressant medication but little evidence exists regarding the best next-step treatment for those whose symptoms are treatment resistant. The CoBalT trial aimed to examine the effectiveness of cognitive behavioural therapy (CBT) as an adjunct to usual care (including pharmacotherapy) for primary care patients with treatment resistant depression compared with usual care alone. METHODS This two parallel-group multicentre randomised controlled trial recruited 469 patients aged 18-75 years with treatment resistant depression (on antidepressants for ≥6 weeks, Beck depression inventory [BDI] score ≥14 and international classification of diseases [ICD]-10 criteria for depression) from 73 UK general practices. Participants were randomised, with a computer generated code (stratified by centre and minimised according to baseline BDI score, whether the general practice had a counsellor, previous treatment with antidepressants, and duration of present episode of depression) to one of two groups: usual care or CBT in addition to usual care, and were followed up for 12 months. Because of the nature of the intervention it was not possible to mask participants, general practitioners, CBT therapists, or researchers to the treatment allocation. Analyses were by intention to treat. The primary outcome was response, defined as at least 50% reduction in depressive symptoms (BDI score) at 6 months compared with baseline. This trial is registered, ISRCTN38231611. FINDINGS Between Nov 4, 2008, and Sept 30, 2010, we assigned 235 patients to usual care, and 234 to CBT plus usual care. 422 participants (90%) were followed up at 6 months and 396 (84%) at 12 months, finishing on Oct 31, 2011. 95 participants (46%) in the intervention group met criteria for response at 6 months compared with 46 (22%) in the usual care group (odds ratio 3·26, 95% CI 2·10-5·06, p<0·001). INTERPRETATION Before this study, no evidence from large-scale randomised controlled trials was available for the effectiveness of augmentation of antidepressant medication with CBT as a next-step for patients whose depression has not responded to pharmacotherapy. Our study has provided robust evidence that CBT as an adjunct to usual care that includes antidepressants is an effective treatment, reducing depressive symptoms in this population. FUNDING National Institute for Health Research Health Technology Assessment.

Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial

BACKGROUND Individuals with a history of recurrent depression have a high risk of repeated depressive relapse or recurrence. Maintenance antidepressants for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to medication. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce risk of relapse or recurrence compared with usual care, but has not yet been compared with maintenance antidepressant treatment in a definitive trial. We aimed to see whether MBCT with support to taper or discontinue antidepressant treatment (MBCT-TS) was superior to maintenance antidepressants for prevention of depressive relapse or recurrence over 24 months. METHODS In this single-blind, parallel, group randomised controlled trial (PREVENT), we recruited adult patients with three or more previous major depressive episodes and on a therapeutic dose of maintenance antidepressants, from primary care general practices in urban and rural settings in the UK. Participants were randomly assigned to either MBCT-TS or maintenance antidepressants (in a 1:1 ratio) with a computer-generated random number sequence with stratification by centre and symptomatic status. Participants were aware of treatment allocation and research assessors were masked to treatment allocation. The primary outcome was time to relapse or recurrence of depression, with patients followed up at five separate intervals during the 24-month study period. The primary analysis was based on the principle of intention to treat. The trial is registered with Current Controlled Trials, ISRCTN26666654. FINDINGS Between March 23, 2010, and Oct 21, 2011, we assessed 2188 participants for eligibility and recruited 424 patients from 95 general practices. 212 patients were randomly assigned to MBCT-TS and 212 to maintenance antidepressants. The time to relapse or recurrence of depression did not differ between MBCT-TS and maintenance antidepressants over 24 months (hazard ratio 0·89, 95% CI 0·67-1·18; p=0·43), nor did the number of serious adverse events. Five adverse events were reported, including two deaths, in each of the MBCT-TS and maintenance antidepressants groups. No adverse events were attributable to the interventions or the trial. INTERPRETATION We found no evidence that MBCT-TS is superior to maintenance antidepressant treatment for the prevention of depressive relapse in individuals at risk for depressive relapse or recurrence. Both treatments were associated with enduring positive outcomes in terms of relapse or recurrence, residual depressive symptoms, and quality of life. FUNDING National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme, and NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.Solitary median maxillary central incisor (SMMCI) is a rare dental anomaly characterized by a symmetric central incisor of normal size, developed and erupted precisely in the midline of the maxilla in both primary and permanent dentitions. SMMCI may occur alone or be associated with other midline structures defects of the body or other systemic disorders. The best known association is holoprosencephaly (HPE). This paper reported a case of SMMCI that companied with other midline structures defects of the body.

Intrusive memories of childhood abuse during depressive episodes

A sample of adult women with major depression who reported childhood sexual or physical abuse completed a measure of the extent to which they were experiencing intrusive memories of the abuse and their efforts to avoid these memories. The majority of women in the sample reported high levels of disturbing intrusive memories, and high levels of avoidance. Those abused women with particularly high levels of intrusions and more avoidance were also more severely depressed than both non-abused women and abused women with low levels of intrusions and avoidance. Higher levels of intrusions and avoidance were also associated with repeated childhood abuse, sexual abuse involving intercourse and sexual abuse involving a primary caregiver.

Effectiveness of the Mindfulness in Schools Programme: non-randomised controlled feasibility study

BACKGROUND Mindfulness-based approaches for adults are effective at enhancing mental health, but few controlled trials have evaluated their effectiveness among young people. AIMS To assess the acceptability and efficacy of a schools-based universal mindfulness intervention to enhance mental health and well-being. METHOD A total of 522 young people aged 12-16 in 12 secondary schools either participated in the Mindfulness in Schools Programme (intervention) or took part in the usual school curriculum (control). RESULTS Rates of acceptability were high. Relative to the controls, and after adjusting for baseline imbalances, children who participated in the intervention reported fewer depressive symptoms post-treatment (P = 0.004) and at follow-up (P = 0.005) and lower stress (P = 0.05) and greater well-being (P = 0.05) at follow-up. The degree to which students in the intervention group practised the mindfulness skills was associated with better well-being (P<0.001) and less stress (P = 0.03) at 3-month follow-up. CONCLUSIONS The findings provide promising evidence of the programmes acceptability and efficacy.

Autobiographical memory style in seasonal affective disorder and its relationship to future symptom remission.

Autobiographical memory was examined in participants with seasonal affective disorder (SAD). In Experiment 1, participants with SAD performed an autobiographical memory task (AMT) in the winter, when depressed. The AMT required participants to generate autobiographical memories to positive and negative cue words. Symptom levels were reassessed in the summer, when participants were remitted. The number of overly general memories to positive cues generated when the SAD participants were depressed predicted symptom levels when remitted, over and above initial symptom levels, with greater winter overgenerality being associated with high levels of summer symptoms. However, this was dependent on the exact measure of depressive symptoms used. The degree of overgenerality of memories in SAD participants was further investigated in Experiment 2. Results revealed that SAD participants did not show elevated recall of overgeneral memories relative to controls. The results as a whole indicate that, even when levels of general memories are no greater in a given target group than in controls, the absolute level of general memories to positive cue words is still independently related to symptom outcome.