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MENTAL HEALTH




Ahmead M, Bower P. The effectiveness of self help technologies for emotional problems in adolescents: a systematic review. Child and Adolescent Psychiatry and Mental Health 2008 2(1) 20.

http://dx.doi.org/10.1186/1753-2000-2-20

http://pmid.us/18651962


Background: Adolescence is a transition period that involves physiological, psychological, and social changes. Emotional problems such as symptoms of anxiety and depression may develop due to these changes. Although many of these problems may not meet diagnostic thresholds, they may develop into more severe disorders and may impact on functioning. However, there are barriers that may make it difficult for adolescents to receive help from health professionals for such problems, one of which is the limited availability of formal psychological therapy. One way of increasing access to help for such problems is through self help technology (i.e. delivery of psychological help through information technology or paper based formats). Although there is a significant evidence base concerning self help in adults, the evidence base is much weaker in adolescents. This study aims to examine the effectiveness of self help technology for the treatment of emotional problems in adolescents by conducting a systematic review of randomized and quasi-experimental evidence. Methods: Five major electronic databases were searched: Medline, PsycInfo, Embase, Cochrane Controlled Trials Register and CINAHL. In addition, nine journals were handsearched and the reference lists of all studies were examined for any additional studies. Fourteen studies were identified. Effect sizes were calculated across 3 outcome measures: attitude towards self (e.g. self esteem); social cognition (e.g. self efficacy); and emotional symptoms (i.e. depression and anxiety symptoms). Results :Meta analysis showed small, non-significant effect size for attitude towards self (ES= -0.14, 95% CI=-0.72 to 0.43), a medium, non-significant effect size for social cognition (ES= -0.49, 95% CI=-1.23 to 0.25) and a medium, non-significant effect size for emotional symptoms (ES=-0.47, 95% CI=-1.00 to 0.07). However, these findings must be considered preliminary, because of the small number of studies, their heterogeneity, and the relatively poor quality of the studies. Conclusions: At present, the adoption of self help technology for adolescents with emotional problems in routine clinical practice cannot be recommended. There is a need to conduct high quality randomised trials in clearly defined populations to further develop the evidence base before implementation

Bellon J, et al Predicting the onset and persistence of episodes of depression in primary health care: the predictD-Spain study. Methodology. BMC Public Health 2008 8:256.


http://dx.doi.org/10.1186/1471-2458-8-256

http://www.biomedcentral.com/1471-2458/8/256

http://pmid.us/18657275


Background: The effects of putative risk factors on the onset and / or persistence of depression remain unclear. We aim to develop comprehensive models to predict the onset and persistence of episodes of depression in primary care. Here we explain the general methodology of the predictD-Spain study, describe and discuss response rates for the first 12 months, and evaluate the reliability of the questionnaires used .Methods: This is a prospective cohort study. A systematic random sample of general practice attendees aged 18-75 was recruited in seven Spanish provinces between October 2005 and February 2006. Depression was measured with the CIDI at baseline, and at 6 and 12 months; it will also be measured at 24 and 36 months. A set of individual, environmental, genetic, professional and organizational risk factors was (or will be) assessed at each follow-up point. In a separate reliability study, a proportional random sample of 401 participants completed the test-retest (251 researcher-administered and 150 self-administered). We performed multiple logistic regression to analyse the differences between the patients who were interviewed and those who were not interviewed during the follow-up. We also checked 118,398 items for data entry from a random sample of 480 patients stratified by province. Results: We selected 7,777 primary care attendees, of whom 1,251 (16%) were excluded. Of the remaining 6,526 eligible patients, 1,084 (16.6%) refused to participate. Thus, 5,442 patients were interviewed at baseline, of whom 70% and 66% remained at 6 and 12 months of follow-up, respectively. No differences were found between patients interviewed and those not interviewed concerning the prevalence of depression and the majority of potential risk factors for depression. All items and questionnaires had good test-retest reliability for both methods of administration, except for the use of recreational drugs over the previous six months. Cronbachas alphas were good and their factorial analyses coherent for the three scales evaluated. There were 191 (0.16%) data entry errors. Conclusions: Of a large cohort of primary care attendees distributed throughout Spain, an acceptable proportion of patients remained at 12 months. The items and questionnaires were reliable and data quality control was excellent

Bortolotti B, et al Psychological interventions for major depression in primary care: a meta-analytic review of randomized controlled trials. General Hospital Psychiatry 2008 30 (4) 293-302.


http://dx.doi.org/10.1016/j.genhosppsych.2008.04.001

http://pmid.us/18585531

Objective: Various studies have tested psychological therapies in the treatment of depression in primary care. Yet, concerns over their clinical effectiveness, as compared to usual general practitioner (GP) care or treatment with antidepressants, have been raised. The present meta-analysis was aimed at assessing currently available evidence on the topic. Method: A systematic search of electronic databases identified 10 randomized controlled trials comparing psychological forms of intervention with either usual GP care or antidepressant medication for major depression. Meta-analytical procedures were used to examine the impact of psychological intervention in primary care on depression, as compared to usual GP care and antidepressant treatment. ResultS: The main analyses showed greater effectiveness of psychological intervention over usual GP care in both the short term [standardized mean difference (SMD)=-0.42, 95% confidence interval (CI)=-0.59 to -0.26, n=408] and long term (SMD=-0.30, 95% CI=-0.45 to -0.14, n=433). The heterogeneity test was not significant in the short term at the P<.05 level (df=5, P=.57, I(2)=0%), but it was significant in the long term (df=5, P=.004, I(2)=70.9%). The comparison between psychological forms of intervention and antidepressant medication yielded no effectiveness differences, for either the short term or the long term. Conclusions: Psychological forms of intervention are significantly linked to clinical improvement in depressive symptomatology and may be useful for supplementing usual GP care



Cahill J, et al. A review and critical appraisal of measures of therapist-patient interactions in mental health settings. Health Technology Assessment. 2008 12 1-68.

http://pmid.us/18510875

Objectives: To assemble and to appraise critically the current literature on tests and measures of therapist-patient interactions in order to make recommendations for practice, training and research, and to establish benchmarks for standardisation, acceptability and routine use of such measures. Data sources: Major electronic databases (including PsycINFO) were searched from inception to 2002. Review methods: A comprehensive conceptual map of the subject area of therapist-patient interactions was developed through data extraction from, and analysis of, studies selected from the literature searches. The results of these searches were assessed and appraised to produce a set of possible therapist-patient measures. These measures were then evaluated. Results: The contextual map included the various concepts and domains that had been used in the context of the literature on therapist-patient interactions, and was used to guide the successive stages of the review. Three developmental processes were identified as necessary for the provision of an effective therapeutic relationship: 'establishing a relationship', 'developing a relationship' and 'maintaining a relationship'. Eighty-three therapist-patient measures having basic information on reliability and validity were identified for critical appraisal. The areas of the conceptual map that received most coverage (i.e. over 50% measures associated with them) were framework, therapist and patient engagement, roles, therapeutic techniques and threats to the relationship. These areas relate to the three key developmental processes outlined above. Of the 83 measures matching the content domain, 43 met the minimum standard. A total of 30 measures displayed adequate responsiveness or precision. None of the 43 measures that met the minimum standard was fully addressed in terms of acceptability and feasibility evidence. The majority of these measures had three or fewer components described. Therefore, out of a total of 83 measures matching the content domain, no measure could be said to have met an industry standard. Conclusions: The findings indicate that the therapist-patient interaction can be measured using a wide range of instruments of varying value. However, due care should be taken in ensuring that the measure is suitable for the context in which it is to be used. Following on from this work, it is suggested that specific research networks for the development of therapist-patient measures should be established, that research activity should prioritise investment in increasing the evidence base of existing measures rather than attempting to develop new ones, and that research activity should focus on improving these existing measures in terms of acceptability and feasibility issues

De Graaf, L E, Clinical and cost-effectiveness of computerised cognitive behavioural therapy for depression in primary care: design of a randomised trial. BMC Public Health 2008;8:224.


http://dx.doi.org/10.1186/1471-2458-8-224

http://www.biomedcentral.com/1471-2458/8/224

http://pmid.us/18590518

Background: Major depression is a common mental health problem in the general population, associated with a substantial impact on quality of life and societal costs. However, many depressed patients in primary care do not receive the care they need. Reason for this is that pharmacotherapy is only effective in severely depressed patients and psychological treatments in primary care are scarce and costly. A more feasible treatment in primary care might be computerised cognitive behavioural therapy. This can be a self-help computer program based on the principles of cognitive behavioural therapy. Although previous studies suggest that computerised cognitive behavioural therapy is effective, more research is necessary. Therefore, the objective of the current study is to evaluate the (cost-) effectiveness of online computerised cognitive behavioural therapy for depression in primary care. Methods:In a randomised trial we will compare (a) computerised cognitive behavioural therapy with (b) treatment as usual by a GP, and (c) computerised cognitive behavioural therapy in combination with usual GP care. Three hundred mild to moderately depressed patients (aged 18-65) will be recruited in the general population by means of a large-scale Internet-based screening (N=200,000). Patients will be randomly allocated to one of the three treatment groups. Primary outcome measure of the clinical evaluation is the severity of depression. Other outcomes include psychological distress, social functioning, and dysfunctional beliefs. The economic evaluation will be performed from a societal perspective, in which all costs will be related to clinical effectiveness and health-related quality of life. All outcome assessments will take place on the Internet at baseline, two, three, six, nine, and twelve months. Costs are measured on a monthly basis. A time horizon of one year will be used without long-term extrapolation of either costs or quality of life.Discussion:Although computerised cognitive behavioural therapy is a promising treatment for depression in primary care, more research is needed. The effectiveness of online computerised cognitive behavioural therapy without support remains to be evaluated as well as the effects of computerised cognitive behavioural therapy in combination with usual GP care. Economic evaluation is also needed. Methodological strengths and weaknesses are discussed. Trial registration The study has been registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236)

Fujiwara T, Kawachi I. A prospective study of individual-level social capital and major depression in the United States. Journal of Epidemiology and Community Health 2008 62 (7) 627-33.

http://dx.doi.org/10.1136/jech.2007.064261

http://pmid.us/18559446



Study objective: To investigate prospectively the associations between depression and cognitive social capital (social trust, sense of belonging, mutual aid) and structural social capital (volunteer work and community participation). Methods: This was a prospective study that was carried out in the USA. The participants were a nationally representative sample of 724 English-speaking non-institutionalised adults (25-74 years old) who participated in the National Survey of Midlife Development in the United States (MIDUS) in 1995-6 and the MIDUS Psychological Experience Follow-Up study in 1998. Main results: In multivariable adjusted logistic regression analyses, those who trusted their neighbours were less likely to develop major depression (MD) during follow-up than those who reported low levels of social capital on these dimensions (adjusted OR of MD for high vs low trust = 0.43; 95% CI 0.20 to 0.93, adjusted for MD at baseline, age, gender, race, education, working status, marital status, physical health and extroversion traits). Structural dimensions of social capital were not associated with MD in adjusted models. Conclusions: Perceptions of higher levels of cognitive social capital (trust of neighbours) are associated with lower risks of developing MD during 2-3 year follow-up. However, after excluding participants with MD at the baseline, the association between trust and MD became non-significant. Structural dimensions were not associated with MD

Ivbijaro G, et al. Addressing long-term physical healthcare needs in a forensic mental health inpatient population using the UK primary care Quality and Outcomes Framework (QOF): an audit Mental Health in Family Medicine 2008; 5(1):51-60.


Objectives: This audit aims to evaluate the effectiveness of delivering an equivalent primary care service to a long-term forensic psychiatric inpatient population, using the UK primary care national Quality and Outcomes Framework (QOF). Method: The audit compares the targets met by the general practitioner with special interest (GPwSI) service, using local and national QOF benchmarks (2005-2006), and determines the prevalence of chronic disease in a long-term inpatient forensic psychiatry population.
Results: The audit results show that the UK national QOF is a useful tool for assessment and evaluation of physical healthcare needs in a non-community based population. It shows an increased prevalence of all QOF-assessed long-term physical conditions when compared to the local East London population and national UK population, confirming previously reported elevated levels of physical healthcare need in psychiatric populations. Conclusions: This audit shows that the UK General Practice QOF can be used as a standardised instrument for commissioning and monitoring the delivery of physical health services to inpatient psychiatric populations, and for the evaluation of the effectiveness of clinical interventions in long-term physical conditions. The audit also demonstrates the effectiveness of using a GPwSI in healthcare delivery in non-community based settings. We suggest that the findings may be generalisable to other long-term inpatient psychiatric and prison populations in order to further the objective of delivering an equivalent primary care service to all populations. The QOF is a set of national primary care audit standards and is freely available on the British Medical Association website or the UK Department of Health website. We suggest that primary care workers in health economies who have not yet developed their own national primary care standards can access and adapt these standards in order to improve the clinical standards of care given to the primary care populations that they serve.

Kerse N, et al. Falls, depression and antidepressants in later life: a large primary care appraisal. PLoS ONE. 2008 3 e2423.


http://dx.doi.org/10.1371/journal.pone.0002423

http://pmid.us/18560599

Background: Depression and falls are common and co-exist for older people. Safe management of each of these conditions is important to quality of life. Methods: A cross-sectional survey was used to examine medication use associated with injurious and non-injurious falls in 21,900 community-dwelling adults, aged 60 years or over from 383 Australian general practices recruited for the DEPS-GP Project. Falls and injury from falls, medication use, depressive symptoms (Primary Health Questionnaire (PHQ-9)), clinical morbidity, suicidal ideation and intent, health status (SF-12 Health Survey), demographic and lifestyle information was reported in a standardised survey. Findings: Respondents were 71.8 years (sd 7.7) of age and 58.4% were women. 24% 11% and 8% reported falls, fall related injury, and sought medical attention respectively. Antidepressant use (odds ratio, OR: 1.46; 95% confidence interval, 95%CI: 1.25, 1.70), questionable depression (5-14 on PHQ OR: 1.32, 95%CI: 1.13, 1.53) and clinically significant symptoms of depression (15 or more on PHQ OR: 1.70, 95%CI: 1.14, 1.50) were independently associated with multiple falls. SSRI use was associated with the highest risk of multiple falls (OR: 1.66, 95%CI: 1.36, 2.02) amongst all psychotropic medications. Similar associations were observed for injurious falls. Over 60% of those with four accumulated risk factors had multiple falls in the previous year (OR: 3.40, 95%CI: 1.79, 6.45); adjusted for other demographic and health factors. Interpretation: Antidepressant use (particularly SSRIs) was strongly associated with falls regardless of presence of depressive symptoms. Strategies to prevent falls should become a routine part of the management of older people with depression

Maxwell M, Pratt R. Prevention and management of depression in primary care in Europe: a holistic model of care and interventions - position paper fo the European Forum for Primary Care. Quality in Primary Care 2008 16 187-96.


This position paper seeks to emphasise the importance of tackling depression and depression-related conditions, and the key role that primary care can (and does) play in the management of these commonmental health problems, and in partnership with others. The paper is aimed at a wide range of individuals and organisations including: policy akers in the EU and its member states; health, social care and voluntary sector service managers and planners; as well as a range of primary and community care professionals. The paper argues for a broad definition of ‘depression’ which reflects the primary care experience and in doing so incorporates a range of options based around a stepped model of care, depending on levels of need, severity and disability. This paper is complementary to the European Forum for Primary Care’s (EFPC’s) position paper Mental Health in Europe, the Role and Contribution of Primary Care, which focuses on the relationship between primary care and other mental health services and issues of access, training, sustainability and quality of care across the whole range of mental health services.1 The topic of depression in primary care can also encompass more-specialised topics such as postnatal depression, bipolar disorder and child and adolescent mental health. However, it is not within the scope of this


Milne A, et al Screening for dementia in primary care: a review of the use, efficacy and quality of measures. International Psychogeriatics 2008 20 (5) 911-26

http://dx.doi.org/10.1017/S1041610208007394

http://pmid.us/18533066

Background: Despite evidence that early identification of dementia is of growing policy and practice significance in the U.K., limited work has been done on evaluating screening measures for use in primary care. The aim of this paper is to offer a clinically informed synthesis of research and practice-based evidence on the utility, efficacy and quality of dementia screening measures. Method: The study has three elements: a review of research literature, a small-scale survey of measures employed in three primary care trusts, and a systematic clinical evaluation of the most commonly used screening instruments. The study integrates data from research and clinical sources. Results: The General Practitioner Assessment of Cognition (GPCOG), the Memory Impairment Screen (MIS), and the Mini-Cognitive Assessment Instrument (Mini-Cog) were found to be brief, easy to administer, clinically acceptable, effective, and minimally affected by education, gender, and ethnicity. All three have psychometric properties similar to the Mini-mental State Examination (MMSE).Conclusions: Although the MMSE is widely used in the U.K., this project identifies the GPCOG, MIS and Mini-Cog as clinically and psychometrically robust and more appropriate for routine use in primary care. A coherent review of evidence coupled with an indepth evaluation of screening instruments has the potential to enhance ability and commitment to early intervention in primary care and, as part of a wider educational strategy, improve the quality and consistency of dementia screening

Pier C, et al. A controlled trial of internet-based cognitive-behavioural therapy for panic disorder with face-to-face support from a general practitioner or email support from a psychologist. Mental Health in Family Medicine 2008 5(1) 29-40.


Background: Panic disorder (PD) is one of the most common anxiety disorders seen in general practice, but provision of evidence-based cognitive-behavioural treatment (CBT) is rare. Many Australian GPs are now trained to deliver focused psychological strategies, but in practice this is time consuming and costly. Objective: To evaluate the efficacy of an internet-based CBT intervention (Panic Online) for the treatment of PD supported by general practitioner (GP)-delivered therapeutic assistance. Design: Panic Online supported by GP-delivered face-to-face therapy was compared to Panic Online supported by psychologist-delivered email therapy. Methods: Sixty-five people with a primary diagnosis of PD (78% of whom also had agoraphobia) completed 12 weeks of therapy using Panic Online and therapeutic assistance with his/her GP (n = 34) or a clinical psychologist (n = 31). The mean duration of PD for participants allocated to these groups was 59 months and 58 months, respectively. Participants completed a clinical diagnostic interview delivered by a psychologist via telephone and questionnaires to assess panic-related symptoms, before and after treatment. Results: The total attrition rate was 20%, with no group differences in attrition frequency. Both treatments led to significant improvements in panic attack frequency, depression, anxiety, stress, anxiety sensitivity and quality of life. There were no statistically significant differences in the two treatments on any of these measures, or in the frequency of participants with clinically significant PD at post assessment. Conclusions: When provided with accessible online treatment protocols, GPs trained to deliver focused psychological strategies can achieve patient outcomes comparable to efficacious treatments delivered by clinical psychologists. The findings of this research provide a model for how GPs may be assisted to provide evidence-based mental healthcare successfully.

Rudell K, Bhui K, Priebe S. Do 'alternative' help-seeking strategies affect primary care service use? A survey of help-seeking for mental distress. BMC Public Health 2008 8:207.


http://dx.doi.org/10.1186/1471-2458-8-207

http://www.biomedcentral.com/1471-2458/8/207

http://pmid.us/18547400

Background: Epidemiological studies suggest that only some distressed individuals seek help from primary care and that pathways to mental health care appear to be ethnically patterned. However few research studies examine how people with common mental disorder manage their mental distress, which help-seeking strategies they employ and whether these are patterned by ethnicity? This study investigates alternative help-seeking strategies in a multi-ethnic community and examines the relationship with primary care use. Methods: Participants were recruited from four GP practice registers and 14 community groups in East London. Of 268 participants, 117 had a common mental disorder according to a valid and structured interview schedule (CIS-R). Participants were of Bangladeshi, black Caribbean and White British ethnic background. For those with a common mental disorder, we examined self-reported help-seeking behaviour, perceived helpfulness of care givers, and associations with primary care service use. Results: We found that alternative help-seeking such as talking to family about distress (OR 15.83, CI 3.9-64.5, P<.001), utilising traditional healers (OR 8.79, CI 1.98- 38.93, p=.004), and severity of distress (1.11, CI 1.03-1.20, p=.006) was positively associated with primary care service use for people with a common mental disorder. Ethnic background influenced the choice of help-seeking strategies, but was less important in perceptions of their helpfulness. Conclusions: Primary care service use was strongly correlated with lay and community help-seeking. Alternative help-seeking was commonly employed in all ethnic groups. A large number of people believed mental distress could not be resolved or they did not know how to resolve it. The implications for health promotion and integrated care pathways are discussed

Sampson EL, et al. Palliative care in advanced dementia; a mixed methods approach for the development of a complex intervention. BMC Palliative.Care 2008;7:8.

http://dx.doi.org/10.1186/1472-684X-7-8

http://www.biomedcentral.com/1472-684X/7/8

http://pmid.us/18620567


Background: There is increasing interest in improving the quality of care that patients with advanced dementia receive when they are dying. Our understanding of the palliative care needs of these patients and the natural history of advanced disease is limited. Many people with advanced dementia have unplanned emergency admissions to the acute hospital; this is a critical event: half will die within 6 months. These patients have complex needs but often lack capacity to express their wishes. Often carers are expected to make decisions. Advance care planning discussions are rarely performed, despite potential benefits such more consistent supportive healthcare, a reduction in emergency admissions to the acute hospital and better resolution of carer bereavement. Design/methods: We have used the MRC complex interventions framework, a "bottom-up" methodology, to develop an intervention for patients with advanced dementia and their carers aiming to 1) define end of life care needs for both patients and carers, 2) pilot a palliative care intervention and 3) produce a framework for advance care planning for patients.The results of qualitative phase 1 work, which involved interviews with carers, hospital and primary care staff from a range of disciplines, have been used to identify key barriers and challenges. For the exploratory trial, 40 patients will be recruited to each of the control and intervention groups. The intervention will be delivered by a nurse specialist. We shall investigate and develop methodology for a phase 3 randomised controlled trial. For example we shall explore the feasibility of randomisation, how best to optimise recruitment, decide on appropriate outcomes and obtain data for power calculations. We will evaluate whether the intervention is pragmatic, feasible and deliverable on acute hospital wards and test model fidelity and its acceptability to carers, patients and staff. Discussion: Results of qualitative phase 1 work suggested that carers and staff were keen to discuss these issues and guided the development of the intervention and choice of outcomes. This will be vital in moving to a phase III trial that is pragmatic and feasible for these complex patients within the NHS


Slade M, et al. Failure to improve appropriateness of referrals to adult community mental health services--lessons from a multi-site cluster randomized controlled trial. Family Practice 2008 25 (3) 181-90.

http://dx.doi.org/10.1093/fampra/cmn025

http://pmid.us/18515810


Background. Non-clinical factors impact on decisions about whether to refer a patient from primary care to specialist mental health services. The aim of this study was to investigate whether introducing a standardized assessment of severity improves agreement on referrals. Methods. Multi-site mixed-method cluster randomized controlled trial, investigating GP referrals from 73 practices (408 839 patients) to 11 community mental health teams (CMHTs). Intervention group GPs were asked to complete a Threshold Assessment Grid (TAG) rating of mental health problem severity. CMHTs rated referral appropriateness (ISRCTN86197914 ). Results. Two hundred and eighty-one GPs made 1061 mental health referrals. The intervention was only partly implemented with 25% of intervention group GPs completing TAGs. No difference was found in appropriateness (OR 1.18, 95% CI 0.91-1.53) or secondary outcomes. Post-referral primary care contact rates were higher for the intervention group (IRR 1.36, 95% CI 1.07-1.73). Qualitative data identified professional and organizational barriers to implementation. Conclusions. Asking GPs to complete a TAG when referring to CMHTs did not improve primary-secondary care agreement on referrals. Low implementation means that uncertainty remains about whether introducing a severity-focussed measure into the referral process is beneficial. Introducing local protocols to manage demand at this interface may not be successful and more attention needs to be paid to human and organizational factors in managing interfaces between services

. Smolders M, et al. Knowledge transfer and improvement of primary and ambulatory care for patients with anxiety. Canadian Journal of Psychiatry 2008 53 (5) 277-93.

http://pmid.us/18551849

Objective: To summarize current evidence on the effectiveness of different knowledge transfer and change interventions for improving primary and ambulatory anxiety care to provide guidance to professionals and policy-makers in mental health care. Method: We searched electronic medical and psychological databases, conducted correspondence with authors, and checked reference lists. Studies examining the effectiveness of knowledge transfer and interventions targeted at improvement of the recognition or management of anxiety in primary and ambulatory health care settings were included. Methodological details and outcomes were independently extracted and checked by 2 reviewers. Where appropriate, data concerning the impact of interventions on symptoms of anxiety were pooled using metaanalytical procedures. Results: We identified 24 studies that met our inclusion criteria. Seven professional-directed interventions and 17 organizational interventions (including patient-oriented interventions) were identified. The methodological quality of studies was variable. Professional-directed interventions only impact the process and outcome of care when embedded in some sort of organizational intervention. Metaanalysis (n = 8 studies) showed no effect of diverse organizational interventions on patients' anxiety symptoms (effect size, -0.08; 95% confidence interval, -0.31 to 0.15; P = 0.50). Collaborative care interventions proved to be the most effective organizational intervention strategies. Six studies reported economic results: 4 studies showed that intervention had a high probability of being cost-effective. Conclusions: Collaborative care seems to be very promising for improving primary and ambulatory care for anxiety. At the level of management and policy, the results of this review mandate the need to offer fair and reasonable reimbursement for collaborative care programs


de Waal MW, et al The role of comorbidity in the detection of psychiatric disorders with checklists for mental and physical symptoms in primary care. Social Psychiatry and Psychiatric Epidemiology 19th July 2008.

http://dx.doi.org/10.1007/s00127-008-0410-5

http://pmid.us/18642122

Objective: To examine the contribution of a mental and physical symptom count to the detection of single or comorbid anxiety, depressive and somatoform disorders. Method: In primary care 1,046 consulting patients completed the Hospital Anxiety and Depression Scale (HADS) and the Physical Symptom Checklist (PSC-51). In a stratified sample of 473 patients DSM-IV psychiatric disorders were assessed using the WHO-SCAN interview. The diagnostic value of the HADS total score and the PSC-51 symptom count was examined with ROC-analyses. Results: The discriminative power of PSC-51 and HADS was highest for patients with both a somatoform disorder and an anxiety or depressive disorder, with an AUC of 0.86 (95% CI: 0.81-0.91) and 0.91 (95% CI: 0.87-0.94) respectively. Using both symptom counts together did not increase the diagnostic value for the detection of the psychiatric disorders. Conclusion: Both symptom counts preferentially detected patients with comorbid disorders. When interpreting diagnostic values of screening questionnaires one should keep in mind that the validity of these values can be dependent of the presence of comorbid disorders


Younes N, et al Long term GP opinions and involvement after a consultation-liaison intervention for mental health problems. BMC Family Practice 2008 9:41

http://dx.doi.org/10.1186/1471-2296-9-41

http://www.biomedcentral.com/1471-2296/9/41

http://pmid.us/18597695


Background: Shared Mental Health care between Psychiatry and Primary care has been developed to improve the care of common mental health problems but has not hitherto been adequately evaluated. The present study evaluated a consultation-liaison intervention with two objectives: to explore long-term GP opinions (relating to impact on their management and on patient medical outcome) and to determine the secondary referral rate, after a sufficient time lapse following the intervention to reflect a "real-world" primary care setting. Methods: All the 139 collaborating GPs (response rate: 84.9%) were invited two years after the intervention to complete a retrospective telephone survey for each patient (181 patients; response rate: 69.6%). Results:91.2% of GPs evaluated effects as positive for primary care management (mainly as support) and 58.9% noted positive effects for patient medical outcome. Two years post-intervention, management was shared care for 79.7% of patients (the GP as the psychiatric care provider) and care by a psychiatrist for 20.3% patients. Secondary referral occurred finally in 44.2% of cases. Conclusions: The intervention supported GP partners in their management of patients with common mental health problems. Further studies are required on the appropriateness of the care provider


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