Patient satisfaction in mental health care. Evaluating an evaluative method.
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Community Mental Health Services↗
Biomedical subjects
G Wilkinson
Publications and source records attributed to G Wilkinson.
An evaluation of community-based psychiatric care for people with treated long-term mental illness.
BACKGROUND: We evaluated integrated, multidisciplinary, community-based care for a cohort of people with treated long-term mental illness over two years in a field trial set in a semi-rural setting. The aim was to organise local psychiatric services on an extramural basis with general practitioner teams as the key element. METHOD: Trained research workers used a structured interview to collect standardised base-line and three-monthly socio-demographic, clinical, social, family adjustment and burden, and treatment measures from patients, informants, and key-workers. Analysis included descriptive statistics and, for longitudinal data, analysis of best-fitted straight lines. RESULTS: We studied 34 patients (14 with schizophrenia, 11 with major affective disorders, and 9 with minor (non-major) affective disorders and anxiety disorders) who had a mean of 12 years continuous illness. At baseline, they were mainly characterised by research workers as mildly ill with fair social adaptive functioning, and by lay informants as having moderate target symptom severity and disturbance of social performance. Over two years, there were statistically significant, slight improvements in clinical global impressions ratings by research workers, and in informants ratings of target symptoms and social performance. Most patients continued to receive prescriptions for psychotropic drugs throughout follow-up, and they had a mean of 47 therapeutic contacts, mainly from nurses. Two patients were admitted to psychiatric hospital. There were few differences between patients in different diagnostic groups. CONCLUSIONS: Integrated, multidisciplinary, community-based psychiatric care for people with treated long-term mental illness is feasible in a semi-rural setting: patients receiving pharmacotherapy and regular psychosocial treatments remained relatively stable on clinical and social measures over two years. The unique way in which the service was monitored, by making regular, systematic assessments of patients and carers, serves as an example for other services.
Adult↗
Can suicide be prevented? Better treatment of mental illness is more appropriate aim.
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Attitude to Health↗
Reliability, validity and factor structure of the 12-item General Health Questionnaire among young males in Italy.
The internal consistency, validity and factor structure of the 12-item General Health Questionnaire (GHQ-12) were investigated in a homogeneous sample consisting of 18-year-old males in Italy. The GHQ-12 proved to be a reliable instrument, as indicated by a Cronbach's alpha of 0.81. When the screening characteristics of the GHQ-12 (scored by the Likert method) were evaluated against the psychiatrist's ratings, the best balance between sensitivity and specificity was found at the GHQ cut-off score of 8/9: at this threshold, sensitivity was 0.68 and was paired to a specificity of 0.59 and an overall misclassification rate of 0.40. Validity coefficients based on a single severity score were rather low compared with those reported in other settings. When a principal components analysis with varimax (and oblimin) rotation was performed, two factors were identified: factor A (general dysphoria) was defined by 7 items related to anxiety and depression; factor B (social dysfunction) included 6 items testing the ability to perform daily activities and to cope with everyday problems. The identified factors revealed distinct ability in the discrimination between subjects with and without emotional disturbance according to the psychiatrist's ratings and correlated differently with 3 Minnesota Multiphasic Personality Inventory subscales (depression, D; conversion hysteria, Hy; psychasthenia, Pt). Thus, the factor structure of the GHQ-12 might provide useful information along with that offered by a single severity score, and the detection of cases might be improved by examining an individual's profile of scores on different subscales derived from factor analysis.
Activities of Daily Living↗
Outcome of depression in psychiatric settings.
We reviewed follow-up studies of adults with depressive disorders seen in psychiatric settings, and noted outcomes in terms of recovery, recurrence, and persistent depression, at six months, one year, two to five years, and ten or more years after an index episode of depression. Recovery increased with time: about half recovered at least briefly by six months, and a large majority did so in the long term. Only about a quarter recovered from an index episode and remained well more than ten years thereafter. A quarter of patients suffered recurrence of depression within a year of an index episode, and three-quarters did so at least once during follow-up periods lasting more than ten years. For more than one in ten patients, the depression proved persistent, the proportion affected remaining relatively stable over time. The review highlighted a relative paucity of conclusive investigations on the outcome of the commonest psychiatric disorder in clinical settings.
Antidepressive Agents↗
Social support, adversities and emotional distress in an Italian community sample.
The association of social support with emotional distress in relation to adversities such as social problems, physical health and undesirable life events was assessed in an Italian community sample of 222 men and 224 women. Univariate comparisons and logistic regression analyses showed that neither the quality of a confiding core relationship nor social support from kin confidants was related to adversities. In women only, social support from friend confidants exerted a statistically significant independent main effect together with social problems and undesirable life events in producing a greater probability of emotional distress. The implications of these findings are discussed considering the socio-cultural characteristics of Italian families and individual coping strategies.
Adaptation, Psychological↗
The role of the practice nurse in the management of depression in general practice: treatment adherence to antidepressant medication.
This pilot study demonstrated the feasibility of providing practice nurse support as an adjunct to standard general practitioner treatment to patients with depressive disorders prescribed antidepressant medication. With respect to the measures used and pilot study objectives identified, there were no statistically significant differences between the study groups in treatment adherence to the prescription of antidepressant medication or in the incidence and severity of adverse events to medication. Large-scale randomized controlled trials are in progress to assess the effectiveness of practice nurse interventions in the management of depressive illness in general practice.
Adult↗
Another British disease? A recent increase in the prevalence of psychiatric morbidity.
AIMS AND OBJECTIVE: To examine trends in the prevalence of psychiatric morbidity in Britain between 1977 and 1985. DESIGN: Secondary analysis of two cross sectional population based surveys. SETTING: The first survey was conducted in 1977 in West London and the second in 1984-85 throughout Great Britain. PARTICIPANTS: Members of the public randomly selected from the electoral register. MEASUREMENTS AND MAIN RESULTS: The main outcome was the prevalence of psychiatric morbidity assessed using the General Health Questionnaire, a self administered measure of neurotic symptoms. There was an increase of at least 8% (95% confidence interval 6.6, 9.8) in the prevalence of psychiatric morbidity between the times of the two surveys and this difference persisted after adjustment for any changes in the sex, age, employment status, marital status, social class, and housing tenancy between the two samples. When the analysis was restricted to the Greater London respondents of the Health and Lifestyle Survey a larger increase in psychiatric morbidity was seen. CONCLUSIONS: It is likely that there was an increase in the prevalence of psychiatric morbidity in Great Britain between these two surveys. Psychiatric morbidity is a public health problem of some importance and the causes of this increase require further study.
Adolescent↗
Reduced levels of alpha-1-antitrypsin in children exposed to high levels of air pollution.
Health risks associated with environmental pollution, particularly in Eastern Europe, are a cause for concern. In order to gain some insight into the effects of exposure to high levels of air pollution particularly by heavy metals, we measured the concentration of nine plasma proteins in plasma samples from newborn babies and 5- to 6-year old children living in heavily polluted areas of Poland, as well as from some newborns and adults from unpolluted areas of Poland and control samples within the local Southampton population. The concentrations of all proteins measured were in or close to their expected range, with the exception of alpha 1-antitrypsin (alpha 1AT). The concentration of this protein was lower in both groups of Polish children from the polluted areas, particularly in the 5- to 6-year old group. These children were shown to be phenotypically normal. Since adult levels of alpha 1AT are usually reached within 2 weeks postpartum, these findings raise the possibility that continued exposure to high levels of pollution may lead to reduced levels of alpha 1AT in plasma; this may compound the impairment of lung function in children living in highly polluted areas.
Air Pollutants↗
Assessment of psychological care in general practice.
OBJECTIVE: To pilot a method of assessing psychological care by general practitioners. DESIGN: Prospective examination of psychological care given in general practice by using general health questionnaire with predetermined quantifiable and case specific indices of outcome established at the original consultation. SETTING: Rural general practice in Clwyd, North Wales. SUBJECTS: 447 consecutive adult general practice attenders. MAIN OUTCOME MEASURES: Three month follow up consultation rates, one year retrospective consultation rates, continuity of care, changes in general health questionnaire scores at follow up, general satisfaction, and acceptability of outcome measures. RESULTS: The principal and trainee identified 72 patients with psychological problems, 46 of whom had new conditions. 133 patients scored over 6 on the 28 item general health questionnaire, 33 of whom were identified as new cases by the general practitioners. 62 patients were seen at follow up, including 23 patients identified by the questionnaire but not by the doctor. The doctors used diagnostic terms to describe the presenting condition in 38 cases. At three month follow up the general health questionnaire scores had fallen by more than 5 points in 22/39 patients identified and managed by doctors and 11/23 identified by the questionnaire. The agreed index of good outcome was almost or completely achieved by 20 of the 39 patients managed by doctors. CONCLUSION: Quantifiable methods of evaluating the quality of the structure, process, and outcome of psychological care can be achieved in general practice.
Community Mental Health Services↗
Psychiatrists in the new NHS.
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Family Practice↗
Nursing comes of age.
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Attitude of Health Personnel↗
Alcohol consumption and lung cancer in white males.
Experimental and epidemiologic investigations in alcoholic and nonalcoholic populations have suggested a role of alcohol in lung carcinogenesis. The association between alcohol consumption and lung cancer was investigated among 280 White males with histologically confirmed, primary lung cancer and 564 White male controls, participants in the Western New York Diet Study (United States). Among heavy smokers (over 40 pack-years), total alcohol consumption was associated with an increased risk of lung cancer with adjustment for age, years of education, pack-years of cigarette smoking, and intake of carotenoids and fat. In this group, the odds ratio for drinkers of more than 24 drinks per month was 1.6 compared with those who drank less. Drinkers of more than 12 beers per month were 1.6 times more likely to develop lung cancer than nondrinkers of beer after controlling for age, years of education, and cigarette smoking (95 percent confidence interval = 1.0-2.4, P for trend = 0.003). Occupational and dietary factors did not seem to explain these findings. Although cigarette smoking is the major cause of lung cancer, the role of alcohol, independent or in interaction with cigarette smoking, deserves further investigation.
Adult↗
Why people with probable minor psychiatric morbidity consult a doctor.
This epidemiological investigation examines factors determining medical consultation in people with probable minor psychiatric morbidity. About 54% of people with probable minor psychiatric morbidity and about 23% of the (numerically much greater) remainder with lower probability of psychiatric morbidity consulted a doctor, usually a primary care physician, in the two weeks prior to a research interview. Medical consultation rates were higher in females than in males. The dominant finding was that in people with probable minor psychiatric morbidity physical illness was strongly associated with medical consultation. Almost 89% of males and 97% of females with probable minor psychiatric morbidity and physical illness consulted a doctor in the two weeks prior to interview. Logistic regression modelling was used to investigate the joint effects on medical consultation of physical illness and six socio-demographic variables, and physical illness emerged as the major single determinant of medical consultation in women and, in men, it exerted its effect through an interaction with lower educational level.
Adolescent↗
A longitudinal study of general practitioner consultations for psychiatric disorders in adolescence.
Patterns of psychiatric diagnoses given during adolescence to a group of individuals continuously registered with a single general practitioner in South London over 20 years were analysed first during 'early adolescence' and secondly during 'early adulthood'. Psychiatric diagnoses were found to be relatively common. Of the young adolescents who received a psychiatric diagnosis (almost one in ten of the group), 38% received a psychiatric diagnosis as young adults compared with only 16% of the remainder. Comorbidity was found to be very common--over 50% of young adults with a diagnosis of depression also had a diagnosis of anxiety and phobic neuroses. Young people with problems of a psychological nature therefore deserve more attention, particularly from the primary care team.
Adolescent↗
QALYs in mental health: a case study.
The applicability of the Charing Cross health indicator (CH-X) to the field of mental health was investigated in a community setting using descriptive statistics and principal components analysis. The CH-X is based on assessments of (i) distress and (ii) disability. Our results suggest that with respect to quality of life in mental health settings measurements of distress may be of greater importance than disability. In addition, the CH-X may be insensitive to variations in the severity of mental disorder and may primarily reflect physical disability as opposed to social disability. QALYs methodology may require the adoption of a multidimensional measure of health in order to fulfil its proposed role in comparing medical and mental health programmes.
Persons with Disabilities↗
Diet, smoking, and alcohol in cancer of the larynx: a case-control study.
A case-control study among white men in western New York was conducted from 1975 through 1985 to examine diet and other risk factors for laryngeal cancer. Incident pathologically confirmed cases (250) and age- and neighborhood-matched controls (250) were interviewed to determine usual diet and lifetime use of tobacco and alcohol. Cigarettes were strongly associated with risk; pipes and cigars were not. Beer and hard liquor but not wine were associated with increased risk. Dietary fat and carotenoids were related to risk in opposite ways. The upper quartile odds ratio for dietary fat was 2.40 [95% confidence interval 1.26, 4.55], and the upper quartile odds ratio for carotenoids was 0.51 (0.26, 1.01). There was effect modification by smoking. Carotenoids were most negatively associated with risk among the lightest smokers, whereas dietary fat was most positively associated with risk among the heaviest smokers. Total calories, protein, and retinol were associated with increased risk; there was no relationship between laryngeal cancer and vitamin C, vitamin E, carbohydrate, or dietary fiber. This study again demonstrates the strong association between tobacco and alcohol and laryngeal cancer and also suggests that diets low in carotenoids and high in fat may increase risk.
Aged↗
Medical students' attitudes to psychiatry in Chile.
There is controversy about the influence of psychiatric clerkships on medical students' attitudes to psychiatry. In general, studies in developed countries have found a short-lasting improvement in attitudes to psychiatry after a psychiatric clerkship. The present study was designed to measure changes in medical students' attitudes following a psychiatric clerkship in a developing country. Medical students from the Faculty of Medicine, University of Chile were interviewed before and after a psychiatric clerkship using a translation into Spanish of an attitude-to-psychiatry questionnaire used previously in the UK. The results were similar to those reported from developed countries. There was a marked early improvement in students' attitudes following their psychiatric clerkship which gradually faded over 3 years. There is scope for improvement in psychiatric undergraduate medical teaching in Chile and this might help to make more lasting improvements in attitudes to psychiatry among medical students.
Attitude of Health Personnel↗