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Biomedical subjects

Ronán M Conroy

Publications and source records attributed to Ronán M Conroy.

6 recordsLinked to original sources
PubMed2006

Reliability and validity of the Hospital Anxiety and Depression Scale and the Beck Depression Inventory (Full and FastScreen scales) in detecting depression in persons with hepatitis C.

BACKGROUND: We examined the performance the Beck Depression Inventory (BDI) and its short form (BDI-FS) and the Hospital Anxiety and Depression Scale depression (HADS-D) and anxiety (HADS-A) subscales in detecting depression in a group of patients with hepatitis C. METHODS: SCID-CV was used to establish DSM-IV diagnosis. Sensitivity, specificity, positive and negative predictive values were used to assess test performance and Cohen's Kappa to measure agreement with DSM diagnosis. RESULTS: Twenty-five of 88 participants had a DSM-IV depressive diagnosis. There was considerable non-overlap between 'caseness' on the BDI and HADS (Kappa=0.44). The HADS depression subscale had poor sensitivity (52%) and poor agreement with clinical diagnosis (Kappa=0.35). The full BDI had a sensitivity of 88% and a Kappa of 0.54 against a sensitivity of 84% and Kappa of 0.42 for the short form. The HADS anxiety subscale predicted depression as well as the depression subscale (sensitivity 88%, Kappa 0.47). CONCLUSIONS: Neither the BDI nor the HADS agrees well with the clinical diagnosis of depressive disorder, nor do they agree well with one another. The anxiety subscale of the HADS appears to measure depression at least as well as the depressive subscale.

Adult↗
PubMed2006

Impact of briefly-assessed depression on secondary prevention outcomes after acute coronary syndrome: a one-year longitudinal survey.

BACKGROUND: Patients with acute coronary syndromes (ACS) are at increased risk of further acute cardiac events. Secondary prevention aims to decrease morbidity and mortality post-ACS. Depression is related to increased risk in this population, and to poorer secondary prevention activities. However, lengthy depression assessment techniques preclude depression assessment in routine care. The present study investigated the relationship of briefly-assessed depression with secondary prevention outcomes one year post-ACS. METHODS: Following ethics committee approval, hospitals recruited patients for a national survey of ACS. Consenting patients with ACS completed a brief depression scale during hospitalisation. The predictive validity of two brief scales was independently assessed, with groups combined for the overall sample. Participants then completed a one-year longitudinal follow-up postal survey of secondary prevention activities. RESULTS: The response rate for follow-up was 86% (n = 681). Proportions taking anti-platelet (88% v 87%; p = 0.334) and lipid-lowering (83% v 84%; p = 0.437) therapies remained unchanged. Prevalence of smoking (40% v 22%; p < 0.001), and median number of cigarettes smoked (20 v 10; p < 0.001) were significantly reduced at one year. Fifty-six per cent of patients reported attending cardiac rehabilitation programmes. Of those aged < 65 years at baseline, 54% had returned to work at one year. A majority (56%) reported feeling physically better. Prevalence of depression was unchanged in those who completed a depression scale at both time points (15% v 17%; p = 0.434). Baseline depression did not predict taking anti-platelet, blood pressure or cholesterol medications (all p > 0.05), but did predict continuation of smoking (OR = 2.3, 95% CI 1.3-4.0, p = 0.003), a higher (above median) number of general practitioner visits (OR = 2.1, 95% CI 1.3-3.4, p = 0.005), failure to return to work (OR = 0.4, 95% CI 0.2-0.8, p = 0.015), and not feeling better (OR = 0.6, 95% CI 0.3-1.0, p = 0.05) at one year. CONCLUSION: Rapid depression assessment can be used to help identify patients with ACS at risk of a range of poorer secondary prevention outcomes. The results provide support for the routine screening of depression in acute settings. Strategies to increase rates of smoking cessation, return to work, general well-being and decrease health service use by depressed patients may need to incorporate some element of treatment for depression.

Acute Disease↗
PubMed2004

Sex workers in Kenya, numbers of clients and associated risks: an exploratory survey.

In Kenya in 1999, an estimated 6.9% of women nationally said they had exchanged sex for money, gifts or favours in the previous year. In 2000 and 2001, in collaboration with sex workers who had formed a network of self-help groups, we conducted an exploratory survey among 475 sex workers in four rural towns and three Nairobi townships, regarding where they worked, the number of clients they had and the risks they were exposed to. Participants were identified by a network of social contacts in the seven centres. Most of the women (88%) worked from bars, hotels, bus stages and discos; 57% lived with a stable partner and almost 90% had dependent children. In the previous month, 17% had been assaulted and 35% raped by clients. Unwanted pregnancy was common; 86% had had at least one abortion. Compared with women in rural towns, township sex workers were younger (median age 22 vs. 26), saw more clients (median 9 vs. 4 per week) and earned more from sex work (up to 63-90 euros vs. 12 euros per week). Issues of alternative sources of income, safety for sex workers and the conditions which create the necessity for sex work are vital to address. The question of number of clients and the nature of sex work have obvious implications for HIV/STI prevention policy.

Adolescent↗
PubMed2002

Attitudes to doctors and medicine: The effect of setting and doctor-patient relationship.

OBJECTIVE: There have been few studies of attitudes to doctors and medicine, despite their potential importance in health psychology. The present study examines the effect on attitudes of setting (general practice vs. antenatal) and context (specific doctors vs. doctors in general). METHOD: Interview survey of 167 antenatal attenders and 113 women general practice attenders, using an extended form of the Attitudes to Doctors and Medicine Scale of Marteau (1990). RESULTS: Although antenatal attenders expressed more positive attitudes to doctors and medicine than general practice attenders, differences were small, and only statistically significant for 4 of 19 scale items. Compared with ratings of doctors in general, however, patients gave much more positive ratings to both their family doctor and the antenatal clinic doctors, the latter being rated higher than the former. Antenatal doctors were most likely to be rated as good doctors, to have the patient's absolute confidence, and to know what was best for them (all p<.001). The scale factor structure originally reported by Marteau could not be confirmed. DISCUSSION: The results suggest that attitudes to doctors and medicine are strongly dependent on whether general stereotypes or particular experiences are assessed. They also suggest that the therapeutic context may be an important factor in the formation of attitudes.

Journal Article↗
PubMedDate not supplied

Depression and anxiety in patients with hepatitis C: prevalence, detection rates and risk factors.

OBJECTIVE: We examined a group of patients awaiting interferon treatment for hepatitis C to estimate the prevalence and detection rates of and risk factors for mood disorders. METHODS: The Structured Clinical Interview for DSM-IV Axis I Disorders: Clinician Version was used to detect psychiatric disorder. Self-completion instruments were used to rate symptom severity, subjective cognitive function, work and social adjustment, stigma, acceptance of illness and treatment satisfaction. RESULTS: The 90 participants included 23 women (26%); 33 (37%) had contracted hepatitis C iatrogenically, 42 (47%) through injecting drug use and the remainder (17%) were of unknown origin. There was a 28% 1-month prevalence of depressive disorders, 72% of whom were previously undiagnosed, and a 24% prevalence of anxiety disorders, 86% previously undiagnosed. Current methadone maintenance was strongly associated with risk of depression (odds ratio, 5.0; 95% CI, 1.08-23.0). After adjustment for age and sex, depression was associated with poorer work and social adjustment, lower acceptance of illness, higher illness stigma, poorer reported thinking and concentration, and higher levels of subjective physical symptoms (all P < .05). Anxiety disorders were uncorrelated with any risk factor. CONCLUSIONS: Depression and anxiety have high prevalences in hepatitis C, and are largely undetected and treated. Depression, but not anxiety, is associated with adverse experiences of illness.

Adult↗