Screening, Detection and Management of Depression in Elderly Primary Care Attenders. I: The Acceptability and Performance of the 15 Item Geriatric Depression Scale (GDS15) and the Development of Short Versions

One-hundred and ninety-eight elderly subjects attending theirgeneral practitioners (GPs) were asked to complete the 15 itemGeriatric Depression Scale (GDS15). Analysable results wereobtained from 194 (98%). Of these, 67 (34%) scored above theGDS15 cut-off (4/5) for significant depressive symptomatology.87.6% found the questionnaire to be acceptable and only 3.6%found it very difficult or very stressful. The GDS15 had a highlevel of internal consistency (Cronbach's alpha = 0.80). Allthe individual items of the GDS15 associated significantly (P<0.01) with total score and ‘caseness’. A singlequestion "do you feel that your life is empty?" identified 84%of ‘cases’. In an attempt to devise short scalesto screen elderly primary care patients for depression, thedata were subjected to logistic regression analysis. Ten (GDS10),four (GDS4) and one (GDS1) item versions were generated. Agreementbetween these short scales and the GDS15 in the original samplewas 95, 91 and 79% respectively. Cronbach's alpha was 0.72 forthe GDS10 and 0.55 for the GDS4. The short scales were thenvalidated in an independent sample of 120 patients in whom bothGDS data and the results of a detailed psychiatric interview(the Geriatric Mental Status Schedule, GMS) were available.The sensitivity and specificity of the GDS10 against GMS casenesswere 87 and 77% (cut-off 3/4); those of the GDS4 were 89 and65% (cut-off 0/1) and 61 and 81% (cut-off 1/2). Sensitivityand specificity for the GDS1 were 59 and 75%. It is concludedthat these short scales may be useful in helping GPs and practicestaff to identify elderly patients with significant depressivesymptoms.     

Anxiety and depression in general practitioners: associations with type of parctice, fundholding, gender and other personal characteristics

BACKGROUND: There is evidence both that a doctor's own well-being is closelyassociated with efficiency and positive attitude to patients,and that levels of stress, anxiety and depression in doctorsare rising. OBJECTIVES: This postal survey aimed to measure anxiety and depression levelsin general practitioners in 1994 and identify any associationswith personal and practice characteristics. METHODS: All general practitioners with patients in Staffordshire wereinvited to complete the Hospital Anxiety and Depression (HAD)scale. RESULTS: Six hundred and twenty of 896 general practitioners replied(response rate 69%). No gender differences were found in ratesof anxiety and depression; overall, 19% of respondents were‘cases’ of anxiety and 22% others had borderlineanxiety scores; 10% were ‘cases’ of depression and16% others had borderline depression scores. Anxiety ‘caseness’was associated with living alone, amount of on-call duties undertaken,and being fourth/fifth wave fundholders. Depression ‘caseness’was associated with having little free time from practice work,amount of on-call, being single handed, and working in a non-trainingpractice. CONCLUSIONS: The authors concluded that the level of mental ill-health ingeneral practitioners is a matter of concern and is associatedwith workload. Keywords. Anxiety, depression, general practitioners, personal characteristics, practice characteristics.     

The impact of the COSHH regulations on workers with occupational asthma

In the UK, the COSHH Regulations give specific guidance thatemployers have duties to inform, instruct and train their employeesabout occupational risks and provide them with suitable healthsurveillance. The aim of the study was to evaluate the impactof the Regulations on employees with occupational asthma. Onehundred consecutive patients attending an occupational lungdisease clinic completed a questionnaire assessing the implementationof the COSHH Regulations in their workplace. Twenty-eight percent had a pre-employment inquiry about asthma, 31% had regularhealth surveillance by questionnaires and 19% had regular lungfunction assessment at work. Pre-employment spirometry was carriedout in 44% of the workers who were exposed to one of the originalseven prescribed agents, significantly more than those who wereexposed to other agents (19%) (p < 0.05). Moreover, figuresfor spirometry during employment were 31% and 8% respectively(p < 0.05). The patients who worked after ‘COSHH’but before ‘MS25’ had a tendency to be providedwith health surveillance more than those who worked after both‘COSHH’ and ‘MS25’. Ninety-one per centof the patients had never been informed about the risks of gettingasthma at work and 73% had never seen the safety data sheets.The workers who (1) worked after ‘COSHH’ introduction;(2) worked in larger firms and (3) were exposed to one of theoriginal seven prescribed agents, had a tendency to be informed,instructed and trained more than the rest. However, there wereonly significant statistical differences (p<0.05) in termsof the safety data sheet provision between the cases who workedbefore the time of the legislation and those employed afterwards.     

Who gets what: politics, evidence, and health promotion

Science journal, starting with its July 2005 issue, presentsits readers with 125 questions and problems yet to be resolvedby the scientific community. These range from the deceptivelysimple (‘what is the structure of water?’), theobvious (‘what triggers puberty?’ or ‘whatare the roots of human culture?’), to the amazingly esoteric(‘do mathematically interesting zero-value solutions ofthe Riemann zeta function all have the form of a+bi?’). More than half of these issues have     

ALCOHOLISM: A LONG-TERM FOLLOW-UP STUDY OF PARTICIPANTS IN AN ALCOHOL TREATMENT PROGRAMME

This paper reports the results of a long-term follow-up studyof 112 alcoholic patients admitted to an intensive 1-month residentialprogramme. Outcomes at the 6-month and 1-year stages were reportedin an earlier paper [G. K. Shaw et al. (1990) British Journalof Psychiatry 157, 190–196]. The length of the follow-upperiod in this study was an average of 9 years. Eighteen patientshad died before the long-term follow-up stage, and of the remaining94 a total of 60 patients were followed up. This study showsthat major improvements on social, psychological and drinkingbehaviour measures, made at 6 months and 1 year follow-up, were,on the whole, maintained and there was a progressive improvementon most variables at each follow-up stage. Major improvementswere achieved by those patients whose drinking was categorizedas ‘abstinent’, ‘controlled’ and ‘improved’.The proportion of patients categorized as ‘unchanged’dropped from 43% at 6 months to 33% at 1 year and to 15% at9 years. By the 1-year follow-up stage, the unchanged groupshowed deterioration on psychological variables such as neuroticism,self-esteem and satisfaction with life situations, continuedto make use of health service resources, and the high levelof alcohol-related physical and social complications remainedunchanged. This group had similar results at long-term follow-upwith the exception of neuroticism, which was significantly lowerin all drinking categories.     

The use of anti-depressants and benzodiazepines in the perpetrators and victims of accidents

The objective of this study was to determine whether there isa greater incidence of psychotropic drugs in the blood of those‘responsible’ for an accident compared with thosenot ‘responsible’ for an accident. Blood sampleswere taken from people involved in accidents presenting at theaccident and emergency departments of two teaching hospitalsover a five-month period and analysed for the presence of alcohol,tricyclic anti-depressants (TCAs) and benzodiazepines (BZs).Details of the accident were used to produce a test group (accidentswhere a drug may have contributed) and a control group (accidentswhere the presence of a drug could not have been a factor).In total, 229 samples were collected. The only criterion forinclusion in the study was that the accident was of sufficientseverity to merit the routine taking of a blood sample, in whichcase an additional amount was taken for the purposes of thisinvestigation. In all, 63 samples (27.5%) were positive forat least one of alcohol, TCA or BZ. Of the accidents representedby these samples, 48 could have been caused by the presenceof the drug (responsible group) and 15 could not (not responsiblegroup). There was a significantly greater representation ofTCAs and BZs in the blood taken from the responsible group comparedwith the not responsible group (P < 0.0045).     

Elevated risk of preeclampsia in pregnant women with depression: depression or antidepressants?

A previous study suggested an increased risk of preeclampsia among women treated with selective serotonin reuptake inhibitors (SSRIs). Using population-based health-care utilization databases from British Columbia (1997-2006), the authors conducted a study of 69,448 pregnancies in women with depression. They compared risk of preeclampsia in women using SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants (TCAs) between gestational weeks 10 and 20 with risk in depressed women not using antidepressants. Among prepregnancy antidepressant users, the authors compared the risk in women who continued antidepressants between gestational weeks 10 and 24 with the risk in those who discontinued. Relative risks and 95% confidence intervals were estimated. The risk of preeclampsia in depressed women not treated with antidepressants (2.4%) was similar to that in women without depression (2.3%). Compared with women with untreated depression, women treated with SSRI, SNRI, and TCA monotherapy had adjusted relative risks of 1.22 (95% confidence interval (CI): 0.97, 1.54), 1.95 (95% CI: 1.25, 3.03), and 3.23 (95% CI: 1.87, 5.59), respectively. Within prepregnancy antidepressant users, the relative risk for preeclampsia among continuers compared with discontinuers was 1.32 (95% CI: 0.95, 1.84) for SSRI, 3.43 (95% CI: 1.77, 6.65) for SNRI, and 3.26 (95% CI: 1.04, 10.24) for TCA monotherapy. Study results suggest that women who use antidepressants during pregnancy, especially SNRIs and TCAs, have an elevated risk of preeclampsia. These associations may reflect drug effects or more severe depression.     

WHEN ALCOHOLICS DRINK AFTERSHAVE: A STUDY OF NONBEVERAGE ALCOHOL CONSUMERS

A one-year prospective study was conducted to describe nonbeveragealcohol (NBA) consumption (the use of substitutes for traditionalforms of ethanol) among alcoholics. It was found that 11% ofinpatient alcoholics at a veterans' hospital and 8.6% of alcoholicsat a community hospital had consumed NBA. Substances consumedranged from toiletries to organic solvents, often in quantitiesexceeding the theoretical lethal dose. ‘Ready availability’was cited as the primary reason for consumption. Social, demographicand psychiatric parameters were then compared between 48 VAalcoholics who used NBA and 48 nonusing alcoholics. No socialor demographic differences were found, but NBA drinkers drankmore alcohol (P < 0.0001), had higher global alcoholic severityscores (P < 0.0001), more severe withdrawal symptoms (P <0.0001), and a higher frequency of antisocial personality disorder(P = 0.009) and drug abuse (P = 0.005). When NBA drinkers weresubdivided by quantity of NBA consumption and recency of latestingestion, no social or psychological differences were foundbetween groups, except for more frequent and heavier illicitdrug use among ‘heavy’ NBA consumers (P < 0.0001).     

ERRATUM

In the article by A. L. Morgan ‘Cholinesterase Problemsarising in a Plant Manufacturing Tri-aryl Phosphates’(Journal of the Society of Occupational Medicine 31, 119–122)on p. 120, the first sentence of Case 1 should read ‘Thisindividual had three split blood samples examined.’     

Testing a conceptual model related to weight perceptions, physical activity and smoking in adolescents

The purpose of this study was to test a conceptual model basedon theoretical and empirically supported relationships relatedto the influences of weight perceptions, weight concerns, desiresto change weight, friends, age and location in relation to physicalactivity (PA) and smoking in adolescents. A total of 1242 malesand 1446 females (mean age = 15.6 ± 1.3) were recruitedfrom rural and urban Canadian schools. Study respondents providedself-reports of PA, ‘smoking’, ‘perceivedbody weight’, ‘desire to change weight’, ‘concernabout weight gain’ and ‘friends' smoking and PAbehaviors’. Results revealed an acceptable fitting model² (40) = 155.63, P < 0.05, root mean square error of approximation= 0.047 and comparative fit index = 0.98. Large effect sizesfor both genders were observed between friends' and adolescents'smoking behavior, and between perceived body weight and desireto change weight. Further, significant differences were identifiedbetween the male and female models [² difference (24) = 65.28,P < 0.05]. Several findings of this study point to the needto design programs to motivate adolescent females to adopt healthyweight-control practices and to target young peoples' socialnetworks to promote health behaviors, especially with regardto smoking. Received on December 22, 2005; accepted on June 15, 2006     

Swiss teenagers, AIDS and sexually transmitted diseases: presentation and evaluation of a preventive exhibition

As part of a larger school-based health program for Swiss apprenticesand students, an AIDS and sexually transmitted disease (STD)prevention exhibition was offered to 7000 boys and girls aged15–19. Its objectives were: (1) to reinforce their knowledgeof STD and AIDS transmission and prevention, and (2) to modifytheir attitudes and behavior regarding (a) the decision whether,when and how to have sex and (b) the use of condoms. The exhibitionconsisted of six posters, reviewed by specially-trained teachersand nurses. Condoms were presented in an amusing way and werefreely available. A case control follow-up survey was carriedout 12 weeks later in two random samples: 798 subjects froman experimental school and 600 subjects from a control schoolcompleted an anonymous multiple-choice questionnaire. Of therespondents, 69% were sexually active, and among this group,76% of the boys and 59% of the girls had used a condom at leastonce but only 15% used them regularly. As regards knowledge,both groups reached high levels (75–97% of right answers);the group exposed to the exhibition scored higher for only twoitems (P < 0.05). Significantly more teenagers in the experimentalgroup said they had handled condoms or had condoms with them‘just in case ...’. This evaluation shows that anAIDS and STD prevention exhibition for teenagers may be bothfeasible and effective. However, future intervention programsshould include practical interpersonal counseling on topicssuch as mutual trust, contraception issues, and the purchaseand use of condoms.     

Breast cancer risk among users of antidepressant medications

BACKGROUND: Breast cancer is the most common cancer in women. Laboratory studies suggest that antidepressants may promote breast cancer tumor growth. Several epidemiologic studies have evaluated this association with conflicting results. METHODS: We conducted a cohort study with a secondary nested case-control analysis based on the General Practice Research Database. Our goal was to assess the association between the risk of breast cancer and use of serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and other antidepressants. We calculated adjusted estimates controlling for breast cancer risk factors using unconditional logistic regression. RESULTS: A total of 3708 cases of breast cancer were ascertained. Overall, antidepressant use was not associated with an increased risk of breast cancer. Current users of SSRIs had an odds ratio (OR) of 0.98 (95% confidence interval=0.81-1.19), whereas current users of TCAs had an OR of 0.86 (0.73-1.00). When only use for longer than 1 year was considered, the corresponding estimates for SSRIs and TCAs were 0.76 (0.53-1.09) and 0.87 (0.70-1.09), respectively. None of the individual drugs was associated with breast cancer risk. CONCLUSIONS: Use of antidepressants was not associated with an increased risk of breast cancer regardless of duration of use, daily dose, or specific drug being used. These results, together with evidence from prior studies, support the lack of a clinically meaningful association between breast cancer risk and antidepressants.     

The Use of Ginseng as an Adjunct in Treatment-Resistant Depression

The treatment of depression has evolved over the past several years since the evolution of tricyclic antidepressants (TCAs) to the serotonin selective reuptake inhibitors (SSRIs). However, some patients are resistant to various medications, and various adjunctive medications have been added to the original medication, to promote a therapeutic response. This case report describes a woman, with a long history of treatment-resistant depression, who was treated with a combination of an SSRI and ginseng.     

The Psychosocial Impact of Mass Screening for Cardiovascular Risk Factors

In Leek, a small town in the north of the Netherlands, 428 menaged between 30–33 years were invited to take part ina screening test for cardiovascular risk factors. Questionnaireswere sent to the 267 men who had participated in the screeningtest as well as to the 161 non-participants, in order to gainan insight into the participatory behaviour and the experienceof those involved. The non-participants gave a diversity ofmotives for not taking part but did not admit to anxiety aboutfinding abnormal results. More than half of the participantswho replied (51%, n = 107) were found to have an ‘abnormality’—;thatis they scored on one or more of cigarette smoking, overweight,hypertension, hyperlipoproteinaemia, albuminuna or glucosuria.The supplementary information provided on nutrition and smokingcaused a large proportion of them to claim they had changedto a more healthy life-style after the screening test. Thosewho were under the impression that they had led healthy livesbut were still found to have an ‘abnormality’ wereoften very astonished and sometimes worried about the result.The men without ‘abnormalities’ did not lead significantlyhealthier lives than the rest in terms of exercise, smoking,diet and so on; for them the result might have a ‘certificateof health’ effect justifying their not always healthybehaviour.     

The Impact of Discussion of Non-Medical Problems in the Physician's Office

Martin FJ, Bass MJ. The impact of discussion of non-medicalproblems in the physician's office. Family Practice 1989; 6:254–258. To determine the impact of discussion of non-medical problemswith the physician, patients with at least one chronic illnesswho were taking medication were interviewed in their familydoctor's office. Of 149 patients interviewed, 90.6% reportedat least one non-medical problem. Half (51%) of those patientswith a problem had discussed it with their doctor. More thanhalf (55%) of those patients discussing a problem reported thatthe discussion was helpful. Patient compliance and satisfactionwere positively associated with ‘helpful’ discussion,but not with discussion per Se. In particular, the two aspectsof doctor-patient communication which were significantly associatedwith feeling helped were: ‘Doctor tells me all I wantto know about my illness’ and ‘Doctor gives me achance to say what is really on my mind’. Both factorsreflect care which is oriented to patient concerns. The studyresults provide support for a patient-centred approach to care.     

Developments in the darkroom: a cross-sectional study of sickness absence, work-related symptoms and environmental monitoring of darkroom technicians in a hospital in Glasgow

Nine female technicians using both manual and automatic processingmethods were matched by age, sex and smoking habits with controlsfrom the occupational therapy department. All were interviewedusing a questionnaire about symptoms experienced during theday in question and the preceding month. Sickness absence informationfor 1987 was obtained, and the working environment was assessedby standard occupational hygiene methods. The technicians andcontrols had similar numbers of episodes of sickness absence(23 versus 24, respectively) but aggregated substantially moredays absence attributed to sickness (204 versus 41). The totalnumber of ‘monthly’ symptoms experienced by thetechnicians was greater than the controls (44 versus 30) aswas the number of ‘daily’ complaints (26 versus6). In all cases, respiratory symptoms were responsible forabout one-third of problems, but statistical analysis (Wilcoxonmatched pairs signed ranks tests) showed that the differenceswere not statistically significant. Occupational hygiene resultswere all within normal limits.     

Reasons for Rejection: Why People Fail to Qualify as Firefighters

In the decade beginning 1 January 1985, 916 individuals (includingfive females) were medically examined with a view to joiningthe full-time service of Strathclyde Fire Brigade (SFB). Onehundred and nine (11.9%), including two females, were rejected.The five main causes of failure were: ocular (n = 46, 42.2%);lack of stamina (n = 21, 19.2%); ‘others’ (n = 12,11.0%); cardiovascular (n = 9, 8.3%) and orthopaedic (n = 6,5.5%). Thirty-two had chest X-rays. One abnormality was found— an azygous lobe — but it played no part in thedecision to decline the applicant. There was little life- orhealth-threatening pathology found. The most serious cases weremurmurs consistent with mitral stenosis and regurgitation (oneeach), one case of ocular melanoma, four cases of hypertensionand two cases of haematuria/ proteinuria (++). This study showsthat potentially serious findings can occasionally be detectedin a population of 18–30 year olds who might be expectedto be of better than average fitness, and that routine chestX-rays are not helpful in the selection process.     

Resistance to peer group pressure: an inadequate basis for alcohol education

saper explores the notion of ‘peer group pressure’as it has been deployed in educational interventions on alcoholfor adolescents. It is argued that ‘peer group pressure’is an inadequate explanation for youthful alcohol use and thatinterventions formulated around the inculcation of resistanceto peer group norms must inevitably be at variance with theeveryday experience of those at whom such interventions areaimed. The paper argues that a reformulation of the conceptof ‘peer group pressure’ opens up its positive featuresand that these offer a strong base for a new range of educationalinitiatives.