Preference, need and utilization of mental health services, Singapore National Mental Health Survey

OBJECTIVE: To ascertain the extent of the community's preference, needs for and utilization of mental health services, and their socio-demographic determinants in the multi-ethnic Asian community in Singapore. The extent to which need, enabling and predisposing factors determine the likelihood to seek professional help was also examined. METHOD: Data were analyzed from the Singapore National Mental Health Survey of 1996, based on a stratified random sample of 2947 Chinese, Malay and Indian subjects of the general population aged 13-64 years. RESULTS: An estimated 37% of the general population indicated they would seek professional help if they experienced a serious emotional or mental problem. Although 16.9% were determined by their high general health questionnaire (GHQ) score to need mental health services, only 2.6% in the population used the services of any professional caregiver. Among persons with high GHQ scores, only 5.9% sought any professional help. Among those with a high GHQ score and who were receptive to professional help, only 10.4% actually sought professional help. General practitioners were the most commonly preferred caregiver (49.3%), and were used by 41.1% of those who sought help. Those who sought professional help were more likely to have a high GHQ score and to be inclined to seek professional help. Malays used mental health services more than Chinese, but they did not show a significantly greater prevalence of high GHQ scores, or a greater preference to seek professional help. Receptivity to professional help, high GHQ score, and Malay ethnicity were independent significant predictors of use of mental health service. CONCLUSION: Need and attitudinal factors predict mental health service utilization, but they still do not explain why a large majority of the population chose not to use mental health services.     

Social support and change in health-related quality of life 6 months after coronary artery bypass grafting

OBJECTIVE: We determined whether perceived social support predicted change in health-related quality of life, operationalized as change in mental health and physical functioning, 6 months after coronary artery bypass grafting (CABG). METHODS: A prospective cohort of 1164 patients undergoing first CABG was interviewed prior to hospital discharge and 6 months later. Perceived instrumental and emotional support were assessed predischarge. Change in mental health and physical functioning was calculated as the difference between 6-month and predischarge SF-36 subscale scores. Stepwise linear regression analyses controlling for prior health-related quality of life, demographics, and clinical presentation were conducted. RESULTS: A total of 1072 (1072/1164=92%) participants completed the 6-month interview; mean age 65.7 (+/-11.1) years. Frequent instrumental support predicted positive change in mental health (beta=3.27, P=.02); change scores were higher when participants had low pre-CABG mental health. Neither social support variable predicted change in physical functioning. CONCLUSIONS: Assessing perceived instrumental support may help clinicians predict post-CABG mental health. More research regarding this relationship is needed before recommending intervention efforts.     

Effects of a yoga breath intervention alone and in combination with an exposure therapy for post‐traumatic stress disorder and depression in survivors of the 2004 South‐East Asia tsunami

Descilo T, Vedamurtachar A, Gerbarg PL, Nagaraja D, Gangadhar BN, Damodaran B, Adelson B, Braslow LH, Marcus S, Brown RP. Effects of a yoga breath intervention alone and in combination with an exposure therapy for PTSD and depression in survivors of the 2004 South‐East Asia tsunami. Objective: This study evaluated the effect of a yoga breath program alone and followed by a trauma reduction exposure technique on post‐traumatic stress disorder and depression in survivors of the 2004 Asian tsunami. Method: In this non‐randomized study, 183 tsunami survivors who scored 50 or above on the Post‐traumatic Checklist‐17 (PCL‐17) were assigned by camps to one of three groups: yoga breath intervention, yoga breath intervention followed by 3–8 h of trauma reduction exposure technique or 6‐week wait list. Measures for post‐traumatic stress disorder (PCL‐17) and depression (BDI‐21) were performed at baseline and at 6, 12 and 24 weeks. Data were analyzed using anova and mixed effects regression. Results: The effect of treatment vs. control was significant at 6 weeks (F_2,178 = 279.616, P < 0.001): mean PCL‐17 declined by 42.5 ± 10.0 SD with yoga breath, 39.2 ± 17.2 with Yoga breath + exposure and 4.6 ± 13.2 in the control. Conclusion: Yoga breath‐based interventions may help relieve psychological distress following mass disasters.     

Attendance at religious services and subsequent mental health in midlife women

OBJECTIVE: Spiritual and religious factors may influence mental health in midlife women. The purpose of this study was to explore whether strength of religious beliefs or attendance at religious services helps to mitigate the stresses of life in mid-life women. METHODS: Data are from a sub-sample of 265 women, ages 40-70, who were participants in the REACH study, a longitudinal study investigating health parameters in a representative sample of households from rural communities in eastern North Carolina. Using t-tests and linear regression analyses, we analyzed the relationship between frequency of attendance at religious services and strength of religious beliefs in 1997 and subsequent mental health in 2003 as measured by the mental health component score (MCS) of the SF-12. RESULTS: The mean MCS in 2003 was significantly higher (better mental health) in women who reported attending religious services > or =1/week compared to those who reported attending <1/week (53.9 vs. 51.7; p < 0.05). In the linear regression model controlling for self-reported health status, baseline attendance at organized religious services remained a significant predictor of the MCS at six-year follow-up (standardized beta = -0.123, p < 0.05). CONCLUSIONS: Attendance at religious services is positively related to subsequent mental health in middle-aged women. The findings support the notion that religious commitment may help mitigate the stress of the midlife period. More research is needed to translate these findings into clinical interventions that can decrease the burden of anxiety and depression on midlife women.     

QEEG Correlates of Auditory-Visual Entrainment Treatment Efficacy of Refractory Depression

Introduction. It is well established that the number of people diagnosed and suffering from depression is on the increase. Many of these patients are not responsive to first-line pharmacological intervention or simply cannot use medications for other reasons. As such, there has been a growing need for nonmedication approaches to treatment. The purpose of this study was to examine the use of auditory-visual EEG entrainment (AVE) at a 14 Hz (beta) frequency to decrease symptoms of depression with corresponding changes in neurophysiology.

Method. Sixteen participants ranged in age from 20 to 67 years and were screened utilizing the Beck Depression Inventory–II (BDI–II) and broken into two groups of 8 (simulated, AVE treatment groups), with a cross-over design. Both groups were given the BDI–II and QEEG testing at baseline, 4 weeks following either AVE or simulated treatment, and then again after an additional 4 weeks and a switch in treatment in the cross-over design.

Results. Results revealed significant reduction of depression only after the 4 weeks on AVE therapy of the BDI–II scores (p > .01). QEEG scores adjusted for normal age deviations demonstrate significant EEG change scores over time in cortical regions associated with mood regulation.

Conclusion. The findings indicate that AVE therapy may be a viable nonmedication therapeutic intervention.     

Personality features, caring burden and mental health of cohabitants of partners with chronic obstructive pulmonary disease or dementia

Objectives: The interplay between personality, mental health and type of disease in explaining caring burden was studied in home-dwelling cohabitants of partners with chronic obstructive pulmonary disease (COPD) or dementia.

Methods: A cross-sectional study including 206 participants with 80% response rate. Neuroticism was assessed by Eysenck Personality Questionnaire (EPQ) and externality by Locus of Control of Behaviour. The Relative Stress Scale evaluated caring burden. Mental health was determined by the General Health Quality (GHQ-28) questionnaire.

Results: Neuroticism and type of illness played a major role in explaining caring burden and mental health. In the COPD and dementia groups, 30.5% and 58.4%, respectively, were above the cut-off point for psychiatric caseness on the GHQ. Both groups had low scores for depression and high scores for social dysfunction, anxiety, insomnia and somatisation. Compared to the dementia group, the COPD group had lower scores and fairly stable levels on all subscales of the GHQ. Females had higher scores on somatic symptoms, anxiety and insomnia; they also reported higher scores on neuroticism and externality.

Conclusion: Differences in personality and illness explained both caring burden and mental health among caregivers. To mitigate the caring burden and mental health problems among home-dwelling caregivers, public health services need to take into account the personality and gender of the caregiver, and also the disease of the ill partner.     

性激素、催乳素与产后抑郁的相关研究

目的：本研究主要探讨产后雌二醇（Ｅ２）、催乳素（ＰＲＬ）变化和产后抑郁症状间的关系。方法：对３８名产妇在产程开始前和产后第７２小时分别抽取血标本,使用放射免疫法检测产后Ｅ２、Ｐ和ＰＲＬ的数量变化,同时用Ｅｄｉｎｇｂｕｒｇｈ产后抑郁量表（ＥＰＤＳ）、Ｂｅｓｋ抑郁量表（ＢＤＩ）、一般健康问卷（ＧＨＱ）对产妇在产后第３天和产后第４２天进行评定。结果：产后第３天ＥＰＤＳ和ＢＤＩ量表分值显著高于产后第４２天,产后Ｅ２变化与ＥＰＤＳ、ＢＤＩ量表分呈显著负相关,产后Ｐ变化和产后第４２天ＧＨＱ量表分呈显著正相关,ＰＲＬ变化和产后情绪状况无明显关系。结论：产后内分泌激素变化可能是产后抑郁的病因之一。     

Gender differences in self-reported minor mental disorder and its association with suicide. A 20-year follow-up of the Renfrew and Paisley cohort

BACKGROUND: Suicide rates are around three times higher in men than women; in contrast women have a higher prevalence of community-diagnosed depression. To investigate this paradox we examined the association of General Health Questionnaire (GHQ)-caseness (score > or = 4), a measure of possible minor mental disorder, with suicide risk in a general population cohort. METHODS: Data were derived from a cohort study based on the 8,466 men and women in the Renfrew and Paisley cohort who completed a 30-item GHQ in the period from 1972 to 1976 and who were followed up to 1995 for all-cause and suicide mortality. RESULTS: The long-term suicide risk associated with possible minor mental disorder was higher in men [hazard ratio 6.78 (1.36-33.71)] than women [hazard ratio 1.66 (0.43-6.45)]; test for interaction between gender and GHQ with respect to suicide risk: p = 0.09. CONCLUSION: These findings indicate either that the long-term risk of suicide in the context of a past episode of minor mental disorder is higher in males than females or that there are sex differences in the validity of responses to mental health screening questionnaires. Further research is required to replicate our finding in larger studies and, if confirmed, clarify which explanation underlies it.     

Unemployment and mental wellbeing: a factory closure study in Finland

The mental wellbeing of the entire personnel (n= 211) of a wood-processing factory located in Hämeenlinna, Finland was studied by mailing a questionnaire to the subjects 6 months after the factory was closed down. The entire personnel (n= 305) of a similar wood-processing factory acted as a control group. Mental wellbeing was measured by means of the 12-item General Health Questionnaire (GHQ score), the 13-item Beck Depression Inventory (BDI score), and the 13-item questionnaire assessing psychosomatic symptoms. Seventy-nine per cent of the study group and 65% of the control group returned the questionnaire. The two groups were similar sociodemographically. Mental wellbeing was poorer in the men of the study group than in the controls. No such difference was detected in women. Mental wellbeing was poorer in all age groups in the study group, especially in married men, than in the controls. The impaired mental wellbeing in the men in the study group was associated with insufficient social support, subjectively poor health, low income and uncertainty about the future. Based on a discriminant analysis, the two groups differed most in terms of GHQ score, income, sex and BDI score.     

Outcomes of critical time intervention case management of homeless veterans after psychiatric hospitalization

OBJECTIVE: This study evaluated a modification of the critical time intervention (CTI) community case management model for homeless veterans with mental illness who were leaving Department of Veterans Affairs (VA) inpatient care. CTI offers time-limited intensive case management designed to negotiate transitions from institutional settings to community living. METHODS: CTI was implemented at eight VA medical centers through a training program that used primarily teleconference-based case review. A comparison cohort (phase 1) of 278 participants was recruited before CTI was implemented, and a treatment cohort (phase 2) of 206 participants was recruited after implementation and offered CTI. Mixed-regression models were used to compare outcomes in phase 1 and phase 2 and controlled for baseline differences between participants in the two phases. RESULTS: Measures of client service delivery show that CTI was successfully implemented at most sites. Phase 1 veterans had a better work history and more drug use at baseline than phase 2 clients had. Controlling for these differences, veterans in phase 2 on average had 19% more days housed in each 90-day reporting period over the one-year follow-up (p<.002) and 14% fewer days in institutional settings (p=.041). Veterans in phase 2 also had 19% lower Addiction Severity Index (ASI) alcohol use scores (p<.001), 14% lower ASI drug use scores (p=.003), and 8% lower ASI psychiatric problem scores (p=.001). CONCLUSIONS: A sustained training program can be used to implement CTI in systems that have little past experience with this approach and can yield improved housing and mental health outcomes.     

Support in the community for people with dementia and their carers: a comparative outcome study of specialist mental health service interventions

BACKGROUND: This study aimed to evaluate outcomes for carers receiving the Admiral Nurse Service, a specialist mental health nursing service for carers of people with dementia. In contrast to many community mental health teams, it works primarily with the caregiver, focuses exclusively on dementia and offers continuing involvement, throughout the caregiving career, including emotional support, provision of information and coordination of practical support. METHOD: 104 carers of people with dementia who were interviewed as soon as possible after being referred to a number of Admiral Nurse (AN) services or conventional services in neighbouring areas, and who were re-interviewed eight months later, form the sample (43 AN; 61 comparison). RESULTS: There were no significant differences between groups, controlling for initial score, on the primary outcome measure at follow-up, the 28-item General Health Questionnaire (GHQ) or its sub-scales, apart from anxiety and insomnia, where outcome was better for the AN group (p = 0.038). Follow-up GHQ scores were associated with ratings of past and current relationship quality. There were no differences in survival in the community between the groups. CONCLUSION: Both conventional and AN services are associated with lower distress scores over an eight-month period. Outcome for people with dementia (in terms of institutional placement) is no worse in the AN group, despite the carer focus. Some support is provided for a model of dementia-specialist service which engages with the caregiver and continues involvement for as long as is required, rather than simply carrying out an assessment and referring the person back to social services or primary care.     

A prospective study of childhood psychopathology: independent predictors of change over three years

BACKGROUND: Whilst the correlates of child mental health problems are well understood, less is known about factors that operate to maintain healthy or unhealthy functioning, or that contribute to change in functioning. A range of factors may be of interest here, including relatively stable characteristics of children or their environment, that may have long-lasting and enduring consequences for their mental health, along with events that prompt changes in a child's mental state. METHODS: Children were followed up 3 years after the original survey for a sub-sample of the 1999 British Child and Adolescent Mental Health Survey (N = 2,587 children). Latent mental health ratings drew on data provided by parent, teacher, and youth versions of the Strengths and Difficulties Questionnaire at baseline, and at follow-up. A residual scores method was used to assess change in functioning over time. RESULTS AND CONCLUSIONS: Latent mental health scores showed strong stability over time (r = 0.71) indicating the need for effective intervention with children who have impairing psychopathology, since they are unlikely to get better spontaneously. A poorer outcome was associated with: externalizing as opposed to emotional symptoms, reading difficulties; living in a single-parent or reconstituted family at baseline; and after exposure between Time 1 and Time 2 to parental separation, parental mental illness, child illness, and loss of a close friendship. All these factors could be targeted in public health or clinical interventions, particularly as predictors of change in child mental health were closely comparable across the range of initial SDQ scores, suggesting that they operated in a similar manner regardless of the initial level of (mal)adjustment.     

Effects on parental mental health of an education and skills training program for parents of young children with autism: a randomized controlled trial

OBJECTIVE: To determine the impact of a parent education and behavior management intervention (PEBM) on the mental health and adjustment of parents with preschool children with autism. METHOD: A randomized, group-comparison design involving a parent education and counseling intervention to control for nonspecific therapist effects and a control sample was used. Two metropolitan and two rural regions were randomly allocated to intervention groups (n = 70) or control (n = 35). The parents of consecutive children with autism (2(1/2)-5 years old) from the autism assessment services for the intervention regions were then randomly allocated to either a 20-week manual-based parent education and behavior management intervention (n = 35) or a manual-based parent education and counseling intervention (n = 35). The main outcome measure of parental mental health was the General Health Questionnaire used pre- and postintervention and at 6-month follow-up. RESULTS: Both treatments resulted in significant and progressive improvement in overall mental health at follow-up (F = 2, 97, p =.007) and mental health significantly improved over time in the 54% of principal caregivers who had the highest levels of mental health problems. The parent education and behavior management intervention was effective in alleviating a greater percentage of anxiety, insomnia, and somatic symptoms and family dysfunction than parent education and counseling at 6-month follow-up. CONCLUSIONS: A 20-week parent education and skills training program for parents of young children newly diagnosed with autism provides significant improvements in parental mental health and adjustment, justifying its addition to early intervention programs at least for parents with mental health problems.     

The California active aging community grant program: Translating science Into practice to promote physical activity in older adults

Background: Attempts to study the translation of evidence-based physical activity interventions in community settings are scarce.Purpose: This project was an investigation of whether 13 diverse local lead agencies could effectively implement a choice-based, telephone-assisted physical activity promotion program for older adults based on intervention models proven efficacious in research settings.Methods: At baseline, participants developed their own physical activity programs through an individualized planning session based on preference, health status, readiness to change, and available community resources. Thereafter, participants received regular telephone calls over a 1-year period from a trained staff member or volunteer support buddy. Additional program components consisted of health education workshops, newsletters, and group-based physical activities. Self-report data on caloric expenditure due to all and moderate or greater intensity physical activities were collected from 447 participants (M age = 68 ± 8.6 years).Results: A significant increase (p ≤ .0001) from baseline to midintervention and intervention endpoint was observed for total weekly caloric expenditure (Mdn change = 644–707 kcal/week) and moderate or greater weekly caloric expenditure (Mdn change = 149–265 kcal/week), as well as for weekly physical activity duration and frequency. These changes were observed in participants across all sites.Conclusions: The increases in weekly caloric expenditure were commensurate with findings from several previous randomized clinical trials. The utilization of community agency staff and volunteers receiving basic training to implement essential program components proved feasible. Very favorable levels of program satisfaction expressed by community staff, volunteer support buddies, and participants, combined with the significant increases in physical activity, warrant further dissemination of the intervention model. This project was supported by the Preventive Health and Health Services Block Grant from the Centers for Disease Control and Prevention, and the American Federation for Aging Research. We thank all of the local program staff and participants for their time and effort.     

Concordance between Composite International Diagnostic Interview and self‐reports of depressive symptoms: a re‐analysis

Concordance between sum scores of self‐reported depressive symptoms and structured interview diagnoses has been studied extensively, but are these the best attainable self‐report‐based predictions for interview diagnoses? We maximized the cross‐validated concordance between World Health Organization's Composite International Diagnostic Interview (CIDI) diagnosis and Beck's Depression Inventory (BDI), and General Health Questionnaire (GHQ), from the viewpoint of exploratory statistics, re‐analysing Health 2000 general‐population sample of adults over 30 years in mainland Finland (N = 5200–5435). BDI sum‐score prediction of CIDI diagnosis could be superseded by using (1) weighted sums of items, (2) classification trees constructed from items, or (3) a single item. Best solution (2) yielded cross‐validated Youden's Index 0.757 [standard error (SE) = 0.001, sensitivity = 0.907, specificity = 0.851], improving the concordance to 1.07‐fold (1.18‐fold for 12‐month diagnosis). A single‐item solution was best for the GHQ. All positive predictive values remained low (0.09–0.31). Thus, CIDI‐to‐questionnaire concordance can be improved by using all information in the questionnaires instead of just sum scores, but latent‐trait theory for questionnaires is incompatible with interview diagnoses (single item achieved better concordance than summing all). Self‐reports have low predictive value for CIDI diagnoses in the general population, but better in settings with higher major depressive disorder (MDD) base rates. Copyright © 2015 John Wiley & Sons, Ltd.     

The Student Check-Up: effects of paraprofessional-delivered Motivational Interviewing on academic outcomes

Paraprofessionals and school volunteers increase the number of youth who receive academic and mental health interventions by providing services that were traditionally reserved for professional staff. However, the promise of these low-cost, high-volume non-professional services is tempered by the lack of experimental evidence documenting their effectiveness. In this study, we trained non-professionals to provide a brief school-based Motivational Interviewing (MI) intervention called the Student Check-Up (SCU) to middle school-students. In contrast with previous studies, we found no significant differences between treatment and control groups in post-treatment academic grades. However, following the SCU, participants randomly assigned to the treatment group rated the importance of in-class participation and academic effort self-efficacy significantly higher than those in the control group. Based on these results, we provide recommendations for improving the effectiveness of paraprofessionals’ use of the SCU and for improving future research methodology in this area.     

Self-rated quality of life measures: Effect of change to a low-fat, high-fiber, fruit and vegetable enriched diet

The Polyp Prevention Trial (PPT) was a multicenter, randomized clinical trial to determine the effect of a low-fat (20% of energy from fat), high-fiber (18 g/1000 kcal/day), high-fruit/vegetable (3.5 servings/1000 kcal/day) eating plan on the recurrence of large bowel adenomatous polyps. The PPT provided an opportunity to examine the impact of dietary changes on quality of life. At baseline and annually for 4 years, participants in the Quality of Life Substudy of PPT completed a Quality of Life Factors (QF) Questionnaire, a modified Block-National Cancer Institute Food Frequency Questionnaire, and a Health and Lifestyle Questionnaire. The 51-item QF Questionnaire assessed changes in nine domains: taste, convenience, cost, self-care, social, health assessment, health belief, health action, and life satisfaction. The analysis compared annual changes in domain scores for intervention (n = 194) and control (n = 200) participants. At Year 1, 363 (92%) completed a questionnaire, and 325 (82%) participants completed a Year 4 questionnaire. There were no statistically significant differences between treatment groups in the change from baseline to Year 1 for the convenience, cost, taste, health assessment, and life satisfaction domains. At Year 1, intervention participants rated the self-care (p < .001), health belief (p = .021), and health action (p < .001) domains significantly higher and the social domain significantly lower (p < .001) than control participants. These changes were consistent through Years 2, 3, and 4. This study National Cancer Institute Contract No. 2SC05221.     

Caregivers' relationship closeness with the person with dementia predicts both positive and negative outcomes for caregivers' physical health and psychological well-being

Closer relationships between caregivers and care recipients with dementia are associated with positive outcomes for care recipients, but it is unclear if closeness is a risk or protective factor for the health and psychological wellbeing of caregivers. We examined 234 care dyads from the population-based Cache County Dementia Progression Study. Caregivers included spouses (49%) and adult offspring (51%). Care recipients mostly had dementia of the Alzheimer’s type (62%). Linear mixed models tested associations between relationship closeness at baseline or changes in closeness prior to versus after dementia onset, with baseline levels and changes over time in caregiver affect (Affect Balance Scale, ABS), depression (Beck Depression Inventory, BDI), and mental and physical health (components of the Short-Form Health Survey, SF-12). After controlling for demographic characteristics of the caregiver, number of caregiver health conditions, and characteristics of the care recipient (type of dementia, functional ability, and behavioral disturbances), we found that higher baseline closeness predicted higher baseline SF-12 mental health scores (better mental health) and lower depression. Higher baseline closeness also predicted greater worsening over time in ABS and SF-12 mental health. In addition, caregivers who reported a loss of closeness in their relationship with the care recipient from pre- to post-dementia displayed improved scores on ABS and SF-12 mental health, but worse SF-12 physical health over the course of the study. These results suggest that closeness and loss of closeness in the care dyad may be associated with both positive and adverse outcomes for caregivers, both cross-sectionally and over time.     

A randomised controlled trial of an educational intervention for depression among Asian women in primary care in the United Kingdom

OBJECTIVE: To determine the effect of patient education on patient perspectives and outcome of depression in a sample of Asian women in primary care. DESIGN: A randomised, clinical trial of "patient education" versus "usual care". SETTING: A general practice in London, which has a high proportion of Asians. SUBJECTS: Seventy patients with psychiatric morbidity (a score of 3 or more on the General Health Questionnaire 12) were recruited for the trial. OUTCOME MEASURES: Patient's explanatory models of illness (the patient's perspective on depression; recognition of depression as illness and recommend a medical intervention for this condition) and psychiatric morbidity at follow-up after two months were the primary outcome measures. RESULTS: One hundred and fifty-five women of Asian decent were contacted. One hundred and forty-eight (95.5%) agreed to take part in the study. Seventy (47.3%) were classed as cases of common mental disorder using the General Health Questionnaire 12. Thirty-five were randomly allocated to receive education about the nature, causes, prevalence and treatment of depression, 35 did not receive such information. There were no statistical differences between the two groups on baseline characteristics. Sixty-six (94.3%) subjects were followed up at two months. An intention to treat analysis showed that there was no difference in explanatory model measures between the two groups at the end of the study. However, more patients who received education were no longer cases (a score of 2 or less on the GHQ) (15/35; 42.9%) compared to controls (7/35; 20%) (p < 0.05) as did those with lower GHQ scores at entry (p < 0.03). Receipt of educational intervention (OR 3.4; 95% CI 1.01, 11.5) and lower GHQ scores at entry (OR 7.1; 95% CI 1.05, 30.2) remained significantly associated with recovery after adjusting for baseline variables using logistic regression. CONCLUSIONS: Patients with common mental disorders, especially those with milder forms of the condition, who received the educational material had a higher recovery rate than patients who do not receive such education. The mechanism for this improvement was unclear, not being reflected in patient's apparent understanding of depression nor explained by change in general practitioner's response. The results of this study need to be replicated.     

Factors associated with dysmorphic concern and psychiatric morbidity in plastic surgery outpatients

OBJECTIVES: To compare new referrals to a plastic surgery clinic for cosmetic (non-medically explained) reasons with a control group of equal size with medically explained symptoms. METHOD: Patients attending for cosmetic (non-medically explained) reasons were compared with the controls using the general health questionnaire (GHQ), and dysmorphic concern questionnaire (DCQ). Patients were divided into high and low DCQ scores on the basis of their median scores. RESULTS: Ninety subjects were approached of whom 84 (93%) participated giving 42 patients each in the cosmetic (non-medically explained) and control groups. Forty-four per cent were referred for mammoplasty (n = 37) and 8% for rhinoplasty (n = 7). The other 40 cases (48%) were for other procedures including excision, abdominoplasty and blepharoplasty. Thirty-two per cent of the sample were GHQ cases (n = 27). Patients presenting for cosmetic (non-medically explained) reasons were 13 times more likely to be female (95% CI = 4.3-41), nine times more likely to have high DCQ scores (95% CI = 3.3-24), six times more likely to be GHQ cases (95% CI = 2.1-17), and seven times more likely to present for mammoplasty. The same factors were associated with high DCQ scores. Patients with high DCQ scores were 32 times as likely to be GHQ cases (95% CI = 6.8-151). On multivariate analysis, dysmorphic concern emerged as the only independent predictor of GHQ caseness rather than sex, surgical diagnosis or procedure (adjusted OR = 32.0, 95 % CI = 6.5-156). Similarly, only GHQ caseness and presentation for cosmetic (non-medically explained) surgery independently predicted DCQ score. CONCLUSIONS: Patients presenting for cosmetic (non-medically explained) surgery have high rates of dysmorphic concern and psychiatric morbidity