The Impact of a Clinical Audit on GP Detection of Depression

2003 ◽  
Vol 9 (1) ◽  
pp. 88
Author(s):  
Patrick G. Bolton ◽  
Sharon M. Parker ◽  
Kylie J. Fergusson ◽  
Jannifer D. Orman
Keyword(s):  
General Practitioner ◽  
General Practitioners ◽  
Rating Scale ◽  
Treatment Guidelines ◽  
Clinical Audit ◽  
Depression Scale ◽  
Self Report ◽  
Comprehensive Treatment ◽  
The Impact ◽  
Educational Workshop

Objective: To determine if a clinical audit and linked educational workshop would improve the ability of general practitioners to accurately detect depression. Design: Pre- and post-data collection over a six-month period (two eight-week collection periods), associated educational workshop, and comprehensive treatment guidelines. Setting: General Practice in the Central Sydney Area. Study participants: A total of 1106 patients (592 pre-, 514 post-collection) from six general practices. Patients were required to be 18-65yrs and willing and able to complete a self-administered depression rating scale. Main Outcome Measures: General practitioner rating of consecutive patients using a tick box scale matched to patients' self-report on the Hospital Anxiety and Depression Scale. Comparison of patients' scores on the two sub-scales of the Scale (depression and anxiety) and the reason for presentation rated by the general practitioner. Results: The mean age of participants was 35 years for audit one and 33 years for audit two with substantially more females participating (73.6% and 68.1%) as opposed to males (26.4% and 31.9%). The presence of psychological problems as identified by the HADS was higher than that reported in the literature and actually decreased from 65.9% in audit one to 59.7% in audit two. There were non-significant increases in the rate at which participating general practitioners detected depression with the proportion of "true negatives" increasing between the audits and the proportion of "false negatives" decreasing. No change occurred in either the true or false positive rates. Conclusions: Within this study, the audit, feedback and educational workshop in combination achieved poor results. This, and the prevalence of depression in the population, suggests further research is warranted to determine an effective method of educating general practitioners to detect depression.

Longitudinal Trends in Quality of Life and Physical Function in Frail Older Dialysis Patients: A Comparison of Assisted Peritoneal Dialysis and In-Center Hemodialysis

2019 ◽  
Vol 39 (2) ◽  
pp. 112-118 ◽  
Author(s):  
Osasuyi Iyasere ◽  
Edwina Brown ◽  
Fabiana Gordon ◽  
Helen Collinson ◽  
Richard Fielding ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Peritoneal Dialysis ◽  
Mixed Model ◽  
Rating Scale ◽  
Depression Scale ◽  
Dialysis Patients ◽  
The Impact ◽  
Assisted Peritoneal Dialysis

Background In-center hemodialysis (HD) has been the standard treatment for older dialysis patients, but reports suggest an associated decline in physical and cognitive function. Cross-sectional data suggest that assisted peritoneal dialysis (aPD), an alternative treatment, is associated with quality of life (QoL) outcomes that are comparable to in-center HD. We compared longitudinal changes in QoL between modalities. Methods We enrolled 106 aPD patients, matched with 100 HD patients from 20 renal centers in England and Northern Ireland. Patients were assessed quarterly for 2 years using the Hospital Anxiety and Depression Scale (HADS), SF-12 physical and mental scores, symptom score, Illness Intrusiveness Rating Scale (IIRS), Barthel's score, and the Renal Treatment Satisfaction Questionnaire (RTSQ). Mixed model analysis was used to assess the impact of dialysis modality on these outcomes during follow-up. P values were adjusted for multiple significance testing. Results Multivariate analysis showed no difference in any of the outcome measures between aPD and HD. Longitudinal trends in outcomes were also not significantly different. Higher age at baseline was associated with lower IIRS and RTSQ scores during follow-up. One-hundred and twenty-five (60.6%) patients dropped out of the study: 59 (28.6%) died, 61 (29.6%) withdrew during follow-up, and 5 (2.5%) were transplanted. Conclusions Quality of life outcomes in frail older aPD patients were equivalent to those receiving in-center HD. Assisted PD is thus a valid alternative to HD for older people with end-stage kidney disease (ESKD) wishing to dialyze at home.

scholarly journals Relationship between parenting styles and depression in adolescents

2019 ◽  
Vol 28 (1) ◽  
pp. 49-59
Author(s):  
Sanchary Prativa ◽  
Farah Deeba
Keyword(s):  
Parenting Style ◽  
Parenting Styles ◽  
Rating Scale ◽  
Depression Scale ◽  
Self Report ◽  
Child Rearing ◽  
Anxiety And Depression ◽  
The Family ◽  
Authoritative Parenting Style ◽  
The Relationship

This study aimed at examining the relationship between parenting styles and depression in adolescents. Convenient sampling was used to collect 100 adolescents (Mean age = 15.25 years, Sd = 0.90) from two colleges of Dhaka city, Bangladesh. Parental Attitude Questionnaire (PAQ) was used to measure parenting styles and two other self-report measures, Hospital Anxiety and Depression Scale (HADS) and Short Mood and Feelings Questionnaire (SMFQ) were used to assess depression in adolescents. From multiple regression analysis significant relationship was found between parenting style and adolescents’ depression measured by one self-rating scale. The overall regression model for investigating the relationship between parenting style and depression in adolescent was significant with HADS, (F = 3.77, p = 0.007) but not significant with SMFQ scores (F = 0.880, p = 0.454). For the dependent variable of depression measured by HADS, the strongest predictors were authoritative parenting style (β = –0.28, p = 0.03) and monthly income of the family which is also significant (β = 0.25, p = 0.01). Implications of the findings for child rearing and research are discussed. Dhaka Univ. J. Biol. Sci. 28(1): 49-59, 2019 (January)

Primary headache and migraine in headache specialists – does personal history of doctors matter?

Cephalalgia ◽  
2019 ◽  
Vol 40 (1) ◽  
pp. 96-106 ◽  
Author(s):  
Stefan Evers ◽  
Nicole Brockmann ◽  
Oliver Summ ◽  
Ingo W Husstedt ◽  
Achim Frese
Keyword(s):  
Cluster Headache ◽  
General Practitioners ◽  
Primary Headache ◽  
Treatment Recommendations ◽  
Personal History ◽  
Self Report ◽  
Primary Headache Disorders ◽  
History Of ◽  
The Impact ◽  
Age And Sex

Objective Migraine is a common disorder affecting more than 10% of the population. The prevalence of migraine among physicians and, in particular, among headache specialists is widely unknown as is the impact of suffering from migraine on the attitudes towards migraine and on treatment recommendations of physicians. We designed a survey among headache specialists and neurologists and compared the results to general pain specialists and general practitioners. Methods A standardized interview in randomly selected samples of these four groups of physicians was performed. The interview included data on the prevalence of migraine and other primary headache disorders in the physician groups, self-report on their own treatment, attitudes towards migraine, and treatment recommendations for migraine. The prevalence rates were also compared to an age- and sex-matched German general population sample. Results The lifetime prevalence of migraine was higher in headache specialists (53.0%) than in general neurologists (43.0%), pain specialists (21.7%), general practitioners (19.3%), and in the general age- and sex-matched population (16.8%). Cluster headache prevalence was high in neurologists (1.9%) and in headache specialists (1.3%); episodic tension-type headache prevalence was significantly lower in general practitioners (19.5%). One reason, among others, was that being a migraine (or cluster headache) patient more often prompted the sufferers to become a specialist in neurology. Physicians with migraine rated the biopsychosocial concept of lower importance for migraine than did physicians without migraine. The self-treatment of migraine in physicians differs from the treatment recommendations to the patients. For example, only 36.4% of the headache specialists with migraine take triptans whereas 94.4% recommend triptans to their patients. Conclusions We conclude that being a headache specialist or a neurologist is associated with an increased migraine or cluster headache prevalence. This personal history of migraine leads to a more somatic view of migraine as a disorder and to different treatment recommendations as compared to self-treatment.

scholarly journals Depressive Symptoms, Pain, and Quality of Life among Patients with Nonalcohol-Related Chronic Pancreatitis

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Wendy E. Balliet ◽  
Shenelle Edwards-Hampton ◽  
Jeffery J. Borckardt ◽  
Katherine Morgan ◽  
David Adams ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pancreatitis ◽  
Depressive Symptoms ◽  
Rating Scale ◽  
Depression Scale ◽  
Self Report ◽  
Cross Sectional ◽  
Depressive Symptomology ◽  
The Mean

Objective. The present study was conducted to determine if depressive symptoms were associated with variability in pain perception and quality of life among patients with nonalcohol-related chronic pancreatitis. Methods. The research design was cross-sectional, and self-report data was collected from 692 patients with nonalcohol-related, intractable pancreatitis. The mean age of the sample was 52.6 (); 41% of the sample were male. Participants completed the MOS SF12 Quality of Life Measure, the Center for Epidemiological Studies 10-item Depression Scale (CESD), and a numeric rating scale measure of “pain on average” from the Brief Pain Inventory. Results. Depressive symptoms were significantly related to participants’ reports of increased pain and decreased quality of life. The mean CESD score of the sample was 10.6 () and 52% of the sample scored above the clinical cutoff for the presence of significant depressive symptomology. Patients scoring above the clinical cutoff on the depression screening measure rated their pain as significantly higher than those below the cutoff () and had significantly lower physical quality of life () and lower mental quality of life (). Conclusion. Although causality cannot be determined based on cross-sectional, correlational data, findings suggest that among patients with nonalcoholic pancreatitis, the presence of depressive symptoms is common and may be a risk factor associated with increased pain and decreased quality of life. Thus, routine screening for depressive symptomology among patients with nonalcoholic pancreatitis may be warranted.

Association among Items from the Self-Report Version of the Hamilton Depression Scale (Carroll Rating Scale) and Respondents' Sex

2007 ◽  
Vol 101 (1) ◽  
pp. 291-301 ◽  
Author(s):  
Ana Luiza Camozzato ◽  
Maria Paz Hidalgo ◽  
Sônia Souza ◽  
Márcia L. F. Chaves
Keyword(s):  
Sex Differences ◽  
Regression Analysis ◽  
General Population ◽  
Rating Scale ◽  
Depression Scale ◽  
The Self ◽  
Self Report ◽  
Sex Bias ◽  
Hamilton Depression Scale ◽  
Nonclinical Sample

The association among items of the self-reported version of the Hamilton Depression Scale (Carroll Rating Scale), answered according to a memory of a maximally disturbing event experienced, and respondents' sex was examined in a nonclinical sample of 320 college students, 164 women ( M age = 21.7 yr., SD = 3.6) and 156 men ( M age = 23.5 yr., SD = 5.8). An assessment of sex bias was also evaluated. Multiple regression analysis showed that statements regarding unhappiness, urge to cry, dizziness and faintness, and waking in the middle of the night were significantly associated with women. Removal of these items from the Carroll Rating Scale Total scores eliminated the sex differences in depression rates. Items that displayed significant sex bias were those regarding behavior and emotions commonly attributed to women within the general population.

scholarly journals The Cornish experience of the ASSIST-CKD project

2017 ◽  
Vol 55 (1) ◽  
pp. 100-106 ◽  
Author(s):  
Anna L Barton ◽  
Angela S Mallard ◽  
Anthea Patterson ◽  
Nicola Thomas ◽  
Stephen Dickinson ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
General Practitioner ◽  
Glomerular Filtration ◽  
General Practitioners ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Number Of Patients ◽  
National Quality ◽  
Improvement Programme ◽  
The Impact

Introduction The ASSIST-CKD project is a national quality improvement programme, aiming to decrease the number of patients presenting late to renal services by enabling laboratories to review up to five years of estimated glomerular filtration rate results graphically and report deteriorating patients to their general practitioner. Aim To assess the impact of the project on the laboratory, and of patient reporting on general practitioner management and the local renal service. Method Each week two searches were performed (Search A: maximum age 65 years, maximum eGFR 50 ml/min/1.73 m2 and Search B: Age 66–120 years, maximum eGFR 40 ml/min/1.73 m2) on patients with an estimated glomerular filtration rate requested by their general practitioner within the previous seven days. Patients showing deterioration in estimated glomerular filtration rate had a printed graph sent to their general practitioner. Feedback on the graphs and their impact on patient management were obtained from the general practitioners via a questionnaire. Results A median of 37 patients/week were listed for review for Search A, with 32% reported; and Search B a median of 227 patients/week listed, 32% reported. General practitioner surgery questionnaires (29) showed the reports were well received. Of general practitioners responding to the questionnaire, 67% had reviewed a patient earlier than intended, 54% had reviewed local guidance, 48% had emailed the renal team and 48% had referred a patient on receipt of a graph; 34% had shown a graph to their patients, of whom 70% found that useful. Conclusion There is some evidence that ASSIST-CKD reporting has enhanced patient care; however, further long-term assessment is still required.

scholarly journals The impact of subjective well-being under neuroleptic treatment on compliance and remission

2006 ◽  
Vol 8 (1) ◽  
pp. 131-136 ◽  
Keyword(s):  
Rating Scale ◽  
Well Being ◽  
Self Report ◽  
Systematic Evaluation ◽  
Antipsychotic Treatment ◽  
Strong Impact ◽  
Subjective Well Being ◽  
Schizophrenic Patients ◽  
Long Term Prognosis ◽  
The Impact

The patients' perspective of antipsychotic treatment was largely neglected for a long period. It has only been during the last 10 years, with the development of atypical antipsychotics, that scientific interest in this issue has markedly increased. Numerous studies have shown that the majority of schizophrenic patients are able to fill out a self-rating scale in a meaningful way, and several self-report scales with sufficient internal consistency and good construct validity have been developed. The effects of antipsychotic treatment on psychopathology and on subjective well-being (SW) are not strongly related; the perspectives of the patient and his/her psychiatrist markedly differ. Recent research indicates that SW/quality of life, much more improved by atypical than by typical antipsychotics, has a strong impact on compliance, as well as on the chance of achieving remission. The data strongly suggest that a systematic evaluation of the patient's perspective of antipsychotic treatment is meaningful and necessary to increase compliance, functional outcome, and long-term prognosis.

Psychiatric Assessment of Anxiety and Depression in Medical Patient

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
D. Telles-Correia ◽  
A. Barbosa ◽  
I. Mega
Keyword(s):  
Learned Helplessness ◽  
Rating Scale ◽  
Depression Scale ◽  
Medical Patient ◽  
Theoretical Models ◽  
Self Report ◽  
Anxiety And Depression ◽  
Medical Illness ◽  
Hamilton Depression Scale ◽  
Depression And Anxiety

Anxiety and depression are very common in patients with medical illness and can be associated to a reduction in quality of life and a poor clinical evolution.The actual concept of anxiety is based on many theoretical models as Goldstein's anxiety model, State/trate anxiety model, Lazarus' transactional stress model. The concept of depression is based on models such as Beck's Cognitive Model and Seligman's learned helplessness model of depression.The link between anxiety/depression and medical illness can be of two kinds: biological (immunological, neuroendocrine, inflammatory systems) and behavioural (coping strategies, adherence to medical advice and prescription, etc).A dimensional approach should be used to access anxiety and depression in medical once the thresholds of depression and anxiety that are associated with medical outcomes are not known.Both self report and rating scale/interview measurements have certain advantages as well as certain inherent disadvantages. Neither approach is universally better than other.Some of the most used instruments are Hamilton Anxiety Scale (HAM), Hamilton Depression Scale (HDS), Montgomery and Asberg Depression Rating Scale (MADRS), Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), and State Trait Anxiety Inventory (STAI).The only scale validated exclusively to access depression and anxiety in medical population, and that can overcome the influence that medical disease has in depression and anxiety is HADS.

Comparative Incidence of Depression in Women and Men, During Pregnancy and after Childbirth

1996 ◽  
Vol 169 (1) ◽  
pp. 30-35 ◽  
Author(s):  
M. E. G. Areias ◽  
R. Kumar ◽  
H. Barros ◽  
E. Figueiredo
Keyword(s):  
Mental Health ◽  
Edinburgh Postnatal Depression Scale ◽  
Rating Scale ◽  
Depression Scale ◽  
Emotional Reactions ◽  
Mothers And Fathers ◽  
Valid Instrument ◽  
Obstetric Services ◽  
The Impact ◽  
First Time

BackgroundComparing women's and men's emotional reactions to childbirth can clarify the impact on mental health of childbirth as a life event.MethodFifty-four first-time mothers attending obstetric services in Oporto, Portugal, and 42 of their husbands or partners participated in a longitudinal study of their mental health. All subjects were given a semi-structured clinical interview (SADS) at 6 months antenatally and at 12 months postnatally and sub-samples were interviewed at 3 months postnatally. At all these times all the mothers and fathers also completed a translated version of a self-rating scale for depression, the Edinburgh Postnatal Depression Scale (EPDS).ResultsMore women than men had past histories of depression but their rates of depression did not differ significantly during pregnancy. In the first 3 months postnatally, nearly a quarter of the women ‘at risk’ were found to have become depressed (major, minor and intermittent) in contrast with less than 5% of the men. In the next nine months men were more prone to become depressed than previously and their conditions tended to follow an earlier onset of depression in their spouses.ConclusionComparisons of EPDS and SADS ratings showed that the translated EPDS was a valid instrument for women but it was less satisfactory when applied to men.

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