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"Gilbody, Simon M"
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Depression in primary care : evidence and practice
\"Although depression is a major cause of illness and disability, the quality of care offered is often poor. Research evidence demonstrating how the quality of primary care can be improved is dispersed in different academic journals and written in technical jargon. Depression in Primary Care: Evidence and Practice summarizes this research in a clear and useable format. This collection of high quality reviews of research evidence takes the form of a series of clinical and economic evaluations. Each provides a clear summary of the best evidence from trials and an accessible 'how to do it' guide, written by international experts. Global approaches towards the organization and delivery of primary care for depression are presented, from the UK, North America, Europe and the developing world. An important source of practical guidance about how to implement quality improvement programs in clinical practice, this book will assist practitioners, researchers and policy makers alike. - Combines clear evidence summaries with a simple and practical guide about how to implement quality improvement programmes in practice - Prepared by international experts and of interest and relevance in all countries and healthcare settings - Addresses a major healthcare priority identified by the World Health Organization, US Agency for Healthcare Research and UK National Institute for Clinical Excellence\"--Provided by publisher.
Book
Diagnostic accuracy of case-finding questions to identify perinatal depression
Guidelines for perinatal mental health care recommend the use of two case-finding questions about depressed feelings and loss of interest in activities, despite the absence of validation studies in this context. We examined the diagnostic accuracy of these questions and of a third question about the need for help asked of women receiving perinatal care.
We evaluated self-reported responses to two case-finding questions against an interviewer-assessed diagnostic standard (DSM-IV criteria for major depressive disorder) among 152 women receiving antenatal care at 26–28 weeks' gestation and postnatal care at 5–13 weeks after delivery. Among women who answered “yes” to either question, we assessed the usefulness of asking a third question about the need for help. We calculated sensitivity, specificity and likelihood ratios for the two case-finding questions and for the added question about the need for help.
Antenatally, the two case-finding questions had a sensitivity of 100% (95% confidence interval [CI] 77%–100%), a specificity of 68% (95% CI 58%–76%), a positive likelihood ratio of 3.03 (95% CI 2.28–4.02) and a negative likelihood ratio of 0.041 (95% CI 0.003–0.63) in identifying perinatal depression. Postnatal results were similar. Among the women who screened positive antenatally, the additional question about the need for help had a sensitivity of 58% (95% CI 38%–76%), a specificity of 91% (95% CI 78%–97%), a positive likelihood ratio of 6.86 (95% CI 2.16–21.7) and a negative likelihood ratio of 0.45 (95% CI 0.25–0.80), with lower sensitivity and higher specificity postnatally.
Negative responses to both of the case-finding questions showed acceptable accuracy for ruling out perinatal depression. For positive responses, the use of a third question about the need for help improved specificity and the ability to rule in depression.
Journal Article
Depression in Primary Care
Although depression is a major cause of illness and disability, the quality of care offered is often poor. Research evidence demonstrating how the quality of primary care can be improved is dispersed in different academic journals and written in technical jargon. Depression in Primary Care: Evidence and Practice summarizes this research in a clear and useable format. This collection of high quality reviews of research evidence takes the form of a series of clinical and economic evaluations. Each provides a clear summary of the best evidence from trials and an accessible 'how to do it' guide, written by international experts. Global approaches towards the organization and delivery of primary care for depression are presented, from the UK, North America, Europe and the developing world. An important source of practical guidance about how to implement quality improvement programs in clinical practice, this book will assist practitioners, researchers and policy makers alike.
eBook
Assessing the quality of diagnostic studies using psychometric instruments: applying QUADAS
Background
There has been an increase in the number of systematic reviews of diagnostic tests, which has resulted in the introduction of two checklists: statement for reporting of diagnostic accuracy (STARD) and quality assessment of diagnostic accuracy studies (QUADAS).
Objective
To examine the validity and usefulness of QUADAS when applied to diagnostic accuracy studies using psychometric instruments and to examine the quality in reporting of these studies during practical application of the checklist.
Method
Two reviewers independently rated the quality of 54 studies using QUADAS. The proportion of agreement was used to assess overall agreement and individual agreement of QUADAS items between reviewers.
Results
The overall agreement between the two reviewers for all QUADAS items combined was 85.7%. The proportion of agreement between reviewers for each item ranged from just over 57–100% and was over 80% for 8 of the items. The poorest agreement was associated with the items for selection criteria, indeterminate results and withdrawals. None of the studies adequately reported all relevant information to enable all QUADAS item to be scored as ‘yes’.
Conclusion
Overall QUADAS was relatively easy to use and appears to be an acceptable tool for appraising the quality of diagnostic accuracy studies using psychometric instruments. The application of QUADAS was hampered by the poor quality of reporting encountered.
Journal Article
Outcomes research in mental health: Systematic review
Outcomes research involves the secondary analysis of data collected routinely by clinical services, in order to judge the effectiveness of interventions and policy initiatives. It permits the study of large databases of patients who are representative of 'real world' practice. However, there are potential problems with this observational design.
To establish the strengths and limitations of outcomes research when applied in mental health.
A systematic review was made of the application of outcomes research in mental health services research.
Nine examples of outcomes research in mental health services were found. Those that used insurance claims data have information on large numbers of patients but use surrogate outcomes that are of questionable value to clinicians and patients. Problems arise when attempting to adjust for important confounding variables using routinely collected claims data, making results difficult to interpret.
Outcomes research is unlikely to be a quick or cheap means of establishing evidence for the effectiveness of mental health practice and policy.
Journal Article
The prevalence of nursing staff stress on adult acute psychiatric in-patient wards
Concerns about recent changes in acute in-patient mental health care environments have led to fears about staff stress and poor morale in acute in-patient mental health care staff.
To review the prevalence of low staff morale, stress, burnout, job satisfaction and psychological well-being amongst staff working in in-patient psychiatric wards.
Systematic review.
Of 34 mental health studies identified, 13 were specific to acute in-patient settings, and 21 were specific to other non-specified ward-based samples. Most studies did not find very high levels of staff burnout and poor morale but were mostly small, of poor quality and provided incomplete or non-standardised prevalence data.
The prevalence of indicators of low morale on acute in-patient mental health wards has been poorly researched and remains unclear. Multi-site, prospective epidemiological studies using validated measures of stress together with personal and organizational variables influencing staff stress in acute in-patient wards are required.
Journal Article
IMPACT collaborative care programme reduces suicide ideation in depressed older adults
Intervention: Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) for Late-Life Depression in Primary Care (1-year collaborative care programme in which a specially trained depression care manager supported primary care clinicians, and provided initial assessment, education about treatments, and telephone support for participants-see http://impact-uw.org for more information) or usual care.
Journal Article
Generating EQ-5D-3L health utility scores from the Edinburgh Postnatal Depression Scale: a perinatal mapping study
BackgroundPerinatal depression (PND) describes depression experienced by parents during pregnancy or in the first year after a baby is born. The EQ-5D instrument (a generic measure of health status) is not often collected in perinatal research, however disease-specific measures, such as the Edinburgh Postnatal Depression Scale (EPDS) are widely used. Mapping can be used to estimate generic health utility index values from disease-specific measures like the EPDS.ObjectiveTo develop a mapping algorithm to estimate EQ-5D utility index values from the EPDS.MethodsPatient-level data from the BaBY PaNDA study (English observational cohort study) provided 1068 observations with paired EPDS and EQ-5D (3-level version; EQ-5D-3L) responses. We compared the performance of six alternative regression model types, each with four specifications of covariates (EPDS score and age: base, squared, and cubed). Model performance (ability to predict utility values) was assessed by ranking mean error, mean absolute error, and root mean square error. Algorithm performance in 3 external datasets was also evaluated.ResultsThere was moderate correlation between EPDS score and utility values (coefficient: – 0.42). The best performing model type was a two-part model, followed by ordinary least squared. Inclusion of squared and cubed covariates improved model performance. Based on graphs of observed and predicted utility values, the algorithm performed better when utility was above 0.6.ConclusionsThis direct mapping algorithm allows the estimation of health utility values from EPDS scores. The algorithm has good external validity but is likely to perform better in samples with higher health status.
Journal Article
Rational Decision Making in Psychiatry: Evidence-Based Psychiatry is Just the Start
Geddes and Harrison make the case simply and persuasively for the value of a systematic approach to identifying and applying research evidence in clinical practice. No sensible psychiatrist, nurse or other therapist can justify a situation where patterns of practice are overly influenced by fashion, tradition, what the chief of staff happens to believe, or what the adverts claim, independent of the scientific basis, as represented by the results of valid experimental research.
Journal Article