The Association Between Self-Reported History of Physical Diseases and Psychological Distress in a Community-Dwelling Japanese Population: The Ohsaki Cohort 2006 Study.

The association between self-reported history of physical diseases and psychological distress in a community-dwelling Japanese population: the Ohsaki Cohort 2006 Study.

Eur J Public Health. 2013 Feb 26;
Nakaya N, Kogure M, Saito-Nakaya K, Tomata Y, Sone T, Kakizaki M, Tsuji I

BACKGROUND: Patients with physical disease are known to suffer considerable psychological distress. Social support may confound the association between physical disease and psychological distress. Population-based epidemiological studies have not been conducted on the association between history of physical disease, psychological distress and social support. METHODS: Using cross-sectional data from 2006, we studied 43 487 community-dwelling people aged ?40 years living in Japan. We examined the association between 13 self-reported histories of physical disease and psychological distress evaluated using the Kessler 6-item psychological distress scale (K6), defined as ?13 points out of 24. To investigate the association, we performed multiple logistic regression analyses adjusted for age, gender, social support and possible confounders. Social support, as the interaction between physical disease and psychological depression, was tested through the addition of cross-product terms to the multivariate-adjusted model. RESULTS: The following histories of physical disease were found significantly and positively associated with psychological distress: cancer, diabetes mellitus, hyperlipidemia, hypertension, myocardial infarction, stroke, gastric or duodenal ulcer, liver disease, arthritis, osteoporosis, kidney disease and fall or fracture (odds ratio, 1.2-2.3). Social support did not modify the association between most histories of physical disease and psychological distress. CONCLUSIONS: Subjects with a history of physical disease were significantly and positively associated with psychological distress, and social support did not modify this association for most physical diseases. Even after patients have left hospital following treatment for physical disease, they require continuous monitoring for psychological distress by doctors and paramedics. HubMed – depression

Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial.

BMJ. 2013; 346: f653
Cartwright M, Hirani SP, Rixon L, Beynon M, Doll H, Bower P, Bardsley M, Steventon A, Knapp M, Henderson C, Rogers A, Sanders C, Fitzpatrick R, Barlow J, Newman SP,

To assess the effect of second generation, home based telehealth on health related quality of life, anxiety, and depressive symptoms over 12 months in patients with long term conditions.A study of patient reported outcomes (the Whole Systems Demonstrator telehealth questionnaire study; baseline n=1573) was nested in a pragmatic, cluster randomised trial of telehealth (the Whole Systems Demonstrator telehealth trial, n=3230). General practice was the unit of randomisation, and telehealth was compared with usual care. Data were collected at baseline, four months (short term), and 12 months (long term). Primary intention to treat analyses tested treatment effectiveness; multilevel models controlled for clustering by general practice and a range of covariates. Analyses were conducted for 759 participants who completed questionnaire measures at all three time points (complete case cohort) and 1201 who completed the baseline assessment plus at least one other assessment (available case cohort). Secondary per protocol analyses tested treatment efficacy and included 633 and 1108 participants in the complete case and available case cohorts, respectively.Provision of primary and secondary care via general practices, specialist nurses, and hospital clinics in three diverse regions of England (Cornwall, Kent, and Newham), with established integrated health and social care systems. PARTICIPANTS : Patients with chronic obstructive pulmonary disease (COPD), diabetes, or heart failure recruited between May 2008 and December 2009.Generic, health related quality of life (assessed by physical and mental health component scores of the SF-12, and the EQ-5D), anxiety (assessed by the six item Brief State-Trait Anxiety Inventory), and depressive symptoms (assessed by the 10 item Centre for Epidemiological Studies Depression Scale).In the intention to treat analyses, differences between treatment groups were small and non-significant for all outcomes in the complete case (0.480?P?0.904) or available case (0.181?P?0.905) cohorts. The magnitude of differences between trial arms did not reach the trial defined, minimal clinically important difference (0.3 standardised mean difference) for any outcome in either cohort at four or 12 months. Per protocol analyses replicated the primary analyses; the main effect of trial arm (telehealth v usual care) was non-significant for any outcome (complete case cohort 0.273?P?0.761; available case cohort 0.145?P?0.696).Second generation, home based telehealth as implemented in the Whole Systems Demonstrator Evaluation was not effective or efficacious compared with usual care only. Telehealth did not improve quality of life or psychological outcomes for patients with chronic obstructive pulmonary disease, diabetes, or heart failure over 12 months. The findings suggest that concerns about potentially deleterious effect of telehealth are unfounded for most patients. TRIAL REGISTRATION : ISRCTN43002091. HubMed – depression

Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data.

BMJ. 2013; 346: f540
Bower P, Kontopantelis E, Sutton A, Kendrick T, Richards DA, Gilbody S, Knowles S, Cuijpers P, Andersson G, Christensen H, Meyer B, Huibers M, Smit F, van Straten A, Warmerdam L, Barkham M, Bilich L, Lovell K, Liu ET

To assess how initial severity of depression affects the benefit derived from low intensity interventions for depression.Meta-analysis of individual patient data from 16 datasets comparing low intensity interventions with usual care.Primary care and community settings.2470 patients with depression.Low intensity interventions for depression (such as guided self help by means of written materials and limited professional support, and internet delivered interventions).Depression outcomes (measured with the Beck Depression Inventory or Center for Epidemiologic Studies Depression Scale), and the effect of initial depression severity on the effects of low intensity interventions.Although patients were referred for low intensity interventions, many had moderate to severe depression at baseline. We found a significant interaction between baseline severity and treatment effect (coefficient -0.1 (95% CI -0.19 to -0.002)), suggesting that patients who are more severely depressed at baseline demonstrate larger treatment effects than those who are less severely depressed. However, the magnitude of the interaction (equivalent to an additional drop of around one point on the Beck Depression Inventory for a one standard deviation increase in initial severity) was small and may not be clinically significant.The data suggest that patients with more severe depression at baseline show at least as much clinical benefit from low intensity interventions as less severely depressed patients and could usefully be offered these interventions as part of a stepped care model. HubMed – depression

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