Guided self-help cognitive behavioural therapy for depression in primary care: a randomised controlled trial.

BACKGROUND: Access to Cognitive behavioural therapy (CBT) for depression is limited. One solution is CBT self-help books. Trial Objectives: To assess the impact of a guided self-help CBT book (GSH-CBT) on mood, compared to treatment as usual (TAU). HYPOTHESES: GSH-CBT will have improved mood and knowledge of the causes and treatment of depression compared to the control receiving TAUGuided self-help will be acceptable to patients and staff. PARTICIPANTS: Adults attending seven general practices in Glasgow, UK with a BDI-II score of ≥14. 141 randomised to GSH-CBT and 140 to TAU. INTERVENTIONS: RCT comparing 'Overcoming Depression: A Five Areas Approach' book plus 3-4 short face to face support appointments totalling up to 2 hours of guided support, compared with general practitioner TAU. PRIMARY OUTCOME: The BDI (II) score at 4 months. Numbers analysed: 281 at baseline, 203 at 4 months (primary outcome), 117 at 12 months. OUTCOME: Mean BDI-II scores were lower in the GSH-CBT group at 4 months by 5.3 points (2.6 to 7.9, p<0.001). At 4 and 12 months there were also significantly higher proportions of participants achieving a 50% reduction in BDI-II in the GSH-CBT arm. The mean support was 2 sessions with 42.7 minutes for session 1, 41.4 minutes for session 2 and 40.2 minutes of support for session 3. Adverse effects/Harms: Significantly less deterioration in mood in GSH-CBT (2.0% compared to 9.8% in the TAU group for BDI-II category change). LIMITATIONS: Weaknesses: Our follow-up rate of 72.2% at 4 months is better than predicted but is poorer at 12 months (41.6%). In the GSH-CBT arm, around 50% of people attended 2 or fewer sessions. 22% failed to take up treatment. CONCLUSIONS: GSH-CBT is substantially more effective than TAU. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN13475030.

Decision making and psychosocial outcomes among living kidney donors: a pilot study.

With an increasing number of available kidney transplant donors comes greater demand for systematic screening of prospective donors to ensure the integrity of the donor's decision and to minimize the risk of a poor postoperative outcome. The present study was intended to explore psychosocial outcomes after kidney donation, aspects of donors' decision making, and donors' experience of the transplantation process. It was hoped that this pilot study would inform the design of a large-scale longitudinal prospective investigation of psychosocial outcomes of kidney donation. In this cross-sectional, retrospective investigation, all patients who had received psychosocial screening before their kidney donation were approached. Seventeen of 43 previous kidney donors responded to a postal questionnaire. Donors' health-related quality of life was higher than population norms on all dimensions. Most participants reported involving someone else in the decision-making process. Donors indicated high levels of satisfaction with virtually all aspects of the donation process. The generalizability of the findings in the context of the limitations of the present pilot study is discussed and specific suggestions for the design of future studies are provided.

Exposure to obstetric complications and subsequent development of bipolar disorder: Systematic review.

BACKGROUND: Research has suggested an association between obstetric complications and bipolar disorder. However, no quantitative evaluation has been made of the pooled data from existing studies. AIMS: To systematically review studies comparing exposure to obstetric complications in cases of bipolar disorder v. non-psychiatric controls, and in cases of bipolar disorder v. cases of other mental disorders. METHOD: Publications were identified by computer searches of seven databases, by hand searches of reference lists and from raw data received from researchers. RESULTS: Forty-six studies were identified, of which 22 met the inclusion criteria. The pooled odds ratio for exposure to obstetric complications and subsequent development of bipolar disorder was 1.01 (95% CI 0.76-1.35) compared with healthy controls, 1.13 (95% CI 0.64-1.99) compared with cases of unipolar disorder and 0.61 (95% CI 0.39-0.95) compared with those who developed schizophrenia. CONCLUSIONS: There is no robust evidence that exposure to obstetric complications increases the risk of developing bipolar disorder. However, the range of events regarded as obstetric complications and methodological inadequacies make definitive conclusions difficult.

Fifteen year olds at risk of parasuicide or suicide: how can we identify them in general practice?

BACKGROUND: Within most western countries, suicide is the second leading cause of death amongst adolescents. OBJECTIVES: This paper aims to help GPs identify 15-year-old adolescents at increased risk from parasuicide and suicide. METHODS: The authors reviewed the case notes of 2359 fifteen year olds from 34 randomly selected general practices. Subjects were divided into two groups: (i) those who had made a suicide attempt at age 15; and (ii) those who had made no suicide attempt at age 15. The main outcome measures were the differences between those who had made a suicide attempt and those who had not with respect to GP consulting rates and reasons for consulting. RESULTS: The 26 subjects (1%) who had attempted suicide at age 15 consulted their GP four times per year compared with 2.3 times for those who had not attempted suicide. Twice as many adolescents who had attempted suicide consulted for upper respiratory tract infection (URTI), and nearly nine times as many consulted more than once for mental health concerns. The average attendance rate for those who had attempted suicide was greater than for those in the control comparison group who consulted their GP for mental health concerns; the attendance rate of those in the control group who had not consulted for mental health issues was lower still. CONCLUSIONS: (i) Fifteen year olds more at risk from parasuicide can be found amongst frequent attenders at general practice. (ii) Consulting more than once for mental health concerns or URTI where there are no physical signs could be an indicator of suicide risk.