Depression: an exploratory parallel-group randomised controlled trial of Antenatal guided self help for WomeN (DAWN): study protocol for a randomised controlled trial.

BACKGROUND: Depression is a common antenatal mental disorder and is associated with an increased risk of adverse effects on the fetus and significant morbidity for the mother; if untreated it can also continue into the post-natal period and affect mother-infant interactions. There has been little research evaluating the effectiveness or cost-effectiveness of antenatal psychological interventions for antenatal depression, particularly for mild to moderate disorders. International guidelines recommend a stepped care approach starting with Guided Self Help, and the aim of this exploratory trial is to investigate Guided Self Help modified for pregnancy. METHODS: The DAWN trial is an exploratory randomised controlled trial of the effectiveness and cost-effectiveness of antenatal Guided Self Help, modified for pregnancy and delivered by National Health Service Psychological Wellbeing Practitioners. Antenatal Guided Self Help, in addition to usual care, is compared with usual care for pregnant women diagnosed with mild to moderate depression and mixed anxiety and depression, using the Structured Clinical Interview for DSM-IV Disorders. Modifications for pregnancy include perinatal mental health training, addressing pregnancy-specific worries and including sections on health issues in pregnancy and planning for parenthood. Women allocated to Guided Self Help will be seen for up to eight sessions by a Psychological Wellbeing Practitioner (including an initial assessment session); there will also be an appointment at 12 weeks after delivery. Research measures including the Edinburgh Postnatal Depression Scale (primary outcome) and other measures of depression, anxiety, quality of life and service use will be collected from women before random allocation, 14 weeks after random allocation and at 12 weeks after delivery. Potential psychological mechanisms of the intervention will be explored using the Pregnancy-Related Thoughts Questionnaire and the Metacognitive Awareness Questionnaire. DISCUSSION: The DAWN trial is the first exploratory trial to investigate the efficacy of antenatal Guided Self Help for pregnant women with mild to moderate depression meeting DSM-IV diagnostic criteria. Recruitment started January 2015 and is expected to be completed by July 2016. TRIAL REGISTRATION: ISRCTN registry: ISRCTN83768230 . Registered on 8 August 2014.

Visuoperceptual deficits in letter-by-letter reading?

A longstanding and controversial issue concerns the underlying mechanisms that give rise to letter-by-letter (LBL) reading: while some researchers propose a prelexical, perceptual basis for the disorder, others postulate a postlexical, linguistic source for the problem. To examine the nature of the deficit underlying LBL reading, in three experiments, we compare the performance of seven LBL readers, matched control participants and one brain-damaged patient, OL, with no reading impairment. Experiment 1 revealed that the LBL patients were impaired, relative to the controls and to OL, on a same/different matching task using checkerboards of black and white squares. Given that the perceptual impairment extends beyond abnormalities with alphanumeric stimuli, the findings are suggestive of a more general visual processing deficit. This interpretation was confirmed in Experiments 2 (matching words and symbol strings) and 3 (visual search of letter and symbol targets), which compared the processing of linguistic and non-linguistic written stimuli, matched for visual complexity. In both experiments, the LBL patients displayed qualitatively similar effects of length and left-to-right sequential ordering on linguistic and non-linguistic stimuli. Moreover, there was a clear association between the perceptual impairments on these tasks and the slope of the reading latency function for the LBL patients. Taken together, these findings are consistent with a significant visuoperceptual impairment in LBL that adversely affects reading performance as well as performance on other non-reading tasks.

An evaluation of statistical procedures for comparing an individual's performance with that of a group of controls.

The single case methodology that is widely used in cognitive neuropsychology often requires a comparison of data from a single individual (the patient) with that from a group of controls, in order to ascertain whether the patient's mean score can be viewed as significantly different from that of controls. This article reviews methods that have been used to deal with such data. Although Analysis of Variance (ANOVA) provides one possible solution of comparing group means, unequal group sizes and differences in variability between patient and controls can violate the assumptions of the test. Using Monte Carlo simulations, it was found that differences in group size and a group of N = 1 did not significantly affect the reliability of the analysis. In contrast, unacceptably high Type I errors were obtained when, in addition to unequal group sizes, there were relatively modest differences between the variance of the patient and that of the controls. We suggest that ANOVA can be used for the comparison of the mean score of an individual with that of a group of controls, but that when there is a difference in variability between the two groups, revised F criteria should be used in order to make the analysis reliable. A table of modified F values is given, which can be used for various departures from homogeneity of variance.