ABSTRACT
BACKGROUND: Major depression is a highly prevalent condition. Its pathogenesis is related to a wide variety of biological and psychosocial factors and among these is factors related to lifestyle. Lifestyle-based interventions seem to be appropriate strategies as coadjutant treatment. The objective of this study is to explore and identify expectations and experiences of both patients and healthcare professionals that can point to the main barriers and facilitators with regard to the promotion of healthy dietary and hygiene behaviours in patients suffering from major depression. METHODS: A qualitative design was used to collect information from a wide range of purposefully and theoretically guided samples of depressed patients and health professionals from Primary Care (PC). Both in-depth interviews and discussion groups were used. A standardized protocol was designed to guide the interviews and groups, including the preparation of a topic list to be addressed, with previously tested, open suggestions that could be of interest. A thematic analysis was performed from grounded theory in order to explore, develop and define until saturation the emergent categories of analysis derived from the individual interview and group data. RESULTS: Both patients as well as PC professionals noted a series of central aspects with respect to the implementation of a programme for the acquisition of healthy dietary and hygiene habits for depressive patients, which may be organized around 'personal', 'programmatic', and 'transversal' aspects. As for the personal aspects, categories regarding 'patient history', and 'disposition' were found; the programmatic aspects included categories such as 'presentation and monitoring', and modification of 'cognitive' and 'behavioural' habits; whereas the transversal aspects comprised the possibilities of 'social support' and defining categories of 'objectives'. CONCLUSION: The implementation of intervention programmes that combine dietary and hygiene-related factors in patients with depression is complex, given the nature of the disorder itself, and its symptoms such as apathy and feelings of guilt or incompetence. Key issues exist for the success of the intervention, such as the simplicity of guidelines, tailoring through motivational interviewing, prolonged and intense monitoring throughout the different stages of the disorder, and the provision of adequate feedback and social support. PC could be an appropriate level in which to implement these interventions.
Subject(s)
Depressive Disorder, Major/diet therapy , Diet , Hygiene , Adolescent , Adult , Aged , Female , Health Personnel , Humans , Male , Middle Aged , Motivational Interviewing/methods , Primary Health Care , Qualitative Research , Social Support , Young AdultABSTRACT
OBJECTIVE: Obesity, metabolic syndrome (MetS) and low adherence to Mediterranean diet are frequent in major depression patients and have been separately related with prognosis. The aim of this study is to analyse their predictive power on major depression outcome, at 6 and 12 months. METHODS: 273 Major depressive patients completed the Beck Depression Inventory for depressive symptoms and the 14-item Mediterranean diet adherence score. MetS was diagnosed according to the International Diabetes Federation (IDF). RESULTS: At the baseline Mediterranean diet adherence was inversely associated with depressive symptoms (p=0.007). Depression response was more likely in those patients with normal weight (p=0.006) and not MetS (p=0.013) but it was not associated with Mediterranean diet adherence (p=0.625). Those patients with MetS and obesity were less likely to improve symptoms of depression than patients with obesity but not MetS. CONCLUSIONS: Obesity and MetS, but not low adherence to the Mediterranean diet at baseline, predicted a poor outcome of depression at 12 months. Our study suggests that MetS is the key factor that impacts negatively in depression prognosis, rather than obesity or diet. If this finding is confirmed, clinicians should be aware about MetS diagnosis and treatment in overweight depressed patients, especially if outcome is not being satisfactory enough.
Subject(s)
Depressive Disorder, Major/epidemiology , Diet, Mediterranean/psychology , Metabolic Syndrome/psychology , Obesity/psychology , Patient Compliance/statistics & numerical data , Female , Follow-Up Studies , Humans , Male , Metabolic Syndrome/diet therapy , Middle Aged , Obesity/diet therapy , Risk FactorsABSTRACT
BACKGROUND: Modifying some lifestyle factors can be useful in depression, at least as an adjuvant treatment. Combining different lifestyle interventions seems to be an adequate strategy to increase their antidepressant efficacy according with preliminary studies, but this issue has not been enough investigated. METHODS: The present study is a randomized, double-blinded, multicentre, two arm-parallel clinical trials, with a 12 month follow-up. The sample consisted of 273 Primary Care patients. Four combined hygienic-dietary written recommendations were given to the patients about diet, exercise, light exposure and sleep hygiene. RESULTS: Both active and control interventions were associated with improvement on BDI (Beck Depression Inventory) scores. However, there were not statistically significant differences (7.0 vs. 7.6; p=0.594). LIMITATIONS: We were unable to monitor whether patients carry out recommendations. Intervention could be too difficult to accomplish for depressed patients without enough support and supervision. CONCLUSIONS: Just giving written lifestyle recommendations are not enough for depressive patients to benefit from them, so perhaps lifestyle change recommendations work or do not work on Depression depending on how they are presented to patients and on monitoring systems of their implementation.
Subject(s)
Depressive Disorder, Major/therapy , Diet , Exercise , Health Behavior , Sleep , Sunlight , Combined Modality Therapy , Depressive Disorder, Major/psychology , Double-Blind Method , Female , Follow-Up Studies , Humans , Male , Psychiatric Status Rating ScalesABSTRACT
La relación entre la violencia y la enfermedad mentalgenera interés en el campo de la psiquiatría. Este estudioanaliza las características de los delitos cometidospor los pacientes ingresados en un hospital psiquiátricopenitenciario y sus diagnósticos.Han sido incluidos en este estudio todos los pacientesingresados en la Unidad de Hospitalización PsiquiátricaPenitenciaria de Catalunya desde noviembre de 2003hasta enero de 2006.Del total de la población de 243 pacientes, un 43,6%cometió delitos violentos. El homicidio fue el más frecuentede estos (51,9% de los delitos violentos). El44,3% de los pacientes con delitos violentos presentabatrastorno psicótico. No hay diferencias estadísticamentesignificativas entre los pacientes con delito violento yaquellos con delito no violento en relación a antecedentesde consumo de sustancias, diagnóstico de trastornode personalidad y retraso mental.La victima más común en los delitos violentos eraalguien conocido por el agresor(AU)
The relationship between violence and mental illnesshas become of much interest in psychiatry. This studyanalyzes the characteristics of offences committed byinpatients in a prison psychiatric hospital and their diagnoses.We considered all subjects admitted to the PenitentiaryPsychiatric Hospitalization Unit of Cataloniafrom November 2003 to January 2006.Of the population of 243 inpatients, 43.6% committedviolent offences. Homicide was the most commonone (51.9% of violent offences); 44.3% of violentoffenders had psychotic disorders. There were no statisticalsignificance differences between violent and nonviolent offenders in previous drugs use, personality disordersdiagnosis and mental retardation. The most commonvictim in violent offences was someone known bythe offender(AU)
Subject(s)
Humans , Male , Female , Violence , Mental Disorders/pathology , Mentally Ill Persons , Forensic Psychiatry/methods , Hospitals, Psychiatric , Prisons , Mental Health , Personality Disorders/diagnosis , Epidemiologic StudiesABSTRACT
UNLABELLED: This project aims to provide knowledge of reality in a psychiatric population neglected as the prison. The objectives of the study are: to estimate the prevalence of mental disorders in a Spanish prison sample, to analyze their association with sociodemographic and criminal as well as assess the impact on quality of life and describe and evaluate the health and social care received by People with mental disorders. Interviewing a total of 708 inmates sentenced to prison 5 distributed in 3 Autonomous Communities. Assessment instruments have been used SCID, IPDE, TONI II to assess the presence of mental disorders, quality of life scale (EuroQol and Social Weather CIES) and utlización service. RESULTS: The field project began in October 2006 to October 2007. There have been a total of 94,4% of planned interviews with results thar allow for data in the epidemiology of mental disorders in prison unprecedented so far.
ABSTRACT
El presente proyecto pretende dar conocimiento de la realidad psiquiátrica en una población poco estudiada como es lapenitenciaria. Los objetivos del estudio son: estimar la prevalencia de los trastornos mentales en una muestra representativapenitenciaria española; analizar su asociación con variables sociodemográficas y delictivas así como evaluar la repercusión sobrela calidad de vida y describir y evaluar la atención sanitaria y social que reciben las personas con trastornos mentales. Se entrevistaa un total de 708 internos penados de 5 centros penitenciarios distribuidos en 3 Comunidades Autónomas. Los instrumentosde evaluación utilizados han sido la SCID, IPDE, TONI II para evaluar la presencia de trastornos mentales; escalas calidadde vida (EuroQol y Clima Social CIES) y de utilización de servicio.Resultados: El trabajo de campo del proyecto se inició en octubre de 2006 finalizando en octubre de 2007. Se han realizadoun 94,4% (708) del total de entrevistas previstas (750) con unos resultados que permiten disponer de datos sobre la epide -miología española de los trastornos mentales en medio penitenciario sin precedentes hasta el momento (AU)
This project aims to provide knowledge of reality in a psychiatric population neglected as the prison. The objectives of thestudy are: to estimate the prevalence of mental disorders in a Spanish prison sample, to analyze their association with sociodemographicand criminal as well as assess the impact on quality of life and describe and evaluate the health and social carereceived by People with mental disorders. Interviewing a total of 708 inmates sentenced to prison 5 distributed in 3Autonomous Communities. Assessment instruments have been used SCID, IPDE, TONI II to assess the presence of mentaldisorders, quality of life scale (EuroQol and Social Weather CIES) and utlización service.Results: The field project began in October 2006 to October 2007. There have been a total of 94.4% of planned interviewswith results that allow for data on the epidemiology of mental disorders in prison unprecedented so far (AU)
