Moderate to severely depressed clients showed greater improvement in cognitive therapy when therapists emphasized changing how they think rather than how they behave, new research has found.
The results suggest cognitive therapists should concentrate, at least during the first few sessions, on using cognitive techniques to help those with more severe depression to break out of negative thought patterns and to see events in their lives more realistically.
The study found that a concentration on changing behavior - such as having patients schedule activities to get them out of the house, and tracking how they spent their time - did not significantly predict subsequent change in depressive symptoms.
"There has been a lot of attention recently on behavioral approaches to treating severe depression, and that may lead some people to suspect that cognitive techniques are not important for more severely depressed patients," said Daniel Strunk, co-author of the study and assistant professor of psychology at Ohio State University.
"But our results suggest that it was the cognitive strategies that actually helped patients improve the most during the first critical weeks of cognitive-behavioral therapy."
Strunk conducted the study with Melissa Brotman of the National Institute of Mental Health and Robert DeRubeis of the University of Pennsylvania. Their results appear online in the journal Behaviour Research and Therapy and will appear in a later print edition.
The study involved 60 patients who were diagnosed with major depression and who were being treated at two university clinics.
All the patients were being treated by one of six cognitive therapists and agreed to have their therapy sessions videotaped for study.
Two trained raters reviewed the videotapes of the first through the fourth therapy sessions. They rated how much the therapists relied on cognitive and behavioral methods and other aspects of the sessions.
In addition, patients completed a questionnaire at each session that measured their depression levels.
The researchers examined the relationship between specific techniques used by their therapists and the extent of improvement in patients' depression scores from one session to the next.
The study focused on the first few weeks of therapy because other studies suggest that is when patients make the largest improvement in depression levels, Strunk said.
Results showed that patients' depression scores improved significantly when their therapists focused on cognitive techniques, but didn't change when their therapists focused on behavioral techniques.
Other factors were also associated with patient improvement, the study found.
Patients improved more when they collaborated with their therapists about a plan for treatment and followed that plan.
Not surprisingly, patients also showed greater improvement when they were more engaged in the therapy process and were open to suggestions from their therapist.
"If you're a patient and willing to fully commit to the therapy process, our data suggest you will see more benefit," Strunk said.
Strunk said this research is being continued at Ohio State's Depression Treatment and Research Clinic. Researchers there are working with people suffering from depression to understand the nature of cognitive change and how it affects their improvement.
"We're trying to understand if cognitive therapy leads people to a profound change in their basic self view, or if it teaches them a set of skills that they have to continually practice over time," he said.
Strunk said these results suggest that, despite the recent attention given to behavioral approaches to treating depression, cognitive techniques appear to be quite powerful.
"In our sample of cognitive therapy patients, cognitive techniques appeared to promote a lessening of depression symptoms in a way that was not true of behavioral techniques," he said.
среда, 31 августа 2011 г.
воскресенье, 28 августа 2011 г.
Coffee Drinking No Longer So Controversial
Although the American Society for Nutrition's popular "controversy session" at Experimental Biology 2007 focuses on the health effects of coffee drinking, panel chair Dr. James Coughlin, a toxicology/safety consultant at Coughlin & Associates, says that recent advances in epidemiologic and experimental knowledge have transformed many of the negative health myths about coffee drinking into validated health benefits.
Indeed, panel co-chair Dan Steffen, who follows coffee and health issues in the Scientific and Regulatory Affairs group of Kraft Foods, note that the "controversy" is often to educate a wider audience about this transformation in understanding.
Coffee is among the most widely consumed beverages in the world, and Dr. Coughlin says that the preponderance of scientific evidence - some by the panelists - suggests that moderate coffee consumption (3-5 cups per day) may be associated with reduced risk of certain disease conditions, such as Parkinson's disease. Some research in neuropharamacology suggests that one cup of coffee can halve the risk of Parkinson's disease. Other studies have found it reduces the risk of Alzheimer's disease, kidney stones, gallstones, depression and even suicide.
Dr. Coughlin and two distinguished researchers discussed some of the benefits - and a couple of the remaining increased risk factors (possible increase in blood pressure and plasma homocysteine) at the Experimental Biology meeting in Washington, DC.
Dr. Rob van Dam, an epidemiologist at the Harvard School of Public Health and the Harvard Medical School, studies the link between diet and the development of type 2 diabetes. Worldwide, an estimated 171 million persons have diabetes, mostly type 2 diabetes, and an alarming increase to 366 million persons is expected for the year 2030. While increased physical activity and restriction of energy intake can substantially reduce risk of type 2 diabetes, he believes insight into the role of other lifestyle factors may contribute to additional prevention strategies for type 2 diabetes.
In recent epidemiological studies in the U.S., Europe and Japan, persons who were heavy coffee consumers had a lower risk of type 2 diabetes than persons who consumed little coffee. Interestingly, he says, associations were similar for caffeinated and decaffeinated coffee, suggesting that coffee components other than caffeine may be beneficial for glucose metabolism.
Coffee contains hundreds of components including substantial amounts of chlorogenic acid, caffeine, magnesium, potassium, vitamin B3, trigonelline, and lignans. Limited evidence suggests that coffee may improve glucose metabolism by reducing the rate of intestinal glucose absorption and by stimulating the secretion of the gut hormone glucagon-like peptide-1 (GLP-1) that is beneficial for the secretion of insulin. However, most mechanistic research on coffee and glucose metabolism has been done in animals and in lab tubes and therefore metabolic studies in humans are currently being conducted. Further research may lead to the development or selection of coffee types with improved health effects.
Dr. Lenore Arab, a nutritional epidemiologist in the David Geffen School of Medicine at UCLA, notes that the first coffee controversy dates back 430 years when in 1570 some monks petitioned the pope to condemn this drink, so popular among Muslims. Pope Clement VIII, liking how it kept the monks from falling sleep during mass, purportedly blessed it instead. The rest, including the United States' wholesale conversion to coffee following the Boston Tea Party, is history.
In reviewing the latest epidemiologic literature on cancers and coffee, Dr. Arab has found there to be close to 400 studies of the associations between coffee consumption and cancers various at various sites. The earlier controversy with regard to colon cancer was based on flawed analyses, she says. More thorough analyses and the accumulation of evidence suggest no negative effect on the incidence of colon cancer, and possible protective effects for adenomas of the colon as well as for rectal cancer and liver cancer. Mechanisms which might contribute to a possible anticarcinogenic effect include reduction in cholesterol, bile acid and neutral sterol secretion in the colon, increased colonic motility and reduced exposure of epithelium to carcinogens, the ability of diterpenes to reduce genotoxicity of carcinogens, and lower DNA adduct formation, and the ability of caffeic acid and chlorogenic acid to decreased DNA methylation. In other cancers - breast, ovarian, and prostate - the evidence is not suggestive of either risk or protection. There are two areas, says Dr. Arab, in which there is some evidence of increased risk: leukemia and stomach cancer. The evidence for the former is intriguing, for the latter insubstantial. She concludes that a systematic review of the newer data for liver, rectal, stomach cancer and for childhood leukemia is due.
Contact: Sylvia Wrobel
Federation of American Societies for Experimental Biology
Indeed, panel co-chair Dan Steffen, who follows coffee and health issues in the Scientific and Regulatory Affairs group of Kraft Foods, note that the "controversy" is often to educate a wider audience about this transformation in understanding.
Coffee is among the most widely consumed beverages in the world, and Dr. Coughlin says that the preponderance of scientific evidence - some by the panelists - suggests that moderate coffee consumption (3-5 cups per day) may be associated with reduced risk of certain disease conditions, such as Parkinson's disease. Some research in neuropharamacology suggests that one cup of coffee can halve the risk of Parkinson's disease. Other studies have found it reduces the risk of Alzheimer's disease, kidney stones, gallstones, depression and even suicide.
Dr. Coughlin and two distinguished researchers discussed some of the benefits - and a couple of the remaining increased risk factors (possible increase in blood pressure and plasma homocysteine) at the Experimental Biology meeting in Washington, DC.
Dr. Rob van Dam, an epidemiologist at the Harvard School of Public Health and the Harvard Medical School, studies the link between diet and the development of type 2 diabetes. Worldwide, an estimated 171 million persons have diabetes, mostly type 2 diabetes, and an alarming increase to 366 million persons is expected for the year 2030. While increased physical activity and restriction of energy intake can substantially reduce risk of type 2 diabetes, he believes insight into the role of other lifestyle factors may contribute to additional prevention strategies for type 2 diabetes.
In recent epidemiological studies in the U.S., Europe and Japan, persons who were heavy coffee consumers had a lower risk of type 2 diabetes than persons who consumed little coffee. Interestingly, he says, associations were similar for caffeinated and decaffeinated coffee, suggesting that coffee components other than caffeine may be beneficial for glucose metabolism.
Coffee contains hundreds of components including substantial amounts of chlorogenic acid, caffeine, magnesium, potassium, vitamin B3, trigonelline, and lignans. Limited evidence suggests that coffee may improve glucose metabolism by reducing the rate of intestinal glucose absorption and by stimulating the secretion of the gut hormone glucagon-like peptide-1 (GLP-1) that is beneficial for the secretion of insulin. However, most mechanistic research on coffee and glucose metabolism has been done in animals and in lab tubes and therefore metabolic studies in humans are currently being conducted. Further research may lead to the development or selection of coffee types with improved health effects.
Dr. Lenore Arab, a nutritional epidemiologist in the David Geffen School of Medicine at UCLA, notes that the first coffee controversy dates back 430 years when in 1570 some monks petitioned the pope to condemn this drink, so popular among Muslims. Pope Clement VIII, liking how it kept the monks from falling sleep during mass, purportedly blessed it instead. The rest, including the United States' wholesale conversion to coffee following the Boston Tea Party, is history.
In reviewing the latest epidemiologic literature on cancers and coffee, Dr. Arab has found there to be close to 400 studies of the associations between coffee consumption and cancers various at various sites. The earlier controversy with regard to colon cancer was based on flawed analyses, she says. More thorough analyses and the accumulation of evidence suggest no negative effect on the incidence of colon cancer, and possible protective effects for adenomas of the colon as well as for rectal cancer and liver cancer. Mechanisms which might contribute to a possible anticarcinogenic effect include reduction in cholesterol, bile acid and neutral sterol secretion in the colon, increased colonic motility and reduced exposure of epithelium to carcinogens, the ability of diterpenes to reduce genotoxicity of carcinogens, and lower DNA adduct formation, and the ability of caffeic acid and chlorogenic acid to decreased DNA methylation. In other cancers - breast, ovarian, and prostate - the evidence is not suggestive of either risk or protection. There are two areas, says Dr. Arab, in which there is some evidence of increased risk: leukemia and stomach cancer. The evidence for the former is intriguing, for the latter insubstantial. She concludes that a systematic review of the newer data for liver, rectal, stomach cancer and for childhood leukemia is due.
Contact: Sylvia Wrobel
Federation of American Societies for Experimental Biology
четверг, 25 августа 2011 г.
CAMH Scientist First Psychiatrist To Win Royal College Medal Award In Medicine
Dr. Jeffrey Meyer, and Head of Neurochemical Imaging in the Mood Disorders at the Centre for Addiction and Mental Health (CAMH), is the first psychiatrist to be honoured with the Royal College Medal Award in Medicine in the award's 60 year history.
For over 30 years, scientists believed that monoamines - mood-related chemicals such as serotonin, norepinephrine and dopamine - are low in the brain during episodes of major depression. This is commonly referred to as a "chemical imbalance", but no one had ever found a convincing explanation for monoamine loss. In 2006, Dr. Meyer unlocked this mystery and released a study that provided an explanation of how the "chemical imbalance" occurs in major depressive episodes - the new leading monoamine theory of depression.
Dr. Meyer, who also holds a Canada Research Chair in Neurochemistry of Depression, investigated whether brain monoamine oxidase A (MAO-A) - an enzyme that breaks down chemicals like serotonin, norepinephrine and dopamine - was higher in those with untreated depression. The results showed that in major depression MAO-A was significantly higher in every brain region that the scientists investigated. On average, MAO-A was 34 per cent higher.
"It's a wonderful honour for Dr. Meyer, for CAMH, and for psychiatry that a clinical scientist's work is being recognized in this way," said Vice President of Research Dr. Bruce G. Pollock. "The Royal College winners have been amongst Canada's most outstanding emerging investigators in medicine and surgery for the past 60 years, and we're proud to have Dr. Meyer included in this distinguished group."
Notes:
The Royal College of Physicians and Surgeons of Canada (RCPSC) is a national, nonprofit organization established in 1929 by a special Act of Parliament to oversee the medical education of specialists in Canada. Each year the RCPSC awards the Medal Award in Medicine to recognize original work in clinical investigation and basic science.
The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital, as well as one of the world's leading research centres in the area of addiction and mental health. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues. CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre.
For over 30 years, scientists believed that monoamines - mood-related chemicals such as serotonin, norepinephrine and dopamine - are low in the brain during episodes of major depression. This is commonly referred to as a "chemical imbalance", but no one had ever found a convincing explanation for monoamine loss. In 2006, Dr. Meyer unlocked this mystery and released a study that provided an explanation of how the "chemical imbalance" occurs in major depressive episodes - the new leading monoamine theory of depression.
Dr. Meyer, who also holds a Canada Research Chair in Neurochemistry of Depression, investigated whether brain monoamine oxidase A (MAO-A) - an enzyme that breaks down chemicals like serotonin, norepinephrine and dopamine - was higher in those with untreated depression. The results showed that in major depression MAO-A was significantly higher in every brain region that the scientists investigated. On average, MAO-A was 34 per cent higher.
"It's a wonderful honour for Dr. Meyer, for CAMH, and for psychiatry that a clinical scientist's work is being recognized in this way," said Vice President of Research Dr. Bruce G. Pollock. "The Royal College winners have been amongst Canada's most outstanding emerging investigators in medicine and surgery for the past 60 years, and we're proud to have Dr. Meyer included in this distinguished group."
Notes:
The Royal College of Physicians and Surgeons of Canada (RCPSC) is a national, nonprofit organization established in 1929 by a special Act of Parliament to oversee the medical education of specialists in Canada. Each year the RCPSC awards the Medal Award in Medicine to recognize original work in clinical investigation and basic science.
The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital, as well as one of the world's leading research centres in the area of addiction and mental health. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues. CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre.
понедельник, 22 августа 2011 г.
Postpartum Depression Is Top Priority For New ACOG President
Today Gerald F. Joseph Jr, MD, of Louisiana, became the 60th president of The American College of Obstetricians and Gynecologists (ACOG), based in Washington, DC. During his inaugural speech at ACOG's Annual Clinical Meeting, Dr. Joseph announced that postpartum depression is the theme of his presidential initiative.
"While in an ideal world, the newly delivered mother is at the peak of her reproductive health, with a beautiful child and, ideally, a supportive, loving family, this unfortunately is not always the case," said Dr. Joseph. "Studies show that this is a most vulnerable time for our patients, especially those prone to depression or those with a history of depression." Complicating matters is that the new mother often can't bring herself to admit to any problems or negative emotions due to societal pressures, he said. Instead of asking for help, she may feel guilty for not being 'grateful' or a 'good' mother.
Dr. Joseph explained that the 'baby blues,' which affect as many as 80% of new mothers, usually start early after delivery and spontaneously resolve within a very short period of time. "But what happens when these negative feelings don't resolve and true major depression becomes a part of the process?" he asked. "This can be devastating for the mother, the child, the partner, the family, and the ob-gyn who is caring for her."
There are three areas in particular that need to be addressed, according to Dr. Joseph. "First, we need to determine the true prevalence and incidence of postpartum depression," he said. Because definitions of depression vary among different studies, postpartum depression is estimated to range anywhere from five percent to more than 25 percent, depending on these changing definitions and the diversity of populations studied. "Second, the available screening tools to assess potentially at-risk pregnant women often are imprecise and leave much to be desired. And, finally, we need to develop evidence-based guidelines for ACOG members to screen for postpartum depression."
"We also need to know how ACOG Fellows screen and identify patients suffering from postpartum depression," Dr. Joseph continued. "When do they counsel? How do they treat? Do they refer to other specialists for treatment? What kind of local programs are available for education and support? These are all questions that we need answers to."
In addition, Dr. Joseph said, "Let us hope that this is the year for real, meaningful health care reform. Effective, affordable health care needs to start on the front end with prevention of disease, rather than the acute care on the back end that too many of our citizens receive today. We end up caring for sicker patients and paying much more for expensive acute care rather than the less expensive preventive care. As president, I assure you that ACOG will continue to push for preventive care for all."
Dr. Joseph is a senior consultant in gynecology at the Ochsner Health Center in Covington, LA, and clinical assistant professor of obstetrics and gynecology at Louisiana State University and Tulane University in New Orleans. He has been an ACOG Fellow since 1978. Dr. Joseph has chaired the Committee on Scientific Program and the task forces on Enhancing Practice Satisfaction and District and Section Contributions. He has been a member of ACOG's Executive Board and has served as the Executive Board liaison to the Society for Maternal-Fetal Medicine. Dr. Joseph has served on the committees on Gynecologic Practice, Nominations, Credentials, and Long-Range Planning and on the task forces on Medical Student Recruitment, Nominations Process, and Scope of Practice. He has been a member of the Council of District Chairs, the Grievance Committee's Appeals Panel Committee, and the medical advisory board for pause® magazine.
Dr. Joseph has served in numerous regional leadership positions, including chair of ACOG District VII and the Louisiana Section. He has also served as District VII scientific program chair and as a member of the Missouri Section Advisory Council. Dr. Joseph is past president of the New Orleans Gynecological and Obstetrical Society and the Southeastern Obstetrical and Gynecological Society. He has been active in the Central Association of Obstetricians and Gynecologists for many years, serving as a member of the board of trustees and as vice president.
Dr. Joseph received his medical degree from Tulane University and completed his residency at Louisiana State University in Shreveport.
The American College of Obstetricians and Gynecologists (ACOG) is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization, ACOG: strongly advocates for quality health care for women; maintains the highest standards of clinical practice and continuing education of its members; promotes patient education; and increases awareness among its members and the public of the changing issues facing women's health care.
Source
American College of Obstetricians and Gynecologists
"While in an ideal world, the newly delivered mother is at the peak of her reproductive health, with a beautiful child and, ideally, a supportive, loving family, this unfortunately is not always the case," said Dr. Joseph. "Studies show that this is a most vulnerable time for our patients, especially those prone to depression or those with a history of depression." Complicating matters is that the new mother often can't bring herself to admit to any problems or negative emotions due to societal pressures, he said. Instead of asking for help, she may feel guilty for not being 'grateful' or a 'good' mother.
Dr. Joseph explained that the 'baby blues,' which affect as many as 80% of new mothers, usually start early after delivery and spontaneously resolve within a very short period of time. "But what happens when these negative feelings don't resolve and true major depression becomes a part of the process?" he asked. "This can be devastating for the mother, the child, the partner, the family, and the ob-gyn who is caring for her."
There are three areas in particular that need to be addressed, according to Dr. Joseph. "First, we need to determine the true prevalence and incidence of postpartum depression," he said. Because definitions of depression vary among different studies, postpartum depression is estimated to range anywhere from five percent to more than 25 percent, depending on these changing definitions and the diversity of populations studied. "Second, the available screening tools to assess potentially at-risk pregnant women often are imprecise and leave much to be desired. And, finally, we need to develop evidence-based guidelines for ACOG members to screen for postpartum depression."
"We also need to know how ACOG Fellows screen and identify patients suffering from postpartum depression," Dr. Joseph continued. "When do they counsel? How do they treat? Do they refer to other specialists for treatment? What kind of local programs are available for education and support? These are all questions that we need answers to."
In addition, Dr. Joseph said, "Let us hope that this is the year for real, meaningful health care reform. Effective, affordable health care needs to start on the front end with prevention of disease, rather than the acute care on the back end that too many of our citizens receive today. We end up caring for sicker patients and paying much more for expensive acute care rather than the less expensive preventive care. As president, I assure you that ACOG will continue to push for preventive care for all."
Dr. Joseph is a senior consultant in gynecology at the Ochsner Health Center in Covington, LA, and clinical assistant professor of obstetrics and gynecology at Louisiana State University and Tulane University in New Orleans. He has been an ACOG Fellow since 1978. Dr. Joseph has chaired the Committee on Scientific Program and the task forces on Enhancing Practice Satisfaction and District and Section Contributions. He has been a member of ACOG's Executive Board and has served as the Executive Board liaison to the Society for Maternal-Fetal Medicine. Dr. Joseph has served on the committees on Gynecologic Practice, Nominations, Credentials, and Long-Range Planning and on the task forces on Medical Student Recruitment, Nominations Process, and Scope of Practice. He has been a member of the Council of District Chairs, the Grievance Committee's Appeals Panel Committee, and the medical advisory board for pause® magazine.
Dr. Joseph has served in numerous regional leadership positions, including chair of ACOG District VII and the Louisiana Section. He has also served as District VII scientific program chair and as a member of the Missouri Section Advisory Council. Dr. Joseph is past president of the New Orleans Gynecological and Obstetrical Society and the Southeastern Obstetrical and Gynecological Society. He has been active in the Central Association of Obstetricians and Gynecologists for many years, serving as a member of the board of trustees and as vice president.
Dr. Joseph received his medical degree from Tulane University and completed his residency at Louisiana State University in Shreveport.
The American College of Obstetricians and Gynecologists (ACOG) is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization, ACOG: strongly advocates for quality health care for women; maintains the highest standards of clinical practice and continuing education of its members; promotes patient education; and increases awareness among its members and the public of the changing issues facing women's health care.
Source
American College of Obstetricians and Gynecologists
пятница, 19 августа 2011 г.
Link Between Depression And Cardiovascular Disease
Depression has long had a popular link to cardiovascular disease and death. However, only during the last 15 years scientific evidence supporting this common wisdom has been available (Glassman et al., 2007a). Since the early 1990s studies have reported prevalences of major depression between 17% and 27% in hospitalized patients with coronary artery disease (CAD) (Rudisch & Nemeroff, 2003).
It is becoming clear that the comorbidity of depression and cardiovascular disease does not occur by chance but the mechanisms responsible for this relationship is poorly understood. Platelet abnormalities, autonomic tone, and health behaviors have all been implicated. There exists also the possibility that depression and vascular disease share certain vulnerability genes (McCaffery et al., 2006).
Moreover, it is now apparent that depression aggravates the course of multiple cardiovascular conditions (Glassman et al., 2007) and has regularly been shown to lower adherence to prescribed medication and secondary prevention measures (Glassman et al., 2007b).
Few randomized controlled trials have evaluated the efficacy of treatments for major depression in patients with coronary artery disease.
Depression and cardiovascular disease
* Depression observed following acute coronary syndrome (ACS) is common and associated with an increased risk of mortality. Medically healthy individuals who suffer from depression are at significantly increased risk of developing heart attacks and strokes later in life (Glassman et al., 2007).
* Acute coronary syndrome is both psychologically and physiologically stressful, and it is common to attribute depression observed following ACS to that stress (Glassman et al., 2006)
Furthermore, the Heart rate variability (HRV), a well-recognized measure reflecting fluctuations in autonomic activity, is an independent predictor of death. Earlier studies show that, after myocardial infarction, HRV values increase approximately 50% between 3- and 12-weeks. In post-ACS patients with depression, improvement in HRV could therefore result from the pharmacological action of an antidepressant drug, from an improving mood independent of the drug, or as a result of recovery from the acute cardiac injury.
Depression treatment among patients with coronary artery disease
Few adequately controlled trials evaluated whether antidepressant treatments are either safe or effective in patients with coronary artery disease (CAD). The largest of these, the Sertraline Antidepressant Heart Attack Trial (SADHART) (Glassman et al., 2002) was designed to evaluate the safety and efficacy of sertraline hydrochloride for treatment of MDD in ACS. No adverse cardiovascular effects of sertraline treatment were detected, sertraline was both safe and effective in post-MI depression and observed a reduction in death and recurrent myocardial infarction. Planned subgroup analyses showed a clear benefit of sertraline over placebo for patients with recurrent depression and those with more severe depression.
In addition, the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy, a randomized, controlled, 12-week, parallel-group trial (CREATE) (Lesperance et al., 2007), was the first trial specifically designed to evaluate the short-term efficacy and tolerability of 2 depression treatments in patients with CAD: citalopram, a first-line SSRI antidepressant and interpersonal psychotherapy (IPT), a short-term, manual-based psychotherapy focusing on the social context of depression. The trial documents the efficacy of citalopram administered in conjunction with weekly clinical management for major depression among patients with coronary artery disease and found no evidence of added value of IPT over clinical management. Similar to the results of SADHART CREATE found the benefits of SSRIs for patients with CAD to be clearer for recurrent episodes of major depression than for first episodes.
Clinical implications
* Depression is a painful state, and it should be treated aggressively when indicators of benefit are present; major depression following myocardial infarction is consistently associated with about a 3-fold increase in cardiac mortality and evidence continues to accumulate (Glassman et al., 2007b).
* Major depression severely impairs heart rate variability recovery following an acute coronary event. It is now clear, that depression is also associated with biological changes involving increased heart rate, inflammatory response, plasma norepinephrine, platelet reactivity, absent post-ACS HRV recovery -- all of which is associated with life-threatening consequences. It also impairs compliance with doctors advice and health behaviors.
* Based on study results and those of previous trials, the selective serotonin-reuptake-inhibitors (SSRI) citalopram or sertraline plus clinical management should be considered as a first-step treatment for patients with CAD and major depression albeit there is still a clear need for additional studies evaluating interventions to prevent the cardiac prognostic impact of depression.
* From a clinician's point of view, patients with depression after myocardial infarction, especially those with prior episodes, should be both carefully watched and aggressively treated, because they are at an elevated cardiac risk and less likely to get better spontaneousely.
References
Glassman AH. Depression and cardiovascular comorbidity. Dialogues Clin Neurosci 2007a;9(1):9-17
Glassman AH, Bigger JT, Gaffney M. Heart Rate Variability in Acute Coronary Syndrome Patients with Major Depression, influence of Sertraline and Mood Improvement. Arch Gen Psychiatry 2007b;64:9
Glassman AH, Bigger JT, Gaffney M, et al. Onset of major depression associated with acute coronary syndromes: relationship of onset, major depressive disorder history, and episode severity to sertraline benefit. Arch Gen Psychiatry 2006;63(3):283-8
Glassman AH, O'Connor CM, Califf RM, et al.; Sertraline Antidepressant Heart Attack Randomized Trial (SADHEART) Group. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 2002;288(6):701-9
Lesperance F, Frasure-Smith N, Koszycki D, et al.; CREATE Investigators. Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. JAMA 2007;297(4):367-79
McCaffery JM, Frasure-Smith N, Dube MP, et al. Common genetic vulnerability to depressive symptoms and coronary artery disease: a review and development of candidate genes related to inflammation and serotonin. Psychosom Med 2006;68(2):187-200
Rudisch B, Nemeroff CB. Epidemiology of comorbid coronary artery disease and depressi on. Biol Psychiatry 2003;54:227-240.
It is becoming clear that the comorbidity of depression and cardiovascular disease does not occur by chance but the mechanisms responsible for this relationship is poorly understood. Platelet abnormalities, autonomic tone, and health behaviors have all been implicated. There exists also the possibility that depression and vascular disease share certain vulnerability genes (McCaffery et al., 2006).
Moreover, it is now apparent that depression aggravates the course of multiple cardiovascular conditions (Glassman et al., 2007) and has regularly been shown to lower adherence to prescribed medication and secondary prevention measures (Glassman et al., 2007b).
Few randomized controlled trials have evaluated the efficacy of treatments for major depression in patients with coronary artery disease.
Depression and cardiovascular disease
* Depression observed following acute coronary syndrome (ACS) is common and associated with an increased risk of mortality. Medically healthy individuals who suffer from depression are at significantly increased risk of developing heart attacks and strokes later in life (Glassman et al., 2007).
* Acute coronary syndrome is both psychologically and physiologically stressful, and it is common to attribute depression observed following ACS to that stress (Glassman et al., 2006)
Furthermore, the Heart rate variability (HRV), a well-recognized measure reflecting fluctuations in autonomic activity, is an independent predictor of death. Earlier studies show that, after myocardial infarction, HRV values increase approximately 50% between 3- and 12-weeks. In post-ACS patients with depression, improvement in HRV could therefore result from the pharmacological action of an antidepressant drug, from an improving mood independent of the drug, or as a result of recovery from the acute cardiac injury.
Depression treatment among patients with coronary artery disease
Few adequately controlled trials evaluated whether antidepressant treatments are either safe or effective in patients with coronary artery disease (CAD). The largest of these, the Sertraline Antidepressant Heart Attack Trial (SADHART) (Glassman et al., 2002) was designed to evaluate the safety and efficacy of sertraline hydrochloride for treatment of MDD in ACS. No adverse cardiovascular effects of sertraline treatment were detected, sertraline was both safe and effective in post-MI depression and observed a reduction in death and recurrent myocardial infarction. Planned subgroup analyses showed a clear benefit of sertraline over placebo for patients with recurrent depression and those with more severe depression.
In addition, the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy, a randomized, controlled, 12-week, parallel-group trial (CREATE) (Lesperance et al., 2007), was the first trial specifically designed to evaluate the short-term efficacy and tolerability of 2 depression treatments in patients with CAD: citalopram, a first-line SSRI antidepressant and interpersonal psychotherapy (IPT), a short-term, manual-based psychotherapy focusing on the social context of depression. The trial documents the efficacy of citalopram administered in conjunction with weekly clinical management for major depression among patients with coronary artery disease and found no evidence of added value of IPT over clinical management. Similar to the results of SADHART CREATE found the benefits of SSRIs for patients with CAD to be clearer for recurrent episodes of major depression than for first episodes.
Clinical implications
* Depression is a painful state, and it should be treated aggressively when indicators of benefit are present; major depression following myocardial infarction is consistently associated with about a 3-fold increase in cardiac mortality and evidence continues to accumulate (Glassman et al., 2007b).
* Major depression severely impairs heart rate variability recovery following an acute coronary event. It is now clear, that depression is also associated with biological changes involving increased heart rate, inflammatory response, plasma norepinephrine, platelet reactivity, absent post-ACS HRV recovery -- all of which is associated with life-threatening consequences. It also impairs compliance with doctors advice and health behaviors.
* Based on study results and those of previous trials, the selective serotonin-reuptake-inhibitors (SSRI) citalopram or sertraline plus clinical management should be considered as a first-step treatment for patients with CAD and major depression albeit there is still a clear need for additional studies evaluating interventions to prevent the cardiac prognostic impact of depression.
* From a clinician's point of view, patients with depression after myocardial infarction, especially those with prior episodes, should be both carefully watched and aggressively treated, because they are at an elevated cardiac risk and less likely to get better spontaneousely.
References
Glassman AH. Depression and cardiovascular comorbidity. Dialogues Clin Neurosci 2007a;9(1):9-17
Glassman AH, Bigger JT, Gaffney M. Heart Rate Variability in Acute Coronary Syndrome Patients with Major Depression, influence of Sertraline and Mood Improvement. Arch Gen Psychiatry 2007b;64:9
Glassman AH, Bigger JT, Gaffney M, et al. Onset of major depression associated with acute coronary syndromes: relationship of onset, major depressive disorder history, and episode severity to sertraline benefit. Arch Gen Psychiatry 2006;63(3):283-8
Glassman AH, O'Connor CM, Califf RM, et al.; Sertraline Antidepressant Heart Attack Randomized Trial (SADHEART) Group. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 2002;288(6):701-9
Lesperance F, Frasure-Smith N, Koszycki D, et al.; CREATE Investigators. Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. JAMA 2007;297(4):367-79
McCaffery JM, Frasure-Smith N, Dube MP, et al. Common genetic vulnerability to depressive symptoms and coronary artery disease: a review and development of candidate genes related to inflammation and serotonin. Psychosom Med 2006;68(2):187-200
Rudisch B, Nemeroff CB. Epidemiology of comorbid coronary artery disease and depressi on. Biol Psychiatry 2003;54:227-240.
вторник, 16 августа 2011 г.
New Study: Despite Suicidality Risks, Patients On Antidepressants Have Received Far Less Follow-up Care Than Is Currently Recommended
Despite concerns
about suicidal thoughts and behavior for patients using antidepressants, a
new study in the August issue of the peer-reviewed American Journal of
Managed Care shows that few patients on these drugs received even the
minimum level of follow-up care. The Food and Drug Administration (FDA)
requires a "black box" warning, the strongest alert possible, on all
antidepressants for increased risk of suicidal thoughts and behavior in
children and adolescents, and has issued a public health advisory about
those risks for adults.
Current FDA guidelines for both pediatric and adult patients recommend
at least weekly face-to-face visits with a health practitioner during the
first four weeks of antidepressant treatment, then every other week during
the next four weeks, and then a visit after 12 weeks. But according to the
study by Medco Health Solutions, Inc. (NYSE: MHS), nearly half of all
patients have no follow-up visits during the first month of taking
antidepressants, and fewer than 18 percent of patients see a practitioner
specifically for mental health follow-up care during that time period.
The new study found that few patients were monitored closely during the
first three months following the start of antidepressant therapy. The
study, which reviewed medical and pharmacy claims of 84,500 pediatric and
adult patients, found that less than 15 percent of patients received the
FDA's current recommended level of follow-up care in the first four weeks
of drug treatment, 18 percent at eight weeks, and 23 percent at 12 weeks.
?
"This study brings to light potentially serious inadequacies in the
follow-up care of patients on antidepressants," said Dr. Glen Stettin,
senior vice president of clinical solutions for Medco and lead author of
the study. "Not only is close monitoring needed to reduce the risk of
adverse outcomes including suicidal tendencies, but also to assess a
patient's response to the treatment, make adjustments to drug dosages when
necessary and help manage side-effects that can lead to poor compliance or
the discontinuation of therapy, which can have extremely negative
consequences as well."
While fewer than half of children 18 years and younger saw a
practitioner at least once for mental health care follow-up in the first
few months of antidepressant treatment, adult visits were even less
frequent:
-- 66 percent of children and 83 percent of adults did not see a
clinician for a mental health care visit in the first four weeks
after antidepressant therapy had begun
-- 58 percent of children and 78 percent of adults had not had such a
visit within 8 weeks
-- 53 percent of children and nearly 76 percent of adult patients had no
mental health care visits during the first 12 weeks of drug therapy
While the study found that general medical visits were more common than
mental health care visits in the first few weeks and months of
antidepressant treatment, still 45 percent of patients saw no health
clinician at all in the first four weeks of drug therapy, more than 30
percent did not see a health provider within eight weeks and 23 percent had
no medical visits at all within 12 weeks.
The retrospective study included 84,500 adult and pediatric patients
who started on a new course of antidepressant therapy between July 2001 and
September 2003. Using an integrated database of medical and pharmacy
claims, the number of health provider visits was identified by reviewing
medical claim information for these patients. The patients all had mental
health care coverage as participants in medical and pharmacy benefit plans
administered by a large managed care organization in the northeastern
United States.
"Although this study assesses clinical practices prior to the current
FDA recommendations, the level of follow-up care seen during this period of
time would be considered substandard even according to older guidelines,"
said Stettin. "It is essential for all patients being placed on
antidepressants to be monitored properly, even if the medication is being
used for indications other than depression."
Antidepressant risks
After considerable debate and litigation through the 1990s to the early
part of this decade, there have been concerns about the risk of suicide
linked to antidepressant use. The difficulty of this debate stems from
whether suicides were caused by the antidepressants or the depression they
were meant to treat. The FDA first proposed the black box warning -- the
agency's strongest safety measure short of recalling the drug -- in October
2004 after analysis of available data showed an increase in the risk of
suicidal tendency ("suicidality") among children being treated with certain
antidepressants. The label change was given final approval on January 12,
2005. The new FDA ruling mandates that all antidepressants bear a black box
warning regarding the potential risk of pediatric suicidality.
The FDA is currently reviewing data regarding a possible increased risk
of suicidality in adults using antidepressant medications.
Medco addresses safety
Last year, following the FDA's call for expanded warning labels on
antidepressants, Medco implemented a broad-reaching integrated
communication effort to contact patients, pharmacists and physicians about
the potential risks associated with antidepressant use. Medco immediately
posted product alerts on medco, the company's online pharmacy website.
As quickly as possible, all antidepressant prescriptions filled through
Medco's mail-service pharmacies included updated patient product
information. The company also provided its 3,500 customer service
representatives with up-to-date product information to address patient and
caregiver questions related to use of antidepressants in pediatric
patients.
To reach physicians and pharmacists, Medco continued the use of its
detailed pediatric drug utilization alerts related specifically to
antidepressants. Medco expanded its safety alert rules in its RationalMed
patient safety system, which identifies patients at risk for adverse drug
events which could lead to hospitalization. During 2005, RationalMed issued
222,094 safety alerts for antidepressant use, of which 15 percent were tied
to age considerations of the patient and another 10 percent were tied to
potential interactions with other drugs or other health conditions. Overall
prescription drug savings from therapy changes in response to the alerts
totaled $4.5 million. Medco also distributed practice summaries to
physicians identifying the patients under the age of 18 within their
practice on antidepressants to help physicians evaluate any necessary
changes in therapy.
About Medco
Medco Health Solutions, Inc. (NYSE: MHS) is the nation's leading
pharmacy benefit manager based on its 2005 total net revenues of nearly $38
billion. Medco's prescription drug benefit programs are designed to drive
down the cost of pharmacy health care for private and public employers,
health plans, labor unions and government agencies of all sizes, and for
individuals served by the Medicare Part D Prescription Drug Program.
Medco's technologically advanced mail-order pharmacies and award-winning
Internet pharmacy have been recognized for setting new industry benchmarks
for pharmacy dispensing quality. Medco serves the needs of patients with
complex conditions requiring sophisticated treatment through its specialty
pharmacy operation, which became the nation's largest with the 2005
acquisition of Accredo Health, Incorporated. Medco is the highest-ranked
pharmacy benefit manager on the 2006 Fortune 500 list. On the Net:
medco.
This press release contains "forward-looking statements" as that term
is defined in the Private Securities Litigation Reform Act of 1995. These
statements involve risks and uncertainties that may cause results to differ
materially from those set forth in the statements. No forward-looking
statement can be guaranteed, and actual results may differ materially from
those projected. We undertake no obligation to publicly update any
forward-looking statement, whether as a result of new information, future
events, or otherwise. Forward-looking statements in this press release
should be evaluated together with the risks and uncertainties that affect
our business, particularly those mentioned in the Risk Factors section of
the Company's Annual Report on Form 10-K filed with the Securities and
Exchange Commission.
Medco Health Solutions, Inc.
medco
about suicidal thoughts and behavior for patients using antidepressants, a
new study in the August issue of the peer-reviewed American Journal of
Managed Care shows that few patients on these drugs received even the
minimum level of follow-up care. The Food and Drug Administration (FDA)
requires a "black box" warning, the strongest alert possible, on all
antidepressants for increased risk of suicidal thoughts and behavior in
children and adolescents, and has issued a public health advisory about
those risks for adults.
Current FDA guidelines for both pediatric and adult patients recommend
at least weekly face-to-face visits with a health practitioner during the
first four weeks of antidepressant treatment, then every other week during
the next four weeks, and then a visit after 12 weeks. But according to the
study by Medco Health Solutions, Inc. (NYSE: MHS), nearly half of all
patients have no follow-up visits during the first month of taking
antidepressants, and fewer than 18 percent of patients see a practitioner
specifically for mental health follow-up care during that time period.
The new study found that few patients were monitored closely during the
first three months following the start of antidepressant therapy. The
study, which reviewed medical and pharmacy claims of 84,500 pediatric and
adult patients, found that less than 15 percent of patients received the
FDA's current recommended level of follow-up care in the first four weeks
of drug treatment, 18 percent at eight weeks, and 23 percent at 12 weeks.
?
"This study brings to light potentially serious inadequacies in the
follow-up care of patients on antidepressants," said Dr. Glen Stettin,
senior vice president of clinical solutions for Medco and lead author of
the study. "Not only is close monitoring needed to reduce the risk of
adverse outcomes including suicidal tendencies, but also to assess a
patient's response to the treatment, make adjustments to drug dosages when
necessary and help manage side-effects that can lead to poor compliance or
the discontinuation of therapy, which can have extremely negative
consequences as well."
While fewer than half of children 18 years and younger saw a
practitioner at least once for mental health care follow-up in the first
few months of antidepressant treatment, adult visits were even less
frequent:
-- 66 percent of children and 83 percent of adults did not see a
clinician for a mental health care visit in the first four weeks
after antidepressant therapy had begun
-- 58 percent of children and 78 percent of adults had not had such a
visit within 8 weeks
-- 53 percent of children and nearly 76 percent of adult patients had no
mental health care visits during the first 12 weeks of drug therapy
While the study found that general medical visits were more common than
mental health care visits in the first few weeks and months of
antidepressant treatment, still 45 percent of patients saw no health
clinician at all in the first four weeks of drug therapy, more than 30
percent did not see a health provider within eight weeks and 23 percent had
no medical visits at all within 12 weeks.
The retrospective study included 84,500 adult and pediatric patients
who started on a new course of antidepressant therapy between July 2001 and
September 2003. Using an integrated database of medical and pharmacy
claims, the number of health provider visits was identified by reviewing
medical claim information for these patients. The patients all had mental
health care coverage as participants in medical and pharmacy benefit plans
administered by a large managed care organization in the northeastern
United States.
"Although this study assesses clinical practices prior to the current
FDA recommendations, the level of follow-up care seen during this period of
time would be considered substandard even according to older guidelines,"
said Stettin. "It is essential for all patients being placed on
antidepressants to be monitored properly, even if the medication is being
used for indications other than depression."
Antidepressant risks
After considerable debate and litigation through the 1990s to the early
part of this decade, there have been concerns about the risk of suicide
linked to antidepressant use. The difficulty of this debate stems from
whether suicides were caused by the antidepressants or the depression they
were meant to treat. The FDA first proposed the black box warning -- the
agency's strongest safety measure short of recalling the drug -- in October
2004 after analysis of available data showed an increase in the risk of
suicidal tendency ("suicidality") among children being treated with certain
antidepressants. The label change was given final approval on January 12,
2005. The new FDA ruling mandates that all antidepressants bear a black box
warning regarding the potential risk of pediatric suicidality.
The FDA is currently reviewing data regarding a possible increased risk
of suicidality in adults using antidepressant medications.
Medco addresses safety
Last year, following the FDA's call for expanded warning labels on
antidepressants, Medco implemented a broad-reaching integrated
communication effort to contact patients, pharmacists and physicians about
the potential risks associated with antidepressant use. Medco immediately
posted product alerts on medco, the company's online pharmacy website.
As quickly as possible, all antidepressant prescriptions filled through
Medco's mail-service pharmacies included updated patient product
information. The company also provided its 3,500 customer service
representatives with up-to-date product information to address patient and
caregiver questions related to use of antidepressants in pediatric
patients.
To reach physicians and pharmacists, Medco continued the use of its
detailed pediatric drug utilization alerts related specifically to
antidepressants. Medco expanded its safety alert rules in its RationalMed
patient safety system, which identifies patients at risk for adverse drug
events which could lead to hospitalization. During 2005, RationalMed issued
222,094 safety alerts for antidepressant use, of which 15 percent were tied
to age considerations of the patient and another 10 percent were tied to
potential interactions with other drugs or other health conditions. Overall
prescription drug savings from therapy changes in response to the alerts
totaled $4.5 million. Medco also distributed practice summaries to
physicians identifying the patients under the age of 18 within their
practice on antidepressants to help physicians evaluate any necessary
changes in therapy.
About Medco
Medco Health Solutions, Inc. (NYSE: MHS) is the nation's leading
pharmacy benefit manager based on its 2005 total net revenues of nearly $38
billion. Medco's prescription drug benefit programs are designed to drive
down the cost of pharmacy health care for private and public employers,
health plans, labor unions and government agencies of all sizes, and for
individuals served by the Medicare Part D Prescription Drug Program.
Medco's technologically advanced mail-order pharmacies and award-winning
Internet pharmacy have been recognized for setting new industry benchmarks
for pharmacy dispensing quality. Medco serves the needs of patients with
complex conditions requiring sophisticated treatment through its specialty
pharmacy operation, which became the nation's largest with the 2005
acquisition of Accredo Health, Incorporated. Medco is the highest-ranked
pharmacy benefit manager on the 2006 Fortune 500 list. On the Net:
medco.
This press release contains "forward-looking statements" as that term
is defined in the Private Securities Litigation Reform Act of 1995. These
statements involve risks and uncertainties that may cause results to differ
materially from those set forth in the statements. No forward-looking
statement can be guaranteed, and actual results may differ materially from
those projected. We undertake no obligation to publicly update any
forward-looking statement, whether as a result of new information, future
events, or otherwise. Forward-looking statements in this press release
should be evaluated together with the risks and uncertainties that affect
our business, particularly those mentioned in the Risk Factors section of
the Company's Annual Report on Form 10-K filed with the Securities and
Exchange Commission.
Medco Health Solutions, Inc.
medco
суббота, 13 августа 2011 г.
A Call For Standardized Measurement Of Outcomes In Depression Treatment
Rhode Island Hospital and Brown University researchers are calling on clinicians to adopt a standardized measurement of outcomes when treating depression. The commentary was published in the June edition of Primary Psychiatry.
Researchers led by Mark Zimmerman, M.D., noted that quantified measurement of outcome is rarely done when treating depression, yet to determine the impact of treatment it is necessary to evaluate outcome. It provides the clinician with a concrete way to assess the degree and completeness of treatment success. However, studies among clinicians in both the United States and the United Kingdom confirm that the vast majority of psychiatrists did not routinely use scales to monitor outcome when treating depression, with less than 10 percent reporting that they always used scales to monitor outcome.
Zimmerman and the researchers determined that one issue serving as an obstacle to evaluating outcomes is a perception of the added burden, as clinicians are already overburdened with paperwork. Because of this, the Rhode Island Hospital team has suggested the use of a self-report questionnaire as a cost-effective option that highly correlates with clinician ratings. A self-report can be brief and will provide clinicians with useful information, improve the efficiency of conducting their clinical evaluation and therefore this measure has a practical value for the clinician.
In addition, the team developed a scale for clinical utility. Known as the Clinically Useful Depression Outcome Scale (CUDOS), it contains 18 items that assess all of the DSM-IV inclusion criteria for major depressive disorder and dysthymic disorder as well as psychosocial impairment and quality of life. The 16 symptoms items are rated on a 5-point Likert scale in order to keep the scale brief. Studies by the research team found the CUDOS to be a reliable and valid measure of depressive symptoms that is sensitive to clinical change and can be used to determine whether depressed patients have remitted from treatment.
Zimmerman notes, "Unlike other areas of medical care that can measure outcomes on numerical values like body temperature, blood pressure and other quantifiable variables, psychiatry is the only medical discipline in which quantified measurements of outcome are not the standard of care. We believe that it is critical to do so, and that systematic outcome assessment will assume an increasing importance during the next decade, if for no other reason that payor mandates will require it."
Zimmerman concludes, "There may be only limited data suggesting that measurement might improve outcome when treating depression; however, there is no reason to wait until such studies are done to provide the benefit of measurement-based care in the treatment of depression. Frankly, there is little downside to adopting this approach as part of an overall treatment plan for the depressed patient."
The commentary and the ensuing recommendations are from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project, for which Zimmerman is the principal investigator. Zimmerman said, "The MIDAS project is unique in its integration of research quality diagnostic methods into a community-based outpatient practice affiliated with an academic medical center."
Founded in 1863, Rhode Island Hospital (rhodeislandhospital/) is a private, not-for-profit hospital and is the largest teaching hospital of The Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Rhode Island Hospital ranks among the top independent hospitals that receive funding from the National Institutes of Health, with research awards of nearly $27 million annually. Many of its physicians are recognized as leaders in their respective fields of cancer, cardiology, diabetes, orthopedics and minimally invasive surgery. The hospital's pediatrics division, Hasbro Children's Hospital, has pioneered numerous procedures and is at the forefront of fetal surgery, orthopedics and pediatric neurosurgery. Rhode Island Hospital is a founding member of the Lifespan health system.
Researchers led by Mark Zimmerman, M.D., noted that quantified measurement of outcome is rarely done when treating depression, yet to determine the impact of treatment it is necessary to evaluate outcome. It provides the clinician with a concrete way to assess the degree and completeness of treatment success. However, studies among clinicians in both the United States and the United Kingdom confirm that the vast majority of psychiatrists did not routinely use scales to monitor outcome when treating depression, with less than 10 percent reporting that they always used scales to monitor outcome.
Zimmerman and the researchers determined that one issue serving as an obstacle to evaluating outcomes is a perception of the added burden, as clinicians are already overburdened with paperwork. Because of this, the Rhode Island Hospital team has suggested the use of a self-report questionnaire as a cost-effective option that highly correlates with clinician ratings. A self-report can be brief and will provide clinicians with useful information, improve the efficiency of conducting their clinical evaluation and therefore this measure has a practical value for the clinician.
In addition, the team developed a scale for clinical utility. Known as the Clinically Useful Depression Outcome Scale (CUDOS), it contains 18 items that assess all of the DSM-IV inclusion criteria for major depressive disorder and dysthymic disorder as well as psychosocial impairment and quality of life. The 16 symptoms items are rated on a 5-point Likert scale in order to keep the scale brief. Studies by the research team found the CUDOS to be a reliable and valid measure of depressive symptoms that is sensitive to clinical change and can be used to determine whether depressed patients have remitted from treatment.
Zimmerman notes, "Unlike other areas of medical care that can measure outcomes on numerical values like body temperature, blood pressure and other quantifiable variables, psychiatry is the only medical discipline in which quantified measurements of outcome are not the standard of care. We believe that it is critical to do so, and that systematic outcome assessment will assume an increasing importance during the next decade, if for no other reason that payor mandates will require it."
Zimmerman concludes, "There may be only limited data suggesting that measurement might improve outcome when treating depression; however, there is no reason to wait until such studies are done to provide the benefit of measurement-based care in the treatment of depression. Frankly, there is little downside to adopting this approach as part of an overall treatment plan for the depressed patient."
The commentary and the ensuing recommendations are from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project, for which Zimmerman is the principal investigator. Zimmerman said, "The MIDAS project is unique in its integration of research quality diagnostic methods into a community-based outpatient practice affiliated with an academic medical center."
Founded in 1863, Rhode Island Hospital (rhodeislandhospital/) is a private, not-for-profit hospital and is the largest teaching hospital of The Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Rhode Island Hospital ranks among the top independent hospitals that receive funding from the National Institutes of Health, with research awards of nearly $27 million annually. Many of its physicians are recognized as leaders in their respective fields of cancer, cardiology, diabetes, orthopedics and minimally invasive surgery. The hospital's pediatrics division, Hasbro Children's Hospital, has pioneered numerous procedures and is at the forefront of fetal surgery, orthopedics and pediatric neurosurgery. Rhode Island Hospital is a founding member of the Lifespan health system.
среда, 10 августа 2011 г.
Suicide Report To Aid Prevention Initiatives
Older people are more successful than any other age group at committing suicide, a new report has revealed.
Staffordshire University academic Derek Beeston from the Centre for Ageing and Mental Health was commissioned to look at the issue by Care Services Improvement Partnership (CSIP) West Midlands.
The findings, derived from a systematic review of research on suicide in older people, will form the backbone of a specialist conference to be hosted at the University's Beaconside campus today (March 27) and which is set to be attended by world experts in the field of depression and suicide.
The review, which highlights the fact that people over 65 are more successful than any other age group at taking their own lives, has already been endorsed by the Royal College of General Practitioners, which has responded by issuing a new guidance to assist family doctors in preventing suicide in older people.
The report Older People and Suicide also finds that discrimination and ageism is evident in primary care and that symptoms of depression are not being identified or treated as they would in younger people.
Key findings include:
- The strongest predictor of eventual suicide for an older person is past attempts
- The suicide of an older person can frequently come 'out of the blue'.
- Attempted suicide by an older person is more likely to result in a future death by suicide than is the case with younger people.
- Many front line staff may misread the signs as being part of 'what it is to be old' or everyday 'wear and tear of life'.
- Suicide in older people is a complex problem which requires interventions in the form of combating stigma, community building and positive social policy initiatives alongside physical health promotion initiatives such as regular health screening.
-Early dementia and retirement are risk factors for suicide in older people.
- Primary care workers should be particularly vigilant for depression in older patients who may also have physical conditions that affect quality of life.
-The identification treatment and management of depression in older people is significant factor in the prevention of suicide
- Some suicides may be prevented by restriction to access of means of suicide such as discouraging the hoarding of prescription and over the counter drugs.
The work, which was completed over nine months, has also been presented to Dr Hugh Griffiths, Deputy Director for Mental Health at the Department of Health and has been brought to the attention of Professor Louis Appleby, the Government's Mental Health Tsar. Professor Appleby has led the National Suicide Prevention Strategy and has filmed an introduction for the conference.
"This work may ultimately have an impact on the National Suicide Prevention strategy," said Derek. "The challenges arising from the review are concerned with tackling discrimination and treating depression as the findings suggest that around two thirds of suicides in olderpeople could probably be avoided.
"Among the 16 to 25 year old agegroup, for every 200 attempts there is one suicide. In males aged over 80 for every two attempt there is one suicide."
STAFFORDSHIRE UNIVERSITY
College Road
Stoke on Trent
Staffordshire
ST4 2DE
staffs.ac.uk
Staffordshire University academic Derek Beeston from the Centre for Ageing and Mental Health was commissioned to look at the issue by Care Services Improvement Partnership (CSIP) West Midlands.
The findings, derived from a systematic review of research on suicide in older people, will form the backbone of a specialist conference to be hosted at the University's Beaconside campus today (March 27) and which is set to be attended by world experts in the field of depression and suicide.
The review, which highlights the fact that people over 65 are more successful than any other age group at taking their own lives, has already been endorsed by the Royal College of General Practitioners, which has responded by issuing a new guidance to assist family doctors in preventing suicide in older people.
The report Older People and Suicide also finds that discrimination and ageism is evident in primary care and that symptoms of depression are not being identified or treated as they would in younger people.
Key findings include:
- The strongest predictor of eventual suicide for an older person is past attempts
- The suicide of an older person can frequently come 'out of the blue'.
- Attempted suicide by an older person is more likely to result in a future death by suicide than is the case with younger people.
- Many front line staff may misread the signs as being part of 'what it is to be old' or everyday 'wear and tear of life'.
- Suicide in older people is a complex problem which requires interventions in the form of combating stigma, community building and positive social policy initiatives alongside physical health promotion initiatives such as regular health screening.
-Early dementia and retirement are risk factors for suicide in older people.
- Primary care workers should be particularly vigilant for depression in older patients who may also have physical conditions that affect quality of life.
-The identification treatment and management of depression in older people is significant factor in the prevention of suicide
- Some suicides may be prevented by restriction to access of means of suicide such as discouraging the hoarding of prescription and over the counter drugs.
The work, which was completed over nine months, has also been presented to Dr Hugh Griffiths, Deputy Director for Mental Health at the Department of Health and has been brought to the attention of Professor Louis Appleby, the Government's Mental Health Tsar. Professor Appleby has led the National Suicide Prevention Strategy and has filmed an introduction for the conference.
"This work may ultimately have an impact on the National Suicide Prevention strategy," said Derek. "The challenges arising from the review are concerned with tackling discrimination and treating depression as the findings suggest that around two thirds of suicides in olderpeople could probably be avoided.
"Among the 16 to 25 year old agegroup, for every 200 attempts there is one suicide. In males aged over 80 for every two attempt there is one suicide."
STAFFORDSHIRE UNIVERSITY
College Road
Stoke on Trent
Staffordshire
ST4 2DE
staffs.ac.uk
воскресенье, 7 августа 2011 г.
Depression Turns Off The Music In The Mother-Baby Dance
Your newborn is crying. If it's a cry of pain, you're going to respond more strongly than you would to a cry of hunger - that's the normal pattern. But if you suffer from post-partum depression, the difference between your response to the pain cry and the hunger cry is going to be even greater. And this, says psychologist Alison Fleming, isn't necessarily a good thing.
As part of a study funded by the Canadian Institutes of Health Research (CIHR), Dr. Fleming, together with her student, Andrea Gonzalez, and collaborator, Meir Steiner, played recordings of newborns' cries. Depressed women, she says, showed more anxiety in response to the pain cry than new mothers who aren't depressed.
"We know that, compared to non-depressed mothers, depressed moms respond less sensitively and more negatively to their infants," says Fleming, a researcher from the University of Toronto (Mississauga). "In this case, their anxiety and their negative feelings could affect their ability to soothe their babies and cope with their distress."
Fleming describes the mother-baby relationship as a dance: baby smiles, mom smiles back; baby vocalizes, mom vocalizes back. Depressed mothers, she has found, have more difficulty interacting with their babies - they don't take part in the dance, as it were.
"They may show little positive affect," she says. "Or they may become agitated and overly - but inappropriately - responsive."
Fleming wants to know more about why women with post-partum depression respond so differently to their babies. So for her next research study (also funded by CIHR), she and her colleagues will use functional magnetic resonance imaging, or fMRI, to see what is happening in the brains of depressed and non-depressed mothers while they look at pictures or hear cries of their babies. A better understanding of how the brain functions in women with post-partum depression could lead to possible interventions, as well as programs to prevent the depression and assist in child development.
But the best prescription for post-partum depression, Fleming says, at least in less severe cases, could be as simple as getting out of the house, spending more time with other people and soliciting support from family and friends.
While anywhere from 15-20% of women in Canada and other western countries experience this depression during the first postpartum weeks, Fleming says, it is not universal across all cultures. In Canada, a lack of extended family networks is coupled with long winters when people stay indoors. Women may feel isolated, particularly when their partners return to work and they are alone for most of the day.
Fortunately, Fleming adds, post-partum depression tends to pass by the time babies are four-to-six months old. When it is more severe, however, it can have negative impacts on both mothers and their babies.
"If mothers stay depressed, babies can have problems with their own social and emotional development later on," Fleming says. "For both moms and their babies, it is really important that mothers experiencing extreme postpartum anxiety or depression talk to their physicians or other health-care providers."
Canadian Institutes of Health Research CIHR
As part of a study funded by the Canadian Institutes of Health Research (CIHR), Dr. Fleming, together with her student, Andrea Gonzalez, and collaborator, Meir Steiner, played recordings of newborns' cries. Depressed women, she says, showed more anxiety in response to the pain cry than new mothers who aren't depressed.
"We know that, compared to non-depressed mothers, depressed moms respond less sensitively and more negatively to their infants," says Fleming, a researcher from the University of Toronto (Mississauga). "In this case, their anxiety and their negative feelings could affect their ability to soothe their babies and cope with their distress."
Fleming describes the mother-baby relationship as a dance: baby smiles, mom smiles back; baby vocalizes, mom vocalizes back. Depressed mothers, she has found, have more difficulty interacting with their babies - they don't take part in the dance, as it were.
"They may show little positive affect," she says. "Or they may become agitated and overly - but inappropriately - responsive."
Fleming wants to know more about why women with post-partum depression respond so differently to their babies. So for her next research study (also funded by CIHR), she and her colleagues will use functional magnetic resonance imaging, or fMRI, to see what is happening in the brains of depressed and non-depressed mothers while they look at pictures or hear cries of their babies. A better understanding of how the brain functions in women with post-partum depression could lead to possible interventions, as well as programs to prevent the depression and assist in child development.
But the best prescription for post-partum depression, Fleming says, at least in less severe cases, could be as simple as getting out of the house, spending more time with other people and soliciting support from family and friends.
While anywhere from 15-20% of women in Canada and other western countries experience this depression during the first postpartum weeks, Fleming says, it is not universal across all cultures. In Canada, a lack of extended family networks is coupled with long winters when people stay indoors. Women may feel isolated, particularly when their partners return to work and they are alone for most of the day.
Fortunately, Fleming adds, post-partum depression tends to pass by the time babies are four-to-six months old. When it is more severe, however, it can have negative impacts on both mothers and their babies.
"If mothers stay depressed, babies can have problems with their own social and emotional development later on," Fleming says. "For both moms and their babies, it is really important that mothers experiencing extreme postpartum anxiety or depression talk to their physicians or other health-care providers."
Canadian Institutes of Health Research CIHR
четверг, 4 августа 2011 г.
Update On Lu AA21004 Clinical Development Programme In Major Depressive Disorder (MDD)
H. Lundbeck A/S (Lundbeck) and Takeda Pharmaceutical Company Limited (Takeda) jointly announced headline results from the first three clinical trials in the phase III development programme with Lu AA21004 in major depressive disorder (MDD). Previously reported clinical phase II data showed equal efficacy with the 5 and 10 mg doses.
In the recently completed phase III clinical trials, Lu AA21004 was tested in doses of 2.5, 5 and 10 mg. Results from two studies, which included the lower dosages, 2.5 and 5 mg, did not reach significance across studies when compared with placebo.
A third trial demonstrated mixed results, with the 2.5 mg dose not reaching statistical significance compared to placebo, and the 5 and 10 mg doses showing separation from placebo, although not in all analyses. These results also suggest that a higher dose may be more efficacious.
In all of these trials, Lu AA21004 was well tolerated and confirmed the previously observed favourable safety profile.
As a result, the most appropriate dose of Lu AA21004 needs to be established. It is anticipated that this work will postpone submission of the new drug application (NDA) in the US with approximately 18-24 months. Lundbeck and Takeda will continue to work with the U.S. Food and Drug Administration (FDA) and other regulatory agencies on the clinical development program and submission plans.
Lu AA21004 is also in phase III development for generalised anxiety disorder (GAD).
About depression
Depression is a very common, debilitating illness affecting around 121 million people worldwide. Depression is not at all recognised by society as the serious disorder it actually is. The symptoms of depression can be chronic or recurrent, and impact patients both mentally and physically. Depression has a significant impact on patient quality of life and imposes a considerable burden on society, yet it is still under-recognised and undertreated with less than 25 percent of those affected having access to effective treatment.
Symptoms include feelings of sadness, anxiety, loss of interest in activities, decreased energy, impaired sleep, impaired concentration, hopelessness, guilt, persistent physical symptoms such as pain and digestive disorders, and in more severe cases, suicidal thoughts and suicide attempts.
Takeda and Lundbeck alliance
In September 2007, H. Lundbeck A/S and Takeda Pharmaceutical Company Limited formed a strategic alliance for the exclusive co-development and co-commercialization in the United States and Japan of several compounds in Lundbeck's pipeline for the treatment of mood and anxiety disorders. The partnership initially focuses on co-development and co-commercialization of the two most advanced compounds in Lundbeck's pipeline for mood and anxiety disorders, Lu AA21004 and Lu AA24530. Once approved, the companies will co-promote the products in the United States and Japan.
About Lundbeck
H. Lundbeck A/S (LUN.CO, LUN DC, HLUKY) is an international pharmaceutical company highly committed to improve the quality of life for people suffering from central nervous system (CNS) disorders. For this purpose Lundbeck is engaged in the research and development, production, marketing and sale of pharmaceuticals across the world, targeted at disorders like depression and anxiety, schizophrenia, insomnia, Huntington's, Alzheimer's and Parkinson's diseases.
Lundbeck was founded in 1915 by Hans Lundbeck in Copenhagen, Denmark, and employs today over 5,500 people worldwide. Lundbeck is one of the world's leading pharmaceutical companies working with CNS disorders. In 2008, the company's revenue was DKK 11.3 billion (approximately EUR 1.5 billion or USD 2.2 billion).
About Takeda
Located in Osaka, Japan, Takeda (TSE:4502) is a research-based global company with its main focus on pharmaceuticals. As the largest pharmaceutical company in Japan and one of the global leaders of the industry, Takeda is committed to striving toward better health for individuals and progress in medicine by developing superior pharmaceutical products.
In the recently completed phase III clinical trials, Lu AA21004 was tested in doses of 2.5, 5 and 10 mg. Results from two studies, which included the lower dosages, 2.5 and 5 mg, did not reach significance across studies when compared with placebo.
A third trial demonstrated mixed results, with the 2.5 mg dose not reaching statistical significance compared to placebo, and the 5 and 10 mg doses showing separation from placebo, although not in all analyses. These results also suggest that a higher dose may be more efficacious.
In all of these trials, Lu AA21004 was well tolerated and confirmed the previously observed favourable safety profile.
As a result, the most appropriate dose of Lu AA21004 needs to be established. It is anticipated that this work will postpone submission of the new drug application (NDA) in the US with approximately 18-24 months. Lundbeck and Takeda will continue to work with the U.S. Food and Drug Administration (FDA) and other regulatory agencies on the clinical development program and submission plans.
Lu AA21004 is also in phase III development for generalised anxiety disorder (GAD).
About depression
Depression is a very common, debilitating illness affecting around 121 million people worldwide. Depression is not at all recognised by society as the serious disorder it actually is. The symptoms of depression can be chronic or recurrent, and impact patients both mentally and physically. Depression has a significant impact on patient quality of life and imposes a considerable burden on society, yet it is still under-recognised and undertreated with less than 25 percent of those affected having access to effective treatment.
Symptoms include feelings of sadness, anxiety, loss of interest in activities, decreased energy, impaired sleep, impaired concentration, hopelessness, guilt, persistent physical symptoms such as pain and digestive disorders, and in more severe cases, suicidal thoughts and suicide attempts.
Takeda and Lundbeck alliance
In September 2007, H. Lundbeck A/S and Takeda Pharmaceutical Company Limited formed a strategic alliance for the exclusive co-development and co-commercialization in the United States and Japan of several compounds in Lundbeck's pipeline for the treatment of mood and anxiety disorders. The partnership initially focuses on co-development and co-commercialization of the two most advanced compounds in Lundbeck's pipeline for mood and anxiety disorders, Lu AA21004 and Lu AA24530. Once approved, the companies will co-promote the products in the United States and Japan.
About Lundbeck
H. Lundbeck A/S (LUN.CO, LUN DC, HLUKY) is an international pharmaceutical company highly committed to improve the quality of life for people suffering from central nervous system (CNS) disorders. For this purpose Lundbeck is engaged in the research and development, production, marketing and sale of pharmaceuticals across the world, targeted at disorders like depression and anxiety, schizophrenia, insomnia, Huntington's, Alzheimer's and Parkinson's diseases.
Lundbeck was founded in 1915 by Hans Lundbeck in Copenhagen, Denmark, and employs today over 5,500 people worldwide. Lundbeck is one of the world's leading pharmaceutical companies working with CNS disorders. In 2008, the company's revenue was DKK 11.3 billion (approximately EUR 1.5 billion or USD 2.2 billion).
About Takeda
Located in Osaka, Japan, Takeda (TSE:4502) is a research-based global company with its main focus on pharmaceuticals. As the largest pharmaceutical company in Japan and one of the global leaders of the industry, Takeda is committed to striving toward better health for individuals and progress in medicine by developing superior pharmaceutical products.
понедельник, 1 августа 2011 г.
Individuals With High Fear Of Crime Twice As Likely To Suffer From Depression, UK
A new UCL (University College London) study has shown that people with a
strong fear of crime are almost twice as likely to show symptoms of
depression. The research, based on data taken from the Whitehall II
study*, also shows that fear of crime is associated with decreased
physical functioning and lower quality of life. The findings are published
in the American Journal of Public Health.
The study's lead author, Dr Mai Stafford, UCL Epidemiology & Public
Health, said: "Very broadly, these results show that if your fear of crime
levels are higher, your health is likely to be worse - particularly your
mental health. Of course, you might expect that people who are depressed
or frail might be more afraid of crime and venturing out of doors, so we
have taken account of previous mental health problems and physical frailty
and adjusted for those accordingly. Even with a level playing field, the
data still demonstrates this strong link between fear of crime and poorer
mental health.
"What's also key here is that the 6,500 participants were not very
elderly - they were all aged between 50 and 75, many were still working,
and they're generally a pretty healthy group of people. Overall, the data
strongly suggests not simply that people who are vulnerable due to their
health or age are more frightened, but that being frightened of crime is
in itself contributing to their poor mental health and quality of life."
Alongside a comprehensive medical examination, study participants were
asked to report on how worried they felt about crime. They rated their
concern on a scale from 'not worried' to 'very worried', about particular
events happening in their neighbourhood: their home being broken into,
being mugged or robbed, their car being stolen or things being stolen from
the car, and being raped.
The researchers then compared the results with data collected about their
mental and physical health - symptoms of anxiety and depression, physical
function, and quality of life. After adjusting for age, gender, employment
grade, length of residence and previous mental health status, researchers
found that participants with a high fear of crime were 1.93 times as
likely to exhibit symptoms of depression and 1.75 times as likely to
exhibit symptoms of anxiety, than those reporting low fear of crime. These
people exercised less, saw friends less often and participated in fewer
social activities compared with less fearful participants.
Dr Stafford explains that: "Things that influence our behaviour influence
our health. One behavioural response to fear of crime is avoidance, so in
this case fear of crime may stop some people taking part in the physical
and social activities that are so good for health and wellbeing. If you
are fearful, you are less willing to go out socially and less inclined to
take physical activity. This impacts heavily on people's mental health and
overall quality of life, as well as having an impact on their physical
health, albeit less pronounced. It seems likely that if we work to reduce
fear of crime, we could actually improve people's health."
Commenting on the findings**, Professor Gloria Laycock, UCL Jill Dando
Institute of Crime Science, said: "Research does suggest that irrespective
of recorded crime levels, public perceptions are that crime is on the
increase. Even though data from the British Crime Survey (BCS) shows that
crime has fallen in the last decade, people believe that crime is rising -
around two in three people believe that crime nationally has increased in
the last two years and two in five people think that crime in their local
area has increased.
"It is very interesting that people's perceptions of overall crime remain
out of kilter with the figures and that these perceptions could actually
have a significant impact on health. We must do more to educate people
about the realities of their vulnerability to crime, as well as taking
action to reduce fear of crime on a local and national level. For example,
we need to look at the ways in which crime is reported in the national and
local press and be sure to avoid sensationalism."
1. *The 'Whitehall II' study originates from the first Whitehall study of
18,000 men in the Civil Service, set up in 1967. The first Whitehall study
showed that men in the lowest employment grades were much more likely to
die prematurely than men in the highest grades. The Whitehall II
longitudinal study was set up to determine what underlies the social
gradient in death and disease and to include women.
2. **Please note that professor Gloria Laycock was not involved in this
research, and is solely giving comment on its findings
3. Statistics are taken from the report Crime in England and Wales
2006/07. The summary document can be found
here.
About UCL
Founded in 1826, UCL was the first English university established after
Oxford and Cambridge, the first to admit students regardless of race,
class, religion or gender, and the first to provide systematic teaching of
law, architecture and medicine. In the government's most recent Research
Assessment Exercise, 59 UCL departments achieved top ratings of 5* and 5,
indicating research quality of international excellence.
UCL is the fourth-ranked UK University in the 2006 league table of the top
500 world Universities produced by the Shanghai Jiao Tong University. UCL
alumni include Mahatma Gandhi (Laws 1889, Indian political and spiritual
leader); Jonathan Dimbleby (Philosophy 1969, writer and television
presenter); Alexander Graham Bell (Phonetics 1860s, inventor of the
telephone), and members of the band Coldplay.
University College London
strong fear of crime are almost twice as likely to show symptoms of
depression. The research, based on data taken from the Whitehall II
study*, also shows that fear of crime is associated with decreased
physical functioning and lower quality of life. The findings are published
in the American Journal of Public Health.
The study's lead author, Dr Mai Stafford, UCL Epidemiology & Public
Health, said: "Very broadly, these results show that if your fear of crime
levels are higher, your health is likely to be worse - particularly your
mental health. Of course, you might expect that people who are depressed
or frail might be more afraid of crime and venturing out of doors, so we
have taken account of previous mental health problems and physical frailty
and adjusted for those accordingly. Even with a level playing field, the
data still demonstrates this strong link between fear of crime and poorer
mental health.
"What's also key here is that the 6,500 participants were not very
elderly - they were all aged between 50 and 75, many were still working,
and they're generally a pretty healthy group of people. Overall, the data
strongly suggests not simply that people who are vulnerable due to their
health or age are more frightened, but that being frightened of crime is
in itself contributing to their poor mental health and quality of life."
Alongside a comprehensive medical examination, study participants were
asked to report on how worried they felt about crime. They rated their
concern on a scale from 'not worried' to 'very worried', about particular
events happening in their neighbourhood: their home being broken into,
being mugged or robbed, their car being stolen or things being stolen from
the car, and being raped.
The researchers then compared the results with data collected about their
mental and physical health - symptoms of anxiety and depression, physical
function, and quality of life. After adjusting for age, gender, employment
grade, length of residence and previous mental health status, researchers
found that participants with a high fear of crime were 1.93 times as
likely to exhibit symptoms of depression and 1.75 times as likely to
exhibit symptoms of anxiety, than those reporting low fear of crime. These
people exercised less, saw friends less often and participated in fewer
social activities compared with less fearful participants.
Dr Stafford explains that: "Things that influence our behaviour influence
our health. One behavioural response to fear of crime is avoidance, so in
this case fear of crime may stop some people taking part in the physical
and social activities that are so good for health and wellbeing. If you
are fearful, you are less willing to go out socially and less inclined to
take physical activity. This impacts heavily on people's mental health and
overall quality of life, as well as having an impact on their physical
health, albeit less pronounced. It seems likely that if we work to reduce
fear of crime, we could actually improve people's health."
Commenting on the findings**, Professor Gloria Laycock, UCL Jill Dando
Institute of Crime Science, said: "Research does suggest that irrespective
of recorded crime levels, public perceptions are that crime is on the
increase. Even though data from the British Crime Survey (BCS) shows that
crime has fallen in the last decade, people believe that crime is rising -
around two in three people believe that crime nationally has increased in
the last two years and two in five people think that crime in their local
area has increased.
"It is very interesting that people's perceptions of overall crime remain
out of kilter with the figures and that these perceptions could actually
have a significant impact on health. We must do more to educate people
about the realities of their vulnerability to crime, as well as taking
action to reduce fear of crime on a local and national level. For example,
we need to look at the ways in which crime is reported in the national and
local press and be sure to avoid sensationalism."
1. *The 'Whitehall II' study originates from the first Whitehall study of
18,000 men in the Civil Service, set up in 1967. The first Whitehall study
showed that men in the lowest employment grades were much more likely to
die prematurely than men in the highest grades. The Whitehall II
longitudinal study was set up to determine what underlies the social
gradient in death and disease and to include women.
2. **Please note that professor Gloria Laycock was not involved in this
research, and is solely giving comment on its findings
3. Statistics are taken from the report Crime in England and Wales
2006/07. The summary document can be found
here.
About UCL
Founded in 1826, UCL was the first English university established after
Oxford and Cambridge, the first to admit students regardless of race,
class, religion or gender, and the first to provide systematic teaching of
law, architecture and medicine. In the government's most recent Research
Assessment Exercise, 59 UCL departments achieved top ratings of 5* and 5,
indicating research quality of international excellence.
UCL is the fourth-ranked UK University in the 2006 league table of the top
500 world Universities produced by the Shanghai Jiao Tong University. UCL
alumni include Mahatma Gandhi (Laws 1889, Indian political and spiritual
leader); Jonathan Dimbleby (Philosophy 1969, writer and television
presenter); Alexander Graham Bell (Phonetics 1860s, inventor of the
telephone), and members of the band Coldplay.
University College London
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