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Dowrick C.,University of Liverpool | Flach C.,Institute of Psychiatry | Leese M.,Institute of Psychiatry | Chatwin J.,University of Southampton | And 8 more authors.
Psychological Medicine | Year: 2011

Background It is important for doctors and patients to know what factors help recovery from depression. Our objectives were to predict the probability of sustained recovery for patients presenting with mild to moderate depression in primary care and to devise a means of estimating this probability on an individual basis.Method Participants in a randomized controlled trial were identified through general practitioners (GPs) around three academic centres in England. Participants were aged >18 years, with Hamilton Depression Rating Scale (HAMD) scores 12-19 inclusive, and at least one physical symptom on the Bradford Somatic Inventory (BSI). Baseline assessments included demographics, treatment preference, life events and difficulties and health and social care use. The outcome was sustained recovery, defined as HAMD score <8 at both 12 and 26 week follow-up. We produced a predictive model of outcome using logistic regression clustered by GP and created a probability tree to demonstrate estimated probability of recovery at the individual level.Results Of 220 participants, 74% provided HAMD scores at 12 and 26 weeks. A total of 39 (24%) achieved sustained recovery, associated with being female, married/cohabiting, having a low BSI score and receiving preferred treatment. A linear predictor gives individual probabilities for sustained recovery given specific characteristics and probability trees illustrate the range of probabilities and their uncertainties for some important combinations of factors.Conclusions Sustained recovery from mild to moderate depression in primary care appears more likely for women, people who are married or cohabiting, have few somatic symptoms and receive their preferred treatment. © 2010 Cambridge University Press.

Lim S.,Yonsei University | Chung W.,Institute of Health Services Research | Kim H.,Yonsei University | Lee S.,Health Insurance Policy Research Institute
Health Policy | Year: 2010

Objective: This study aimed to identify the most influential socioeconomic indicator of smoking in South Korea. Methods: This study analyzed a nationally representative sample (6141 men and 7133 women aged 20-65) from the 2001 and 2005 Korea National Health and Nutrition Surveys. Weighted estimates were computed, adjusting for a complex survey design using "surveyfreq" and "surveylogistic" procedures of SAS 9.1 software. Results: The adjusted OR for smoking in renters compared to homeowners was 1.50 (95% CI: 1.32-1.71) in men and 3.21 (95% CI: 2.41-4.27) in women, and larger in the older than younger groups. For non-married versus married individuals, the OR was 1.37 (95% CI: 1.19-1.59) in men and 3.25 (95% CI: 2.48-4.25) in women; the OR in non-married renters compared married homeowners was 1.79 (95% CI: 1.45-2.22) in men and 10.63 (95% CI: 7.31-15.45) in women. Conclusion: Housing tenure was a strong predictor of smoking in South Korea and its significance was very pronounced in non-married individuals. Housing policies to encourage homeownership could be effective in reducing smoking in countries such as China, India, and Vietnam where house ownership is regarded as the ultimate financial safeguard, there are numerous, and traditional attitudes toward marriage are undergoing transition. © 2009 Elsevier Ireland Ltd. All rights reserved.

Rowe R.,University of Sheffield | Maughan B.,Kings College London | Moran P.,Kings College London | Ford T.,Institute of Health Services Research | And 2 more authors.
Journal of Child Psychology and Psychiatry and Allied Disciplines | Year: 2010

Background: Callous and unemotional (CU) traits might usefully subtype DSM-IV conduct disorder (CD). We investigate this hypothesis in a large, nationally representative sample of 5-16-year-olds. We also examine the characteristics of children with high CU traits but without CD. Methods: Data come from the 2004 British Child and Adolescent Mental Health Survey including 7,977 children, 5,326 of whom were followed up after 3 years. DSM-IV diagnoses of psychiatric disorder were based on parent, teacher and child report. CU traits were assessed by parent report. Results: Of the 2% of the sample who were diagnosed with DSM-IV CD, 46.1% were high on CU traits. In addition, 2.9% of the sample were high on CU traits without CD. Children with CD and CU traits showed more severe behavioural disturbance and were at substantially higher risk of CD diagnosis 3 years later. Children high on CU traits without CD showed evidence of disturbed functioning. Conclusions: Subtyping CD using CU traits identifies children with more severe and persistent psychopathology. Children with high CU traits but no CD diagnosis require further investigation. © 2009 Association for Child and Adolescent Mental Health.

Russell G.,University of Exeter | Ford T.,Institute of Health Services Research | Steer C.,University of Bristol | Golding J.,University of Bristol
Journal of Child Psychology and Psychiatry and Allied Disciplines | Year: 2010

Background: Data from epidemiology have consistently highlighted a disparity between the true prevalence of childhood psychiatric disorders and their recognition as defined by receiving a clinical diagnosis. Few studies have looked specifically at the level of unidentified autistic spectrum disorder (ASD) in the population. Method: Logistic regression was used to determine the behavioural traits associated with receiving a diagnosis of ASD using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). A composite score was derived to measure levels of autistic traits; undiagnosed children with scores matching those diagnosed with ASD were identified. Levels of educational provision beyond that provided by standard schooling were examined. Results: Fifty-five percent of children with autistic traits at the same levels as those who had an autism diagnosis had not been identified as needing extra support from education or specialised health services. Of those who were identified as having special needs, 37.5% had been formally diagnosed with an ASD. For children with impairment at the same level as that associated with Asperger's syndrome, 57% had no special provision at school, and were not accessing specialised health services. Twenty-six percent of those who did have special provision at school had an ASD diagnosis. Conclusions: The results suggest that there may be a substantial proportion of children on the autistic spectrum who are never identified by services. © 2010 Association for Child and Adolescent Mental Health.

Chung W.,Institute of Health Services Research | Oh S.-M.,Yonsei University | Suh T.,The Korea Institute for Health and Social Affairs | Lee Y.M.,Ajou University | And 2 more authors.
Health Policy | Year: 2010

Objective: In a rapidly aging society, inappropriately long geropsychiatric inpatient hospitalization is a challenging concern for mental health policy-makers and researchers. This study aimed to investigate patient and institutional factors affecting geropsychiatric inpatient length of stay (LOS), providing an overview of current geropsychiatric health care system in South Korea. Methods: This retrospective, population-based, cross-sectional study analysed nationwide reimbursement claim databases covering the entire elderly population of Korea between January 2005 and June 2006. Given the nested structure of the data, a multivariate multilevel regression analysis was performed. Results: The average LOS was 128 days. Males, patients with schizophrenia, and those enrolled in a National Medical Care Aid program tended to have longer hospital stays. Patient age was negatively related to LOS. Institutional variables related to longer hospitalizations included a psychiatric hospital, a higher number of beds, fewer human resource employees, a higher proportion of male, oldest old, and patients with dementia. Conclusions: Our results suggest that policies targeting geropsychiatric patients diagnosed with schizophrenia, enrolled in National Medical Care Aid programs, and admitted to psychiatric hospitals could reduce LOS. Additionally, the impact of the patient composition of a medical institution on LOS needs to be closely investigated. © 2009 Elsevier Ireland Ltd. All rights reserved.

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