No abstract

[266 words]Background: Only one-third of patients with depression respond fully to antidepressant medication

Objective. To determine the degree and causes of any excess mortality observed during the early years of inflammatory polyarthritis (IP).Methods. Between 1990 and 1994, a total of 1,236 patients were registered with the Norfolk Arthritis Register, a primary care-based inception cohort. All patients were tracked on the National Health Service Central Register for notification of death. The vital status of each patient was determined as of December 31, 1999. Causes of death were coded according to the International Classification of Diseases, Ninth Revision. Expected death rates were calculated using annual death rates for the Norfolk population. Standardized mortality ratios (SMRs) were calculated for all IP patients and for the subgroups of patients who did and did not satisfy the American College of Rheumatology (ACR) 1987 criteria for rheumatoid arthritis (RA) at baseline, as well as for the subgroups who were and were not rheumatoid factor (RF) positive at baseline.Results. By December 31, 1999, 160 patients (13%; 79 women and 81 men) had died. The median duration of followup in the entire cohort was 6.9 years. Mortality rates were not significantly increased in the entire group of patients with IP or in the subgroup who met the ACR 1987 criteria for RA at baseline. In contrast, RF-positive patients had an increased rate of death from all causes (SMR in men 1.51, in women 1.41). Cardiovascular disease was the most common cause of death. The majority of the excess mortality in the RF-positive patients could be attributed to cardiovascular causes (SMR in men 1.34, in women 2.02).Conclusion. Excess mortality in the early years of IP is confined to patients who are seropositive for RF. While excess cardiovascular mortality has been described in patients with established RA, this is the first report of premature death from heart disease in the early years of IP.

BackgroundThe Beck Depression Inventory, 2nd edition (BDI-II) is widely used in research on depression. However, the minimal clinically important difference (MCID) is unknown. MCID can be estimated in several ways. Here we take a patient-centred approach, anchoring the change on the BDI-II to the patient's global report of improvement.MethodWe used data collected (n = 1039) from three randomized controlled trials for the management of depression. Improvement on a ‘global rating of change’ question was compared with changes in BDI-II scores using general linear modelling to explore baseline dependency, assessing whether MCID is best measured in absolute terms (i.e. difference) or as percent reduction in scores from baseline (i.e. ratio), and receiver operator characteristics (ROC) to estimate MCID according to the optimal threshold above which individuals report feeling ‘better’.ResultsImprovement in BDI-II scores associated with reporting feeling ‘better’ depended on initial depression severity, and statistical modelling indicated that MCID is best measured on a ratio scale as a percentage reduction of score. We estimated a MCID of a 17.5% reduction in scores from baseline from ROC analyses. The corresponding estimate for individuals with longer duration depression who had not responded to antidepressants was higher at 32%.ConclusionsMCID on the BDI-II is dependent on baseline severity, is best measured on a ratio scale, and the MCID for treatment-resistant depression is larger than that for more typical depression. This has important implications for clinical trials and practice.

The study indicates that insomnia, worry, anxiety and depression are potential risk factors for new inceptions of paranoid thinking. The results also corroborate an emerging literature indicating that anxiety, worry and depression may encourage the persistence of paranoid thinking. The study provides the first longitudinal evidence linking insomnia and paranoia. The important clinical implication is that the use of interventions for common mental health difficulties in people with psychosis may have the additional benefit of reducing paranoia.

This intervention program produces only modest effects in reducing LBP and disability over a 1-year period. The observation that patient preference for treatment influences outcome warrants further investigation.

Studies examining the validity of the Short Mood and Feelings Questionnaire (SMFQ; Angold, Costello, & Messer, 1995) have largely focused on selected or clinical samples in childhood (6-11 years) or early to midadolescence (12-16 years) and have not investigated misclassifications or how the SMFQ relates to adult depression measures. Using data from the Avon Longitudinal Study of Parents and Children (2012), we assessed the validity of the SMFQ in relation to an adult depression measure administered in late adolescence (age 17-18 years). We also investigated sociodemographic and clinical variables previously shown to affect misclassification on short self-administered questionnaires compared with more detailed assessments of depression. We assessed construct validity using factor and item response theory analysis. To investigate content validity, we tabulated SMFQ items against the International Classification of Diseases (ICD-10; World Health Organization, 1992) and Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) depressive symptoms. Criterion validity was examined using receiver operating characteristic (ROC) analysis. Potential misclassifications were investigated using logistic regression and multiple-indicator multiple-cause modeling. Factor analysis produced high loadings, low residual variances, and appropriate model fit indices. Seven of the 10 ICD-10 depressive symptoms were covered by at least 1 SMFQ item. The discriminatory ability of the SMFQ for meeting ICD-10 diagnostic criteria for depression was very high (area under ROC curve = 0.90). Individuals with anxiety symptoms, females, and less well-educated individuals overreported depressive symptoms on the SMFQ in relation to ICD-10 depression. We conclude the SMFQ is a valid instrument capturing a latent trait of depression in a community-based sample in late adolescence. Further work should be carried out to increase understanding of variables associated with misclassification.

Objective To investigate the effectiveness of facilitated physical activity as an adjunctive treatment for adults with depression presenting in primary care.Design Pragmatic, multicentre, two arm parallel randomised controlled trial.Setting General practices in Bristol and Exeter.