Background Depression is usually managed in primary care, but most antidepressant trials are of patients from secondary care mental health services, with eligibility criteria based on diagnosis and severity of depressive symptoms. Antidepressants are now used in a much wider group of people than in previous regulatory trials. We investigated the clinical effectiveness of sertraline in patients in primary care with depressive symptoms ranging from mild to severe and tested the role of severity and duration in treatment response. MethodsThe PANDA study was a pragmatic, multicentre, double-blind, placebo-controlled randomised trial of patients from 179 primary care surgeries in four UK cities (Bristol, Liverpool, London, and York). We included patients aged 18 to 74 years who had depressive symptoms of any severity or duration in the past 2 years, where there was clinical uncertainty about the benefit of an antidepressant. This strategy was designed to improve the generalisability of our sample to current use of antidepressants within primary care. Patients were randomly assigned (1:1) with a remote computer-generated code to sertraline or placebo, and were stratified by severity, duration, and site with random block length. Patients received one capsule (sertraline 50 mg or placebo orally) daily for one week then two capsules daily for up to 11 weeks, consistent with evidence on optimal dosages for efficacy and acceptability. The primary outcome was depressive symptoms 6 weeks after randomisation, measured by Patient Health Questionnaire, 9-item version (PHQ-9) scores. Secondary outcomes at 2, 6 and 12 weeks were depressive symptoms and remission (PHQ-9 and Beck Depression Inventory-II), generalised anxiety symptoms (Generalised Anxiety Disorder Assessment 7-item version), mental and physical health-related quality of life (12-item Short-Form Health Survey), and self-reported improvement. All analyses compared groups as randomised (intention-to-treat). The study is registered with EudraCT, 2013-003440-22 (protocol number 13/0413; version 6.1) and ISRCTN, ISRCTN84544741, and is closed to new participants.
Background Sexual minority adolescents are more likely to have mental health problems, adverse social environments, and negative health outcomes compared with their heterosexual counterparts. There is a paucity of up-to-date population-level estimates of the extent of risk across these domains in the UK. We analysed outcomes across mental health, social environment, and health-related domains in sexual minority adolescents compared with their heterosexual counterparts in a large, contemporary national cohort. Methods The Millennium Cohort Study (MCS) is a birth cohort study in the UK following up children born betweenSept 1, 2000, and Jan 11, 2002 across England, Wales, Scotland, and Northern Ireland. Children recruited from the MCS have been followed up over six recruitment sweeps to date at ages 9 months, 3 years, 5 years, 7 years, 11 years, and 14 years. We analysed mental health, social, and health-related outcomes in sexual minority versus heterosexual adolescents at age 14 years. Additionally, we estimated the accumulation of multiple adverse outcomes in both groups. The primary aim of the study was to assess whether sexual minority adolescents experienced more adverse outcomes than heterosexual adolescents. FindingsBetween January, 2015, and April, 2016, 9885 adolescents provided a response about their sexual attraction. 629 (6%) of 9885 adolescents (481 female participants and 148 male participants) were identified as sexual minorities. 9256 (94%) of 9885 participants (4431 female and 4825 male) were attracted to the opposite sex or not attracted to the same sex and identified as heterosexual. Sexual minority adolescents were more likely to experience high depressive symptoms (odds ratio [OR] 5•43, 95% CI 4•32-6•83; p<0•0001), self-harm (5•80, 4•55-7•41; p<0•0001), lower life satisfaction (3•66, 2•92-4•58; p<0•0001), lower self-esteem (β 1•83, 95% CI 1•47-2•19; p<0•0001), and all forms of bullying and victimisation. Sexual minorities were more likely to have tried alcohol (OR 1•85, 95% CI 1•47-2•33; p<0•0001), smoking (2•41, 1•92 -3•03; p<0•0001), and cannabis (3•22, 2•24-4•61; p<0•0001), and also had increased odds of being less physically active (β 0•36, 95% CI 0•25-0•46; p<0•0001), perceiving themselves as overweight (OR 1•73, 95% CI 1•40-2•14; p<0•0001), and dieting to lose weight (1•98, 1•58-2•48; p<0•0001). Sexual minority adolescents had more co-occurring mental health outcomes (mean 1•43 of 3 outcomes, 95% CI 1•34-1•52) compared with heterosexual adolescents (0•40 of 3 outcomes, 0•38-0•41), and more total cumulative difficulties (mean 9•43 of 28 outcomes, 95% CI 9•09-9•76 in sexual minority adolescents vs 6•16 of 28 outcomes, 6•08-6•23 in heterosexual adolescents).Interpretation Sexual minority adolescents in the UK experience disparities in mental health, social, and healthrelated outcomes despite living in a time of substantial progress in rights for sexual minorities. These adverse outcomes co-occur, with implications for lifelong health and social outcomes. Health and educational practitioners...
The stressful experiences that many asylum seekers and refugees (AS&R) are exposed to during forced migration, and during resettlement in host countries, can have a profound impact on their mental health. Comparatively less research attention has been allocated to exploring other indices of quality of life (QoL) in AS&R populations. This review aimed to (i) synthesize the predictors and correlates of QoL of AS&R populations in high-income countries, and (ii) to identify the methodological strengths and weaknesses of this body of research. Fourteen databases were systematically searched (Medline, PsychINFO,
ObjectivesCommon mental health disorders such as depression and anxiety are highly prevalent and carry significant health care and economic burdens. The UK's improving access to psychological therapies (IAPT) initiative was developed as a cost‐effective way of reducing the pernicious effects of these disorders. IAPT interventions, such as guided self‐help, have been subjected to considerable quantitative evaluation. However, there has been minimal investigation into clients’ experiences of the one‐to‐one low‐intensity interventions (LIIs), which form a key component of IAPT service provision. Qualitative exploration could provide rich data regarding experiences of psychological change and factors affecting therapeutic experiences. This will enable informative, client led insights into how low‐intensity therapy can be improved.MethodsInterpretative phenomenological analysis of eight semi‐structured interviews was used to develop an idiosyncratic understanding of clients’ experiences of one‐to‐one LIIs following entry into a randomized control trial (RCT).ResultsFour superordinate themes were identified from clients’ accounts: goals and expectations of therapy, beneficial aspects of therapy, non‐beneficial aspects of therapy, and the experience of psychological change. A heuristic model of interrelationships between factors is proposed.ConclusionsBoth therapeutic techniques and relationships contribute to beneficial therapeutic experiences. The results reported here can be used to inform practice by harnessing the most beneficial aspects of therapy, such as developing adaptive therapeutic approaches to clients’ clinical needs and facilitating idiosyncratic processes of psychological change. Due to limited qualitative research in this area, further research should be conducted in different service settings to assess differences and similarities in clients’ experiences.Practitioner points Therapists who adapted to clients’ individual needs were perceived as more effective than those who did not.Effective therapeutic experiences were exemplified by a personal therapeutic approach, enough time to discuss issues and normalizing client's experiences.Clients develop idiosyncratic models of change which should be encouraged by therapists over and above clinical models.
Purpose This study employed an intersectional framework to examine impact of inequities related to sexual and ethnic minority identities in risk for health, wellbeing, and health-related behaviors in a nationally representative sample. MethodsThe study sample comprised 9,789 (51% female) adolescents aged 17 years from the UK-wide Millennium Cohort Study, with data on self-identified sexual-and ethnic-identities. Adolescents were grouped into White-Heterosexual, White sexual minority (White-SM), ethnic minority (EM)-heterosexual, and ethnic-and sexual minority (EM-SM) categories.Mental health (e.g., self-reported psychological distress, doctor-diagnosed depression, attempted suicide, victimisation), general health (self-rated health, chronic illness, Body mass index) and a range of healthrelated behaviors (e.g., smoking, substance use) were assessed by questionnaires. Associations were analysed using logistic and linear regression (adjusted for sex and parental income). ResultsSexual minority individuals (White:18% and ethnic minority:3%) had increased odds for mental illhealth and attempted suicide, with higher odds in White-SM than EM-SM. Compared to Whiteheterosexual individuals, White-SM and EM-SM had higher risk for psychological distress (Odds ratios[OR]3.47/2.24 for White-SM/EM-SM respectively), and emotional problems (OR3.17/1.65). They had higher odds for attempted suicide (OR2.78/2.02), self-harm (OR3.06/1.52), and poor sleep quality (OR1.88/1.67).In contrast, White-Heterosexual and White-SM groups had similarly high proportions reporting risky behaviors except for drug use (OR1.34) and risky sex (OR1.40) which are more common in White-SM individuals. EM-Heterosexual and EM-SM individuals had decreased odds for health-related behaviors.Conclusions Sexual minority (White and EM) individuals had substantially worse mental health compared to their heterosexual peers. Adverse health-related behaviors were more common in White sexual minority individuals. Investigation into the mechanisms leading to these differences is needed.
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