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Opolski, Melissa; Wilson, Ian G

doi:10.1186/1745-0179-1-18

Cited by 132 publications

(52 citation statements)

References 58 publications

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“…48 There is similar evidence for high psychological morbidity in asthma and CHD. 49,50 Poor health outcomes associated with psychological symptoms…”

Section: High Psychological Morbidity Associated With Long-term Condimentioning

confidence: 99%

“…Depression has an adverse effect on QoL in asthma, 49 COPD, 51 diabetes 52 and CHD. 53 Depression has been linked to adverse morbidity and mortality in CHD 53,54 and COPD.…”

Section: High Psychological Morbidity Associated With Long-term Condimentioning

confidence: 99%

“…55 Those with CHD who are also depressed have higher rates of complications and are more likely to undergo invasive procedures. 56,57 Depression has also been linked to poorer self-care in asthma 49 and in diabetes. 58 Recent work also suggests that depression in diabetes is associated with an increased risk of dementia.…”

Section: High Psychological Morbidity Associated With Long-term Condimentioning

confidence: 99%

“…Admission to hospital with an acute exacerbation of illness is linked both to severity of illness 20,23,24,30,57,250 and to depression. 27,29,30,49,92,251 There is also a well-recognised bidirectional association between the severity of physical illness and depression. 252 Living alone is linked both to an increased risk of depression in people with LTCs 253 and to worse outcome, 254 and life stressors are also associated with an increased risk of depression in elderly people.…”

Section: Longitudinal Prospective Study To Determine Predictors Of Unmentioning

confidence: 99%

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CHOICE: Choosing Health Options In Chronic Care Emergencies

Guthrie

Afzal

Blakeley

et al. 2017

Programme Grants Appl Res

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BackgroundOver 70% of the health-care budget in England is spent on the care of people with long-term conditions (LTCs), and a major cost component is unscheduled health care. Psychological morbidity is high in people with LTCs and is associated with a range of adverse outcomes, including increased mortality, poorer physical health outcomes, increased health costs and service utilisation.ObjectivesThe aim of this programme of research was to examine the relationship between psychological morbidity and use of unscheduled care in people with LTCs, and to develop a psychosocial intervention that would have the potential to reduce unscheduled care use. We focused largely on emergency hospital admissions (EHAs) and attendances at emergency departments (EDs).DesignA three-phase mixed-methods study. Research methods included systematic reviews; a longitudinal prospective cohort study in primary care to identify people with LTCs at risk of EHA or ED admission; a replication study in primary care using routinely collected data; an exploratory and feasibility cluster randomised controlled trial in primary care; and qualitative studies to identify personal reasons for the use of unscheduled care and factors in routine consultations in primary care that may influence health-care use. People with lived experience of LTCs worked closely with the research team.SettingPrimary care. Manchester and London.ParticipantsPeople aged ≥ 18 years with at least one of four common LTCs: asthma, coronary heart disease, chronic obstructive pulmonary disease (COPD) and diabetes. Participants also included health-care staff.ResultsEvidence synthesis suggested that depression, but not anxiety, is a predictor of use of unscheduled care in patients with LTCs, and low-intensity complex interventions reduce unscheduled care use in people with asthma and COPD. The results of the prospective study were that depression, not having a partner and life stressors, in addition to prior use of unscheduled care, severity of illness and multimorbidity, were independent predictors of EHA and ED admission. Approximately half of the cost of health care for people with LTCs was accounted for by use of unscheduled care. The results of the replication study, carried out in London, broadly supported our findings for risk of ED attendances, but not EHAs. This was most likely due to low rates of detection of depression in general practitioner (GP) data sets. Qualitative work showed that patients were reluctant to use unscheduled care, deciding to do so when they perceived a serious and urgent need for care, and following previous experience that unscheduled care had successfully and unquestioningly met similar needs in the past. In general, emergency and primary care doctors did not regard unscheduled care as problematic. We found there are missed opportunities to identify and discuss psychosocial issues during routine consultations in primary care due to the ‘overmechanisation’ of routine health-care reviews. The feasibility trial examined two levels of an intervention for people with COPD: we tried to improve the way in which practices manage patients with COPD and developed a targeted psychosocial treatment for patients at risk of using unscheduled care. The former had low acceptability, whereas the latter had high acceptability. Exploratory health economic analyses suggested that the practice-level intervention would be unlikely to be cost-effective, limiting the value of detailed health economic modelling.LimitationsThe findings of this programme may not apply to all people with LTCs. It was conducted in an area of high social deprivation, which may limit the generalisability to more affluent areas. The response rate to the prospective longitudinal study was low. The feasibility trial focused solely on people with COPD.ConclusionsPrior use of unscheduled care is the most powerful predictor of unscheduled care use in people with LTCs. However, psychosocial factors, particularly depression, are important additional predictors of use of unscheduled care in patients with LTCs, independent of severity and multimorbidity. Patients and health-care practitioners are unaware that psychosocial factors influence health-care use, and such factors are rarely acknowledged or addressed in consultations or discussions about use of unscheduled care. A targeted patient intervention for people with LTCs and comorbid depression has shown high levels of acceptability when delivered in a primary care context. An intervention at the level of the GP practice showed little evidence of acceptability or cost-effectiveness.Future workThe potential benefits of case-finding for depression in patients with LTCs in primary care need to be evaluated, in addition to further evaluation of the targeted patient intervention.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…48 There is similar evidence for high psychological morbidity in asthma and CHD. 49,50 Poor health outcomes associated with psychological symptoms…”

Section: High Psychological Morbidity Associated With Long-term Condimentioning

confidence: 99%

“…Depression has an adverse effect on QoL in asthma, 49 COPD, 51 diabetes 52 and CHD. 53 Depression has been linked to adverse morbidity and mortality in CHD 53,54 and COPD.…”

Section: High Psychological Morbidity Associated With Long-term Condimentioning

confidence: 99%

Section: High Psychological Morbidity Associated With Long-term Condimentioning

confidence: 99%

Section: Longitudinal Prospective Study To Determine Predictors Of Unmentioning

confidence: 99%

See 2 more Smart Citations

CHOICE: Choosing Health Options In Chronic Care Emergencies

Guthrie

Afzal

Blakeley

et al. 2017

Programme Grants Appl Res

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“…In this vein, researchers have found that in adults with asthma, the presence of depressive symptoms reduces the compliance and control of the treatment for the disease (Bosley, Fosbury, & Cochrane, 1995;Strine et al, 2008) and that children with asthma and a comorbid depressive disorder have increased healthcare utilization compared to children with asthma but without depressive disorder (Richardson et al, 2006). Additionally, researchers have found that depressive symptoms may influence the cognitive functioning of individuals with asthma (DiMatteo et al, 2000;Opolski & Wilson, 2005).…”

Section: Asthma and Depressionmentioning

confidence: 99%

Depression, Anxiety, and Health-Related Quality of Life in Adolescents and Young Adults With Allergies and Asthma

Molzon

Hullmann

Eddington

et al. 2011

Journal of Asthma & Allergy Educators

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The current study sought to compare rates of depressive symptoms, anxious symptoms, and healthrelated quality of life (HRQOL) in adolescents and young adults (AYAs) with allergies, asthma, and healthy controls. Participants were undergraduate students aged 18 to 29 years with self-reported allergies (N = 79), asthma (N = 79), and with no history of a chronic illness (N = 79). Participants completed the Center for Epidemiologic Studies Depression Scale, the Zung Self-Rating Anxiety Scale, and the SF-36 Health Survey Questionnaire as self-report measures of depressive symptoms, anxious symptoms, and HRQOL, respectively. A series of ANCOVAs (analysis of covariance; allergies vs asthma vs healthy controls) was conducted to examine differences between the groups. The results of the current examination suggest that AYAs with allergies are indeed at risk for experiencing higher rates of depressive and anxious symptoms and poorer HRQOL than healthy AYAs. Furthermore, they are experiencing psychosocial concerns on par with or worse than those of AYAs with asthma. Allergies, often perceived as a relatively benign illness, have commonly been overlooked in discussions of psychosocial concerns related to chronic illnesses. The results of the current study suggest that young adults with allergies are also an important population to examine.

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Increasing Physical Activity in Patients With Asthma Through Positive Affect and Self-affirmation

Mancuso

Choi²,

Westermann³

et al. 2012

Arch Intern Med

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Background Patients with asthma engage in less physical activity than peers without asthma. Protocols are needed to prudently increase physical activity in asthma patients. We evaluated whether an educational intervention enhanced with positive affect induction and self-affirmation was more effective than the educational protocol alone in increasing physical activity in asthma patients. Methods We conducted a randomized trial in New York City from September 28, 2004, through July 5, 2007, of 258 asthma patients, 252 completed the trial. At enrollment, control subjects completed a survey measuring energy expenditure, made a contract to increase physical activity, received a pedometer and an asthma workbook, and then underwent bimonthly follow-up telephone calls. Intervention patients received this protocol plus small gifts and instructions in fostering positive affect and self-affirmation. The main outcome was the within-patient change in energy expenditure in kilocalories per week from enrollment to 12 months with an intent-to-treat analysis. Results Mean (SD) energy expenditure at enrollment was 1767 (1686) kcal/wk among controls and 1860 (1633) kcal/wk among intervention patients (p=.65) and increased by 415 (95% CI, 76–754; p=.02) and 398 (95% CI, 145–652; p=.002) kcal/wk, respectively, with no difference between groups (p=.94). For both groups, energy expenditure was sustained through 12 months. No adverse events were attributed to the trial. In multivariate analysis, increased energy expenditure was associated with less social support, decreased depressive symptoms, more follow-up calls, use of the pedometer, fulfillment of the contract, and the intervention among patients who required urgent asthma care (all p<.10, 2-sided test). Conclusions A multiple-component protocol was effective in increasing physical activity in asthma patients, but an intervention to increase positive affect and self-affirmation was not effective within this protocol. The intervention may have had some benefit, however, in the subgroup of patients who required urgent asthma care during the trial.

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Untitled

Cited by 132 publications

References 58 publications

CHOICE: Choosing Health Options In Chronic Care Emergencies

CHOICE: Choosing Health Options In Chronic Care Emergencies

Depression, Anxiety, and Health-Related Quality of Life in Adolescents and Young Adults With Allergies and Asthma

Increasing Physical Activity in Patients With Asthma Through Positive Affect and Self-affirmation

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