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Time to change: let’s challenge mental health discrimination

On 26th January the BMJ reported on the new £18 million Time to Change campaign  " ... to tackle the discrimination and stigma that surrounds mental health ... The Time to Change initiative is funded by Comic Relief and the National Lottery. Its aim is to tell the public that it is no longer acceptable to discriminate against people with a mental illness ... The campaign's website gives details of what can be done to help people with a mental illness and how to run a local campaign to support national initiatives ... The campaign says that mental illness is one of the last taboos and that shame and stigma can stop people seeking help. It highlights the fact that mental illness is far more common than people realise with one in four people experiencing a mental health problem at some time in their life. And it promotes the message that it is possible to help people with a mental heath problem by being there for them and not cutting them out of your life ... The campaign is based on similar national initiatives in New Zealand and Scotland.

Recent research: six studies on prevalence of depression & anxiety, and risk factors for depression, bipolar disorder & suicide

Here are a couple of studies on the prevalence of depression and anxiety, and four on risk factors for depression, bipolar disorder and suicide.  Strine et al report on a major survey of depression and anxiety in the United States.  They found "The overall prevalence of current depressive symptoms was 8.7% (range by state and territory, 5.3%-13.7%); of a lifetime diagnosis of depression, 15.7% (range, 6.8%-21.3%); and of a lifetime diagnosis of anxiety, 11.3% (range, 5.4%-17.2%)."  Smoking, lack of exercise, and excessive drinking were all associated with increased likelihood of mental disorders, as too was physical ill health.  Young et al, in a separate study, looked at the likelihood of depression and anxiety becoming persistent.  They estimated - at nearly 3 year follow-up - that the US prevalence of persistent depressive or anxiety disorder was 4.7%.  Only about a quarter of these sufferers were using appropriate medication and only about a fifth appropriate counselling.

Handouts & questionnaires for health anxiety disorder

Here are the two main questionnaires currently used to assess Health Anxiety Disorder - the HAI and the HAQ.  The HAI is the one recommended by the NHS Improving Access to Psychological Therapies (IAPT) initiative.  I've also added a scale put together by Adrian Wells that assesses safety behaviours and extent of disease belief.  Finally there is a classic CBT thoughts record.  I don't use these kinds of records much any more, but I've added it for 'completeness'.

Health anxiety inventory (HAI) - the 18 item (short form) HAI is the disorder specific scale recommended by the IAPT initiative.  The third page of the download gives typical scores for a Health Anxiety group, a more general anxiety group, a control group, and so on.   

Health anxiety questionnaire (HAQ) - this 21 item health anxiety questionnaire yields four subscales, which can make it easier therapeutically to target specific behaviours like reassurance seeking.  The third page of the download gives some idea of likely scores in different disorders.

Recent research: mind-body & body-mind effects for cancer, allergy, dementia, & mental health

Here are five studies on the loose theme of how the mind affects the body, and the body affects the mind ... and that the distinction between mind and body is pretty arbitrary anyway.  Using meta-analysis, Chida & colleagues highlight considerable evidence suggesting that stress-related psychosocial factors have an adverse effect on cancer incidence and survival.  Andersen & colleagues report a randomized controlled trial to respond to this in women diagnosed with breast cancer.  Women in the stress management arm of the study received an initial one-year, 26 session intervention in groups of 8 to 12 people.  The aim was to reduce distress and improve quality of life, improve health behaviors (diet, exercise, smoking cessation), and facilitate cancer treatment compliance and medical follow-up.

Handouts & questionnaires for generalized anxiety disorder (GAD)

Here are a series of assessment questionnaires and handouts for Generalized Anxiety Disorder:

GAD, 2 question screen - answering "yes" to either of the two screening questions on this sheet suggests it's worth checking for a diagnosis of full Generalized Anxiety Disorder (GAD) - for example by using the GADQ (see below).

GAD, questionnaire (GADQ) - a simple questionnaire for making a full diagnosis of GAD.

GAD, assessment (GADSS) and scoring - the GAD Severity Scale.  Useful, and pays more attention to GAD's associated physical symptoms than the more purely worry-focussed scales that are often used.

GAD, metacognitions (Wells) - GAD assessment scale developed by Wells.  Includes measures of safety behaviours and metacognitions.

Recent research: egosystem & ecosystem

In the end the love you take is equal to the love you make.   Beatles

This is essentially the Beatles closing statement. It is the last lyric on the last album they recorded.
(Let It Be was the last album they released, but it was recorded earlier).

Handouts & questionnaires for “outcomes toolkit” (IAPT)

The "Improving Access to Psychological Therapies" (IAPT) initiative is very ambitious and exciting.  It states its principal aim is to support English Primary Care Trusts in implementing "National Institute for Health and Clinical Excellence" (NICE) guidelines for people suffering from depression and anxiety disorders.  IAPT go on to say that "At present, only a quarter of the 6 million people in the UK with these conditions are in treatment, with debilitating effects on society."

One aspect of this carefully planned initiative is strong encouragement to assess and monitor the progress of those who are getting help.  Visiting the IAPT "Outcomes Toolkit and FAQ" web page provides access to several freely downloadable documents.  The emphasis is on good assessment measures that are free to use.  See below:

IAPT Outcomes Toolkit 2008/9 PDF - this 81 page 1.1Mb Adobe PDF is the September 08 version with amended IAPT Paper Based Data Set Questionnaires.

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