Well here I am, eight or so miles up Glen Affric, lying in a little one man tent in the rain.  I'm 59 today.  I woke at 2.30am wanting a pee and murmured a quiet "Happy birthday" to myself before choosing a moment between showers to stumble out to relieve myself.  I could see a few stars through the clouds.  Since then it's been raining pretty much every time I've woken.  So comfortable, toasty in a sleeping bag on a self-inflating mat in this beautifully designed Hilleberg Akto tent.  Amazing.  I came in on a mountain bike yesterday along the Forestry track south of the loch, bumping and occasionally having to get off to push the bike ... but such an improvement on walking and having to backpack in all supplies, tent, sleeping things - everything I need for three days.  It would have been heavy and slow to have carried it.  As it was, I arrived pretty quickly and pretty easily.

I'm at my friend Larry's flat in Glasgow.  We're doing one of our three-to-four monthly check-ins -  reviewing and planning how our lives are going.  I arrived here from Edinburgh yesterday evening and we spent time catching up and looking ahead.  This morning though, when I woke, I found it hard to think clearly about the time between now and early August when we next plan to meet like this.  The mountains of Glen Affric are beginning to grow closer and fill my immediate field of vision.

Looking back over relevant research papers that caught my attention last month, some stand out for me more than the others.  Here are three on depression that stood out and got me thinking.  The Fergusson et al paper looks at links between alcohol abuse and major depression.  There has been debate for years on whether alcohol dependence leads to depression or depression leads to alcohol dependence.  In this kind of debate, it's usually a good bet that both pathways contain some truth.  What this study adds is that often it is the alcohol dependence that is primary.  As the authors state " ... the associations between AAD (alcohol abuse or dependence) and MD (major depression) were best explained by a causal model in which problems with alcohol led to increased risk of MD as opposed to a self-medication model in which MD led to increased risk of AAD." 

For many years my work split fairly evenly between helping people with psychological difficulties and helping people with pain problems.  Quite a few people were troubled with both.  In the last several years I have done much less work with pain, although I still see some people for overall pain management.  This has been partly because I was trying to keep up-to-date with too many fields, so stepping back from pain work made sense.  It has also been partly because the flourishing of research into happiness & wellbeing has fascinated me and taken up time.  Here are a collection of pain-associated assessment and information sheets that I accumulated over the years.  They are obviously relevant for work with pain, and some (e.g. one year symptom diary) can be adapted for work with stress & psychological difficulties. 

IBS severity score & background - this is a scale that was used by Professor Whorwell and his research team in Manchester.

In 2001 the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) WCRF/AICR set themselves the task of systematically assessing all good research on diet, physical activity and cancer and publishing a report that would be the largest study of its kind with conclusions that would be best the evidence could demonstrate.  Over 100 scientists from 30 countries were involved.  An expert panel of 21 of these scientists worked for 5 years to produce the report "Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective."  The follow-up companion Policy Report "Policy and Action for Cancer Prevention"  was published a little over a month ago and has recommendations for a series of different groups and organizations including government, industry, the media, schools, and work places. 

Here are five papers mostly looking at aspects of overweight.  The first, published recently in the Lancet, is a huge study on the effects of body-mass index (BMI) on subsequent mortality in nearly 900,000 adults.  It shows progressive excess mortality above the BMI range 22.5-25 kg/m2.  (To calculate your BMI click here).  At 40-45 kg/m2, the reduction in life expectancy of 8-10 years is comparable to the effects of being a smoker.  The second paper, by Neovius et al, also involved large numbers - over 45,000 older adolescents.  Again it showed excess mortality at long term follow-up, and commented "Obesity and overweight were as hazardous as heavy and light smoking, respectively".  The third study by Katseva et al looked at modifiable risk factors in European patients with cardiac disease.  The findings were depressing with obesity, for example, increasing stepwise from 25% at first survey, to 32.6% at second, to 38% at third survey.  Overall the authors concluded "These time trends show a compelling need for more effective lifestyle management of patients with coronary heart disease ... To salvage the acutely ischaemic myocardium without addressing the underlying causes of the disease is futile; we need to invest in prevention." 

A recent article in the British Medical Journal (Kmietowicz 2009) reports that "The chief medical officer for England has called for a minimum price of 50 pence (0.54; $0.70) to be charged for a unit of alcohol to reduce excessive drinking and its associated harms.  Liam Donaldson said that antisocial drinking should be targeted in the same way as smoking in public places so that being drunk is no longer an aim or socially acceptable.  ‘England has a drink problem and the whole of society bears the burden,' said Professor Donaldson at the launch of his 2008 annual report. ‘The passive effects of heavy drinking on innocent parties are easily underestimated and frequently ignored. The concept of passive drinking and the devastating collateral effect that alcohol can have on others must be addressed on a national scale.'  He said that evidence shows that price and access are the two key factors that can help to change drinking habits, as they were for tobacco."  

This set of five papers documents, in part, our mixed viewpoints on depression.  Worryingly, Mehta & colleagues show deteriorating public attitudes towards mental illness in England (and to a lesser extent Scotland) between 1994 and 2003.  Meanwhile Blumner et al demonstrate a shift towards a more biological view on causes and treatment of depression in the US between 1996 and 2006.

In contrast, Miranda et al's editorial (and Grote et al's research) highlight the growing evidence showing psychotherapies for depression can be "very effective for low-income and minority populations in the United States and abroad" - extending their validity well beyond more privileged groups in developed countries.  Andersson too discusses a further way to make psychotherapies more widely available and helpful - in this case, the increasing literature documenting the widespread value of delivering cognitive behavioural therapy via the internet.     

This is the eleventh and final post about the Moroccan trip - a reflection once I was back in Scotland. 

So it's before breakfast on Tuesday morning in Edinburgh.  We got back about 36 hours ago.  I'm now mostly into the swing of "normal, everyday life" again.  150 plus emails, piles of post, phone messages - the usual "welcome back" after being away.  I said at the end of the first post about this trip (just 12 days ago) " ... it feels a fun, slightly crazy thing to attempt - to try to combine/construct something that's a mix of adventure, holiday, time with good friends, and also a meditation retreat.  Like trying to play some strange mix of musical styles."  We achieved this well.  Good.  And now what's been brought back with us?