SummaryBackgroundResults of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects.MethodsFOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762.FindingsBetween Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months.InterpretationFluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function.FundingUK Stroke Association and NIHR Health Technology Assessment Programme.

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We analyse the relationships between subjective wellbeing (SWB), wages and internal migration. Our study addresses whether people make (revealed preference) location and migration decisions based on SWB and/or wage prospects. We present both a theoretical intertemporal location choice model and empirical analyses using the Australian longitudinal HILDA dataset. Our theory predicts considerable heterogeneity in location choices for individuals at different life stages depending on their individual characteristics, including their rate of time preference. We find that people's location at a point in time is determined largely by their previous period's location reflecting high moving costs. In addition, labour market conditions affect location choice and influence individuals' decisions to migrate out of an area. Focusing on migrants, we find that place-based SWB is a highly significant ex ante predictor of a migrant's chosen location. Furthermore, we find a significant and sustained ex post uplift in individual SWB for migrants, which holds across a range of sub-samples. By contrast, wage income responses show much less significance, albeit with heterogeneity across groups. The estimated pronounced upturn in SWB for migrants substantiates the usefulness of SWB both as a concept for policy-makers to target and for researchers to incorporate in their studies.

Empirical studies have consistently documented that while married men tend to lead more prosperous careers after moving, migration tends to be disruptive for careers of married women. We extend this literature by exploring whether migration is followed by a change in subjective wellbeing (SWB). We examine how this experience differs by individuals of different gender, relationship-status and motivations for moving (of both partners in a couple relationship, where relevant). The results are compared to wage differences following migration. All results are conditioned on time-varying personal characteristics, including important life events. Consistent with prior literature, males have a stronger tendency than females to increase their earnings after moving. However, we find that females have a stronger tendency than males to increase their SWB following a move. These gender differences are pronounced for couples. Differences tend to narrow, but do not disappear, once we account for motivations for moving of individuals and, where relevant, of their partner.

Access to the data used in this study was provided by Statistics New Zealand (SNZ) under conditions designed to give effect to the security and confidentiality provisions of the Statistics Act 1975. All frequency counts using Census data were subject to base three rounding in accordance with SNZ's release policy for census data.