Physical illness in those with mental illness: Psychiatric services need to change focus

Daly, Oscar

doi:10.1192/bjp.bp.116.182915

Cited by 3 publications

(6 citation statements)

References 8 publications

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“… 20 On these grounds, the PHQ-9 was also used as a depression screening and outcome measure in the previous DEPSCREEN-INFO trial and was well accepted by patients and physicians. 12 Given that the DEPSCREEN-INFO trial indicated that a 1-month follow-up may be too short to reflect all effects of the feedback intervention, the primary outcome for this study is depression severity after 6 months.…”

Section: Methods and Analysismentioning

confidence: 99%

“…No major risks for serious adverse events caused by the application of the feedback intervention were identified in the DEPSCREEN-INFO trial. 12 Numerous studies have shown that depression screening does not cause suicidality or self-harm. 33 34 It seems that questions about suicidality lower the risk of suicide.…”

Section: Ethics and Disseminationmentioning

confidence: 99%

“…16 11 The DEPSCREEN-INFO randomised controlled trial (RCT) showed that patient-targeted feedback after depression screening can increase patient engagement and reduce depression severity. 12 Such patient-targeted feedback interventions provide a valuable framework for addressing the patient as an active partner in depression care. 13 The rationale is that providing feedback (with respect to depression status and recommendations) will induce favourable behavioural changes (ie, active treatment seeking, increased involvement with depression, improved coping) and will lead to improved outcomes (ie, decreased depression severity).…”

Section: Introductionmentioning

confidence: 99%

“… 13 The rationale is that providing feedback (with respect to depression status and recommendations) will induce favourable behavioural changes (ie, active treatment seeking, increased involvement with depression, improved coping) and will lead to improved outcomes (ie, decreased depression severity). 12 The DEPSCREEN-INFO trial was conducted with cardiac patients. As major depression affects one out of six patients in primary care, feedback intervention could also have great potential for general practice.…”

Section: Introductionmentioning

confidence: 99%

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Depression screening using patient-targeted feedback in general practices: study protocol of the German multicentre GET.FEEDBACK.GP randomised controlled trial

et al. 2020

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IntroductionApproximately one out of six patients in primary care suffers from depression, which often remains undetected. Evidence regarding the efficacy of depression screening in primary care, however, is inconsistent. A previous single-centre randomised controlled trial (RCT) in cardiac patients, the DEPSCREEN-INFO trial, provided the first evidence that written feedback to patients following a positive depression screening reduces depression severity and leads to more comprehensive patient engagement in mental healthcare. To amplify these effects, the feedback should be tailored according to patients’ needs and preferences. The GET.FEEDBACK.GP RCT will test the efficacy of this patient-targeted feedback intervention in primary care.Methods and analysisThe multicentre three-arm GET.FEEDBACK.GP RCT aims to recruit a total of 1074 primary care patients from North, East and South Germany. Patients will be screened for depression using the Patient Health Questionnaire-9 (PHQ-9). In the case of a positive depression screening result (PHQ-9 score ≥10), the participant will be randomised into one of three groups to either receive (a) patient-targeted and general practitioner (GP)-targeted feedback regarding the depression screening results, (b) only GP-targeted feedback or (c) no feedback. Patients will be followed over a period of 12 months. The primary outcome is depression severity (PHQ-9) 6 months after screening. Secondary outcomes include patient engagement in mental healthcare, professional depression care and cost-effectiveness. According to a statistical analysis plan, the primary endpoint of all randomised patients will be analysed regarding the intention-to-treat principle.Ethics and disseminationThe Ethics Committee of the Hamburg Medical Association approved the study. A clinical trial company will ensure data safety, monitoring and supervision. The multicentre GET.FEEDBACK.GP RCT is the first trial in primary care that tests the efficacy of a patient-targeted feedback intervention as an adjunct to depression screening. Its results have the potential to influence future depression guidelines and will be disseminated in scientific as well as patient-friendly language.Trial registration numberNCT03988985.

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Section: Methods and Analysismentioning

confidence: 99%

Section: Ethics and Disseminationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Depression screening using patient-targeted feedback in general practices: study protocol of the German multicentre GET.FEEDBACK.GP randomised controlled trial

et al. 2020

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“…There are high levels of comorbid mental illness among consumers in generalist hospital wards (Daly ; Hert et al . ).…”

Section: Introductionmentioning

confidence: 99%

A constructivist grounded theory of generalist health professionals and their mental health work

Brunero

Ramjan

Salamonson

et al. 2018

Int J Mental Health Nurs

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Generalist health professionals, often without formal mental health training, provide treatment and care to people with serious mental illness who present with physical health problems in general hospital settings. This article will present findings from a constructivist grounded theory study of the work delivered by generalist health staff to consumers with mental illness on the general medical/surgical wards of two metropolitan hospitals in Sydney, Australia. The results analysed included three participant observations, two focus groups, and 21 interviews and hospital policy and protocol documents. A substantive theory of mental health work in general hospital settings is illustrated which conceptualizes the following categories: (i) the experience: conflicting realities and ideals; (ii) The Context: facilitating social distancing; and (iii) the social processes: invisibility affecting confidence. The categories are understood through the theoretical lens of symbolic interactionism with the theory providing insights into how the generalist health professionals understand their sense of self or identity.

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Where’s that stethoscope? A survey of psychiatrists’ attitudes to their role in managing physical health

Greenstone

Burlingham

2020

JMHTEP

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Purpose This study aims to explore current attitudes among doctors working in psychiatry, with regard to their perceived role and their confidence in managing their patients’ physical health problems. Design/methodology/approach A 20-item electronic questionnaire was distributed to doctors working in psychiatry within two large UK mental health trusts in 2018. Quantitative analysis was conducted, alongside qualitative analysis of free-text comments made by participants. Findings Many participants perceived their physical examination skills to have deteriorated since working in psychiatry (78 per cent). Participants were questioned on which professional group should hold responsibility for managing the physical health of patients under psychiatric services. A minority felt it should be psychiatrist-led (5 per cent), followed by general practitioner (GP)-led (42 per cent) and then shared responsibility (47 per cent). The majority felt there should be more focused training on physical health in the Core (72 per cent) and Advanced (63 per cent) psychiatry training. Key themes from a framework analysis of qualitative data included potential barriers to shared care, psychiatrists’ concerns regarding their experience and confidence in managing physical health, reasons in favour of shared responsibility, ideas for training and suggestions for improving the current situation. Originality/value Psychiatric patients may engage less well with health services, yet psychiatric medication often impacts significantly on physical health. In this context, there is often a blurring of role boundaries between a psychiatrist and a GP, and there is considerable variation between individual teams. There is a consistent call for more physical health training opportunities for psychiatrists and for mental health services to more proactively promote the physical health of their patients.

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Physical illness in those with mental illness: Psychiatric services need to change focus

Abstract: SummaryThose with mental illness die prematurely. One reason may be that psychiatrists are overly concerned with risk, focusing too much on this aspect of practice and neglecting the physical health needs of our patients. We need to reconsider how we approach our patients and their needs.

Cited by 3 publications

References 8 publications

Depression screening using patient-targeted feedback in general practices: study protocol of the German multicentre GET.FEEDBACK.GP randomised controlled trial

Depression screening using patient-targeted feedback in general practices: study protocol of the German multicentre GET.FEEDBACK.GP randomised controlled trial

A constructivist grounded theory of generalist health professionals and their mental health work

Where’s that stethoscope? A survey of psychiatrists’ attitudes to their role in managing physical health

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