Publications (13) View all
-
Article: The normalisation of disrupted attentional processing of infant distress in depressed pregnant women following Cognitive Behavioural Therapy.
[show abstract] [hide abstract]
ABSTRACT: BACKGROUND: Maternal depression is associated with abnormal processing of infant distress. This may explain why depression disrupts maternal behaviour and ultimately child outcomes. Understanding and improving such processing, in depressed mothers as early as possible is thus important. AIM: The focus of the current study was to investigate whether Cognitive Behavioural Therapy (CBT) normalises depressed pregnant women's abnormal attentional processing of infant distress. METHOD: Depressed pregnant women participating in a randomised control trial completed a measure of attentional bias for infant distress before and after intervention. Women received either CBT (n=12) or usual care [UC] (n=12) between their first and last trimesters of pregnancy. RESULTS: At baseline, depressed women in both arms showed a diminished attentional bias for infant distress compared to a non-depressed comparison group (n=51). Following intervention attentional biases of women who received CBT increased becoming comparable to non-depressed women. In contrast there was no improvement in the UC arm. CONCLUSIONS: If replicated, the findings may suggest that CBT during pregnancy improves mother's basic processing of infant stimuli before their child is born. LIMITATIONS: The sample size was relatively small and there was some loss to follow up between the pre and post intervention sessions.Journal of affective disorders 08/2012; · 3.76 Impact Factor -
Article: Facilitated physical activity as a treatment for depressed adults: randomised controlled trial.
[show abstract] [hide abstract]
ABSTRACT: To investigate the effectiveness of facilitated physical activity as an adjunctive treatment for adults with depression presenting in primary care. Pragmatic, multicentre, two arm parallel randomised controlled trial. General practices in Bristol and Exeter. 361 adults aged 18-69 who had recently consulted their general practitioner with symptoms of depression. All those randomised had a diagnosis of an episode of depression as assessed by the clinical interview schedule-revised and a Beck depression inventory score of 14 or more. In addition to usual care, intervention participants were offered up to three face to face sessions and 10 telephone calls with a trained physical activity facilitator over eight months. The intervention was based on theory and aimed to provide individually tailored support and encouragement to engage in physical activity. The primary outcome was self reported symptoms of depression, assessed with the Beck depression inventory at four months post-randomisation. Secondary outcomes included use of antidepressants and physical activity at the four, eight, and 12 month follow-up points, and symptoms of depression at eight and 12 month follow-up. There was no evidence that participants offered the physical activity intervention reported improvement in mood by the four month follow-up point compared with those in the usual care group; adjusted between group difference in mean Beck depression inventory score -0.54 (95% confidence interval -3.06 to 1.99; P=0.68). Similarly, there was no evidence that the intervention group reported a change in mood by the eight and 12 month follow-up points. Nor was there evidence that the intervention reduced antidepressant use compared with usual care (adjusted odds ratio 0.63, 95% confidence interval 0.19 to 2.06; P=0.44) over the duration of the trial. However, participants allocated to the intervention group reported more physical activity during the follow-up period than those allocated to the usual care group (adjusted odds ratio 2.27, 95% confidence interval 1.32 to 3.89; P=0.003). The addition of a facilitated physical activity intervention to usual care did not improve depression outcome or reduce use of antidepressants compared with usual care alone. Current Controlled Trials ISRCTN16900744.BMJ (Clinical research ed.). 01/2012; 344:e2758. -
Article: Physical activity as a treatment for depression: the TREAD randomised trial protocol.
[show abstract] [hide abstract]
ABSTRACT: Depression is one of the most common reasons for consulting a General Practitioner (GP) within the UK. Whilst antidepressants have been shown to be clinically effective, many patients and healthcare professionals would like to access other forms of treatment as an alternative or adjunct to drug therapy for depression. A recent systematic review presented some evidence that physical activity could offer one such option, although further investigation is needed to test its effectiveness within the context of the National Health Service.The aim of this paper is to describe the protocol for a randomised, controlled trial (RCT) designed to evaluate an intervention developed to increase physical activity as a treatment for depression within primary care. The TREAD study is a pragmatic, multi-centre, two-arm RCT which targets patients presenting with a new episode of depression. Patients were approached if they were aged 18-69, had recently consulted their GP for depression and, where appropriate, had been taking antidepressants for less than one month. Only those patients with a confirmed diagnosis of a depressive episode as assessed by the Clinical Interview Schedule-Revised (CIS-R), a Beck Depression Inventory (BDI) score of at least 14 and informed written consent were included in the study. Eligible patients were individually randomised to one of two treatment groups; usual GP care or usual GP care plus facilitated physical activity. The primary outcome of the trial is clinical symptoms of depression assessed using the BDI four months after randomisation. A number of secondary outcomes are also measured at the 4-, 8- and 12-month follow-up points including quality of life, attitude to and involvement in physical activity and antidepressant use/adherence. Outcomes will be analysed on an intention-to-treat (ITT) basis and will use linear and logistic regression models to compare treatments. The results of the trial will provide information about the effectiveness of physical activity as a treatment for depression. Given the current prevalence of depression and its associated economic burden, it is hoped that TREAD will provide a timely contribution to the evidence on treatment options for patients, clinicians and policy-makers.Trial registration: ISRCTN 16900744.Trials 11/2010; 11:105. · 2.02 Impact Factor -
Article: The Quality of Residential and Day Services for Adults with Intellectual Disabilities in Eight Local Authorities in England: Objective Data Gained in Support of a Social Services Inspectorate Inspection
[show abstract] [hide abstract]
ABSTRACT: Objective data on the quality of 15 residential homes and 17 day centres were collected as part of a Social Services Inspecorate inspection of services for adults with learning disabilities in eight local authorities in England. A sample of 56 residents was drawn from the former and information collected on their behavioural characteristics, social and community integration, autonomy, receipt of attention and assistance from staff, and participation in activity. The activity timetables of the latter were analysed to determine their emphases. Representative group activities taking place within the centres were observed and user:staff ratios, user receipt of attention from staff and user engagement in activity recorded. Findings from the residential settings demonstrated that the frequency of community integration, the extent of autonomy and the level of activity were associated with resident ability. However, there was a lack of association between staff:resident interaction and resident needs for support. Given the ranges on the quality of life indicators investigated, people with more severe disabilities were found to lead segregated and under occupied existences. These findings add weight to the need to be more precise about the determinants of quality and, in particular, the role and performance of staff. A cluster analysis of day centres based on their activity distributions produced two clusters in common with an earlier Welsh survey; centres with an emphasis on ‘recreation and personal development’ or ‘recreation’. The English sample, however, had a lesser emphasis on both contract work and open employment and contained centres which had a greater representation of personal development and education. Developing consensus on the functions and goals of day services is required if day service reform is to lead to the most effective organisational and operational arrangements.Journal of Applied Research in Intellectual Disabilities 03/2010; 12(4):273 - 293. · 1.38 Impact Factor -
Article: The Impact of Repeated Health Checks for Adults with Intellectual Disabilities
[show abstract] [hide abstract]
ABSTRACT: Background An earlier study (Baxter et al. 2006) found that a structured health check conducted in primary care identified clinically significant previously unrecognized morbidity among adults with intellectual disabilities. The aim here was to examine whether follow-up health checks would identify equally significant newly identified morbidity and to investigate this as a function of the interval between health checks.Method Adults with intellectual disabilities who had had an initial health check (n = 108) participated: group 1 (n = 39) had a repeat health check an average of 28 months later, group 2 (n = 36) had a repeat health check an average of 44 months later and group 3 (n = 33) did not have a subsequent health check. Thirty participants in group 1 had a second repeat health check an average of 14 months after the first repeat. An audit of the results of the health check established whether morbidity was newly identified. Information was collected on each participant’s age, gender, place of residence, skills, challenging behaviour, social abilities, psychiatric status and perceived health. Comparisons within groups over time or between groups at a point in time were made using non-parametric statistics.Results A similar number of newly identified health problems were found at the repeat health check compared to the initial check. The nature of needs identified was also similar. There was no association between the number of new needs identified at the repeat health check and the interval between it and the initial check. The perceived health of participants receiving health checks tended to decline.Conclusions As the level of new need revealed by repeated checks at even the shortest interval since the previous check studied here (mean = 14 months) was as high as that found by the initial check, annual health checking could be a justifiable intervention for this population. Decline in perceived health may represent more accurate assessment by carers following feedback from the health checks.Journal of Applied Research in Intellectual Disabilities 06/2008; 21(6):585 - 596. · 1.38 Impact Factor
