Chronic Physical Health Problems Research Articles

A feasibility study for NOn-Traditional providers to support the management of Elderly People with Anxiety and Depression: The NOTEPAD study Protocol

BackgroundAnxiety and depression are common among older people, with up to 20% reporting such symptoms, and the prevalence increases with co-morbid chronic physical health problems. Access to treatment for anxiety and depression in this population is poor due to a combination of factors at the level of patient, practitioner and healthcare system.There is evidence to suggest that older people with anxiety and/or depression may benefit both from one-to-one interventions and group social or educational activities, which reduce loneliness, are participatory and offer some activity. Non-traditional providers (support workers) working within third-sector (voluntary) organisations are a valuable source of expertise within the community but are under-utilised by primary care practitioners. Such a resource could increase access to care, and be less stigmatising and more acceptable for older people.MethodsThe study is in three phases and this paper describes the protocol for phase III, which will evaluate the feasibility of recruiting general practices and patients into the study, and determine whether support workers can deliver the intervention to older people with sufficient fidelity and whether this approach is acceptable to patients, general practitioners and the third-sector providers.Phase III of the NOTEPAD study is a randomised controlled trial (RCT) that is individually randomised. It recruited participants from approximately six general practices in the UK. In total, 100 participants aged 65 years and over who score 10 or more on PHQ9 or GAD7 for anxiety or depression will be recruited and randomised to the intervention or usual general practice care. A mixed methods approach will be used and follow-up will be conducted 12 weeks post-randomisation.DiscussionThis study will inform the design and methods of a future full-scale RCT.Trial registrationISRCTN, ID: ISRCTN16318986. Registered 10 November 2016. The ISRCTN registration is in line with the World Health Organization Trial Registration Data Set. The present paper represents the original version of the protocol. Any changes to the protocol will be communicated to ISRCTN.

Dimensions of improvement the physical health of people with mental illness

The article analyzes a recent meta-analysis of mortality in mental illness, which has concluded that mental health conditions constitute a population attributable risk (PAR) of 14.3% and are, therefore, responsible for more than 8 million annual deaths worldwide, ahead of ischaemic heart disease, stroke, chronic obstructive pulmonary disease (CORP) and HIV/AIDS. It is proved that this huge death rate is partially attributable to an increased likelihood of people with a mental illness developing physical health problems. This is particularly the case in cardiovascular disease (CVD), by far the largest contributor to worldwide disease-related mortality, where diagnosis is as much as two and a half times more likely for people with major depressive disorder or schizophrenia, and may yet be even higher for people with bipolar disorder. It is clear that international governments and social services need to take heed of this looming public health crisis and implement new strategies and services capable of breaking the cycle and preventing early deaths. However, the global health budget is not unlimited and therefore it is crucial that the strategies prioritised are taken forward, and are efficient, evidence-based, and flexible enough to draw significant outcomes from a variety of contexts. The only way these three criteria can be satisfied, is through a concrete understanding of the causes of reduced physical health in people with mental illness. Mental health and physical health are so interlinked, maybe it is unhelpful to think of them as two separate entities and just focus on promoting health in general. The reintegration of psychiatric care and general somatic services, with an ultimate goal of providing optimal services to this vulnerable patient population, seems to represent one of the most important challenges for psychiatric care today. Integrated treatment programmes in which medical providers are supported to treat common mental health problems offer a chance to treat ‘the whole patient’, an approach that is more patient-centred and often more effective than an approach in which mental health, acute and chronic physical health, reproductive health, and chronic pain problems are each addressed in a different ‘silo’ without effective communication between providers.

Youth with chronic health problems: how do they fare in main-stream mentoring programs?

BackgroundYouth with chronic physical health problems often experience social and emotional problems. We investigate the relationship between participation in the Big Brothers Big Sisters of Canada community-based mentoring programs (BBBS) and youth social and mood outcomes by youth health status.MethodsYouth newly enrolled in BBBS were classified by health status (one or more chronic physical health problems without activity limitation, n = 191; one or more chronic physical health problems with activity limitation, n = 94; no chronic health problem or activity limitation, n = 536) and mentoring status (yes/no) at 18 month follow-up. Youth outcomes measured at follow-up were social anxiety, depressed mood, and peer self-esteem.ResultsYouth with chronic health problems and activity limitation were more likely to live with two biological parents, use mental health or social services, and have parents who reported difficulties with depressed mood, social anxiety, family functioning and neighbourhood problems. At 18 month follow-up, mentored youth in this health status group experienced fewer symptoms of social anxiety and higher peer self-esteem compared to non-mentored youth. Mentored youth with chronic health problems without activity limitation and mentored youth with no health problems or limitations did not show significant improvements in social anxiety and peer self-esteem. Regardless of their health status, mentored youth reported fewer symptoms of depressed mood than non-mentored youth.ConclusionsYouth with chronic health problems, particularly those with activity limitation as well, demonstrate a capacity to experience social and mood benefits associated with mentoring.

Parkinson's disease: a focus on policy for 2017

British Journal of Neuroscience NursingVol. 13, No. 5 PolicyParkinson's disease: a focus on policy for 2017Sue ThomasSue ThomasSearch for more papers by this authorSue ThomasPublished Online:26 Oct 2017https://doi.org/10.12968/bjnn.2017.13.5.232AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References All Party Parliamentary Group on Parkinson's. https://tinyurl.com/yabocrcf (accessed 16 October 2017) Google ScholarChaudhuri KR, Prieto-Jurcynska C, Naidu Y et al.. The nondeclaration of nonmotor symptoms of Parkinson's disease to health care professionals: an international study using the non-motor symptoms questionnaire. Mov Disord. 2010;25(6):704–9 Crossref, Google ScholarChen JJ, Marsh L. Anxiety in Parkinson's disease: Identification and management. Ther Adv Neurol Disord. 2014;7(1):52–9 Crossref, Google ScholarDobkin RD, Rubino JT, Friedman Jill, Allen LA, Gara MA, Menza M. Barriers to mental health care utilization in Parkinson's disease. J Geriatr Psychiatry Neurol. 2013;26(2): 105–16 Crossref, Google ScholarFoltynie T, Brayne CE, Robbins TW, Barker RA. The cognitive ability of an incident cohort of Parkinson's patients in the UK. The CamPaIGN study. Brain. 2004;127(3): 550–60 Crossref, Google ScholarGlobal Parkinson's Disease Survey Steering Committee. Factors impacting on quality of life in Parkinson's disease: results from an international survey. Mov Disord. 2002;17(1):60–7 Crossref, Google ScholarNational Institute for Health and Care Excellence. Parkinson's disease in over 20s: diagnosis and management (CG35); 2006. https://www.nice.org.uk/guidance/cg35 (accessed 16 October 2017) Google ScholarNational Institute for Health and Care Excellence. Guideline: Depression in adults with a chronic physical health problem: recognition and management (CG91), 2009. https://www.nice.org.uk/guidance/cg91 (accessed 16 October 2017) Google ScholarNational Institute for Health and Care Excellence. Guideline: Parkinson's disease in Adults (NG71), 2017a. https://www.nice.org.uk/guidance/ng71 (accessed 16 October 2017) Google ScholarNational Institute for Health and Care Excellence. Draft Quality Standard on Parkinson's, 2017b. https://tinyurl.com/y8vqm4rp (accessed 16 October 2017) Google ScholarNHS Digital. Hospital Episode Statistics (HES). http://www.digital.nhs.uk/hes (accessed 16 October 2017) Google ScholarNHS England. Clinical Commissioning Policy: Levodopa-Carbidopa Intestinal Gel (LCIG), 2015. https://tinyurl.com/y8nps9c6 (accessed 16 October 2017) Google ScholarWilmington Healthcare Ltd. Hospital Episode Statistics for Parkinson's; 2017. https://tinyurl.com/yb9d3vft (accessed 16 October 2017) Google Scholar FiguresReferencesRelatedDetails 2 October 2017Volume 13Issue 5ISSN (print): 1747-0307ISSN (online): 2052-2800 Metrics History Published online 26 October 2017 Published in print 2 October 2017 Information© MA Healthcare LimitedPDF download

Qualitative study to explore the health and well-being impacts on adults providing informal support to female domestic violence survivors

ObjectivesDomestic violence (DV) is hazardous to survivors' health, from injuries sustained and from resultant chronic physical and mental health problems. Support from friends and relatives is significant in the lives...

Association of Serotonin 1A Receptor Polymorphism with Variation in Health-Related Quality of Life in Korean Hemodialysis Patients.

ObjectiveHemodialysis patients may have psychological distress and reduced quality of life (QoL) related to chronic physical health problems. Genetic polymorphisms associated with reduced QoL in hemodialysis patients. The aim of this study was to investigate the relationship between genetic polymorphisms and variation in health-related QoL in Korean hemodialysis patients.MethodsThe 36-item Short-Form Health Survey and the Korean Hospital Anxiety and Depression Scale were used to assess health-related QoL and psychological distress, respectively. Twenty hundred and five clinically stable patients from 6 hemodialysis centers have participated with informed consents. Sociodemographic factors, clinical factors, and genotypes of serotonin 1A receptor, brain-derived neurotrophic factors, and glucocorticoid receptor were assessed. Independent t-tests, correlation analyses, multiple regression analyses were performed for statistical analyses.ResultsThe serotonin 1A receptor CC genotype group showed significantly higher physical and mental QoL levels than those with the GG/GC genotypes. In the final linear regression analysis, serotonin 1A receptor CC genotype was significantly associated with positive physical and mental QoL levels.ConclusionConclusionaaSerotonin 1A receptor polymorphism, as well as age and depression, were significantly associated with mental and physical QoL in hemodialysis patients. Functional activity in the serotonin receptor system may have a modulating effect on health-related QoL in hemodialysis patients.

Self-Forgiveness and Life Satisfaction in People Living with HIV/AIDS

The basic goals of the present study were to explore the nature and patterns of relationship between self-forgiveness and life satisfaction of the participants diagnosed with HIV/AIDS and normal healthy persons with no reported chronic physical and/or mental health problems. A total of eighty participants comprising forty diagnosed HIV/AIDS adult patients aged 30 to 42 years (M = 35.50, SD = 4.77) and forty normal individuals aged 19 to 40 years (M =26.81, SD = 4.79) took part in the study whose self-forgiveness and life satisfaction were measured through standardized psychometric tools. The results of the present study demonstrated that the participants inflicted with HIV/AIDS had lower mean self-forgiveness score as compared to their normal counterparts. The same trend was found to be recurring again for the life satisfaction scores of HIV/AIDS and normal participants. The results of the study have been discussed in the light of current theoretical background of forgiveness, life satisfaction and chronic disease. The findings of the study have important implications for policy makers, health professionals, caregivers, students, researchers and administrators.

Psychiatric problems in childhood lead to problems transitioning to adulthood

Most psychiatric disorders are first diagnosed in childhood, unlike most chronic physical health problems. Therefore, the disorders and their sequelae can affect people into adulthood and throughout their entire lives. In particular, the rare but highly impairing disorders such as schizophrenia and pervasive developmental disorders cause a significant burden, but so do more common emotional and behavioral disorders, many of which may fade as the child ages into adulthood.

Intimate partner violence and physical and mental health among women utilizing community health services in Gujarat, India

BackgroundIntimate partner violence (IPV) is a significant public health threat which causes injury and acute and chronic physical and mental health problems. In India, a high percentage of women experience IPV. The purposes of this study include 1) to describe the lifetime prevalence of IPV, and 2) to examine the association between IPV and physical and mental health well-being, among women utilizing community health services for the economically disadvantaged in India.MethodsWomen utilizing community health services (N = 219) aged between 18 and 62 years completed a self-administered survey in Gujarat, India. Standardized instruments were used to measure perceived physical and mental health well-being. In addition, participants were asked about their lifetime experience with IPV, and socio-demographic questions. Analysis was restricted to the ever-married participants who completed the questions on IPV (N = 167).ResultsParticipants with a lifetime history of IPV were more likely to have reported poorer physical and mental health compared to those without a lifetime history of IPV. More than half of the participants with an IPV history experienced multiple types of IPV (physical, sexual and/or emotional IPV). While being in the highest caste was a significant positive factor associated with better health, caste and other socio-demographic factors were not associated with IPV.ConclusionsWomen in India face risk of IPV. Yet those experiencing IPV do not seek help or rely on informal help sources. Community health organizations may take a role in IPV prevention and intervention. Diversity of intervention options would be important to encourage more women with IPV experience to seek help.

Chronic Physical Health Problems Moderate Changes in Depression and Substance Use Among Dual Diagnosed Individuals During and After Treatment

Background: Physical illnesses frequently co-occur with depression and substance use disorders and may impact their improvement. Physical illness symptoms may overlap with or exacerbate somatic symptoms of depression. Individuals may use substances to cope with symptoms of physical illness. Objectives: We examined whether chronic physical health problems moderated changes in depression and substance use among dual diagnosed individuals during and in the year following treatment. Methods: Participants were recruited from a Veterans Affairs dual diagnosis outpatient program between March 2000 and November 2007 and were randomized to either Integrated Cognitive-Behavioral Therapy or Twelve-Step Facilitation Therapy. A total of 214 veterans with assessment data for the variables of interest were included in analyses. Participants completed quarterly depression, substance use, and health assessments over an 18 month period. We used linear-mixed effects models to analyze patterns of change for depression and substance use. Results: Individuals with severe chronic health problems and higher intake depression showed slower improvements in both nonsomatic and somatic depression symptoms. Individuals with severe chronic health problems and higher midtreatment substance use showed less improvement in substance use. Conclusions: Assessing and addressing physical health issues during depression and substance use disorder treatment may improve outcomes.

Chronic Physical Health Problems in Sexual Minority Women: Review of the Literature.

Although there is substantial literature about sexual minority women's mental health and use of alcohol, tobacco, and other drugs (ATOD), only recently has attention been focused on chronic physical health disorders thought to stem from stress and exposure to ATOD use. The most extensively studied aspect of physical health has been weight, with the majority of studies reporting higher prevalence of overweight and obesity. In addition, many studies report higher levels of stressful experiences in both childhood and adulthood for sexual minority women. In this paper, the hypothesized relationship between stress, unhealthy behaviors, and five common chronic physical health disorders is explored via review of the literature. Only asthma appeared to be consistently more common in sexual minority women, and few or no differences in diabetes, hypertension, cardiovascular disease, and most cancers were found. The limitations of these studies are reviewed, and the need for studies that directly address the relationships among stress, health-damaging practices, and chronic disorder is emphasized. However, if these findings hold up, and sexual minority women are not more prone to these disorders, the field may need better theoretical frameworks from which to explore potential differences in the manifestation of mental versus chronic physical health disparities.

Quality of primary care for resettled refugees in the Netherlands with chronic mental and physical health problems: a cross-sectional analysis of medical records and interview data.

BackgroundA high prevalence of mental and physical ill health among refugees resettled in the Netherlands has been reported. With this study we aim to assess the quality of primary healthcare for resettled refugees in the Netherlands with chronic mental and non-communicable health problems, we examined: a) general practitioners’ (GP) recognition of common mental disorders (CMD) (depression and anxiety, and post-traumatic stress disorder (PTSD) symptoms); b) patients’ awareness of diabetes type II (DMII) and hypertension (HT); and c) GPs’ adherence to guidelines for CMD, DMII and HT.MethodsFrom 172 refugees resettled in the Netherlands, interview data (2010–2011) and medical records (n = 106), were examined. Inclusion was based on medical record diagnoses for DMII and HT, and on questionnaire-based CMD measures (Hopkins Symptom Checklist for depression and anxiety; Harvard Trauma Questionnaire for PTSD). GP recognition of CMD was calculated as the number of CMD cases registered in the medical record compared with those found in interviews. Patient awareness of HT and DMII was scored as the percentage of subjects diagnosed by the GP who reported their condition during the interview. GPs’ adherence to guidelines for CMD, DMII and HT was measured using established indicators.ResultsWe identified 37 resettled refugees with CMD of which 18 (49%) had been recognised by the GP. We identified 16 refugees with DMII and 14 with HT from the medical record; 24 (80%) were aware of their condition. Thirty-five out of these 53 (66%) resettled refugees with chronic mental and non-communicable disorders received guideline-adherent treatment.ConclusionThis study shows that awareness in resettled refugees of GP diagnosed DMII and HT is high, whereas GP recognition of CMD and overall guideline adherence are moderate.

IPS: The Place to Get Your Integrated Care Questions Answered

Back to table of contents Next article APA InstituteFull AccessIPS: The Place to Get Your Integrated Care Questions AnsweredAlvaro Camacho, M.D.Alvaro CamachoSearch for more papers by this author, M.D.Published Online:5 Aug 2014https://doi.org/10.1176/appi.pn.2014.9a20AbstractThe Scientific Program Commitee of the Institute on Psychiatric Services has ensured that integrated care topics have a prominent place on this year’s program.Integration of general medical and mental health has been an issue for discussion since the 1960s, when psychiatrists in England started to spend more time addressing physical complaints associated with comorbid depression and anxiety. Initially, it was thought that general practitioners could treat these conditions, but further surveys showed that the problem needed a more comprehensive approach by psychiatrists and mental health professionals due to the complexity of the comorbid physical and mental illnesses.Songquan Deng/ShutterstockStudies have shown that more than 95 percent of patients with mental illness are treated in community clinics, with anxiety and depression accounting for the vast majority of these conditions. Government policies around the world have embraced providing mental health services in local community clinics, with the vision of improving quality of care and providing a cost-effective service. Tony Kendrick and colleagues performed a formative research study in which 90 percent of primary care providers said they would treat individuals with mental illness if they had the support or available consultation from a psychiatrist, psychiatric nurse, or psychologist to discuss treatment options, referrals, and psychosocial interventions. But this arrangement has not occurred most of the time, with primary care providers expressing frustration when caring for people with mental illness due to lack of communication with mental health care providers, lack of resources outside the community clinic, and poor response to treatment needs by local governments. These concerns have contributed to a crisis that requires changes in health policy and leadership. Since the introduction of the 2008 federal parity law, which mandates equal benefits for Americans whether they suffer from mental or physical illness, and now with the Affordable Care Act, the health care system has been facing the new challenge of integrating not only mental health needs but the growing chronic physical health problems that Americans face and that are likely to become more prevalent as the population ages.The California Psychiatric Association, in association with APA, has voiced the need for legislators to make integrated care a priority to improve and promote treatment of mental illness within primary care services. APA’s 2014 Institute on Psychiatric Services—to be held October 30 to November 2 in San Francisco—will have several interesting and informative lectures and other sessions that will address the growing interest in integrated care. We are fortunate to have this meeting here in California, where the idea of integrated care has been in the works for quite some time.There is a consistent body of evidence in the literature that addresses the effectiveness, efficiency, and continuing need to integrate mental and physical health. We are confident that attendees at this year’s institute will find that this meeting will go a long way toward fulfilling the needs of those who dedicate their practice to treating individuals attending our community health clinics. It is clear that community clinics will continue to provide the vast majority of health care and prevention in the United States. ■ Registration and other information about the 2014 Institute on Psychiatric Services can be accessed here.Alvaro Camacho, M.D., is an assistant clinical professor of psychiatry at the University of California, San Diego, director of the Sun Valley Research Center, and a member of the Scientific Program Committee for the Institute on Psychiatric Services. ISSUES NewArchived

Factors Associated with Depression among Elderly Living in Old Age Homes in Kathmandu Valley

Introduction: The elderly people not only face physical problems as they are age, they also experience mental health related problems. The main objective of the study was to identify the level of depression and the factors associated with them among elderly living in old age homes in Kathmandu Valley of Nepal. Methods: The cross-sectional descriptive analytical study design was used among 173 respondents who were selected by purposive sampling method. Interview was carried out using socio-demographic and other variables related tool, the partially adopted coping checklist and the Geriatric Depression Scale (GDS). The data analysis was done by using Epidata and SPSS software version 16. Chi-square test and odds ratio were calculated. Results: This study revealed that 126 (72.8%) respondents had depression. Out of them, according to GDS, 98 (56.6%) and 28 (16.2%) respondents had mild and severe depression respectively. Among 45 male respondents, 28 (62.2%) had depression as compared to 98 (76.6%) out of 128 female respondents. The respondents who had chronic physical health problems; different types of worries like financial security, lack of social relation, lack of favorite activities, fear of future and dissatisfaction with environment of the elderly homes, feeling of stress and even those respondents who used coping strategies like self blame were found to have depression. Conclusion: Based on these findings, it can be suggested that new coping strategies as well as mind diversional activities should be sought for preventing depression among elderly living in old age homes.

Collaborative care for comorbid depression and diabetes: a systematic review and meta-analysis

ObjectiveThe collaborative care model is recommended for depression in adults with a chronic physical health problem like diabetes. We sought to systematically assess the effect of collaborative care on depression...

IAPT for people with chronic physical health problems: An audit and evaluation of training

This paper describes an audit carried out with clinicians in an established South London Improving Access to Psychological Therapies (IAPT) service, exploring: (a) the number of clients seen who have a co-morbid physical health condition, and (b) therapists’ perceptions of their own competence at offering these clients effective interventions. Based on the responses received, top-up workshops were designed and delivered to increase skills and self-efficacy in working with this client group, and workshop objectives were evaluated. This report describes the audit and then considers the implications for training needs, and the content and evaluation of workshops.

Assessing positive mental health in people with chronic physical health problems: correlations with socio-demographic variables and physical health status.

BackgroundA holistic perspective on health implies giving careful consideration to the relationship between physical and mental health. In this regard the present study sought to determine the level of Positive Mental Health (PMH) among people with chronic physical health problems, and to examine the relationship between the observed levels of PMH and both physical health status and socio-demographic variables.MethodsThe study was based on the Multifactor Model of Positive Mental Health (Lluch, 1999), which comprises six factors: Personal Satisfaction (F1), Prosocial Attitude (F2), Self-control (F3), Autonomy (F4), Problem-solving and Self-actualization (F5), and Interpersonal Relationship Skills (F6). The sample comprised 259 adults with chronic physical health problems who were recruited through a primary care center in the province of Barcelona (Spain). Positive mental health was assessed by means of the Positive Mental Health Questionnaire (Lluch, 1999).ResultsLevels of PMH differed, either on the global scale or on specific factors, in relation to the following variables: age: global PMH scores decreased with age (r=-0.129; p=0.038); b) gender: men scored higher on F1 (t=2.203; p=0.028) and F4 (t=3.182; p=0.002), while women scored higher on F2 (t -3.086; p=0.002) and F6 (t=-2.744; p=0.007); c) number of health conditions: the fewer the number of health problems the higher the PMH score on F5 (r=-0.146; p=0.019); d) daily medication: polymedication patients had lower PMH scores, both globally and on various factors; e) use of analgesics: occasional use of painkillers was associated with higher PMH scores on F1 (t=-2.811; p=0.006). There were no significant differences in global PMH scores according to the type of chronic health condition. The only significant difference in the analysis by factors was that patients with hypertension obtained lower PMH scores on the factor Autonomy (t=2.165; p=0.032).ConclusionsMost people with chronic physical health problems have medium or high levels of PMH. The variables that adversely affect PMH are old age, polypharmacy and frequent consumption of analgesics. The type of health problem does not influence the levels of PMH. Much more extensive studies with samples without chronic pathology are now required in order to be able to draw more robust conclusions.

Depression in Adults With a Chronic Physical Health Problem. National Collaborating Centre for Mental Health. (2010) London

Depression in Adults With a Chronic Physical Health Problem. National Collaborating Centre for Mental Health. (2010) London

Examining the cost effectiveness of interventions to promote the physical health of people with mental health problems: a systematic review

BackgroundRecently attention has begun to focus not only on assessing the effectiveness of interventions to tackle mental health problems, but also on measures to prevent physical co-morbidity. Individuals with mental health problems are at significantly increased risk of chronic physical health problems, such as cardiovascular disease or diabetes, as well as reduced life expectancy. The excess costs of co-morbid physical and mental health problems are substantial. Potentially, measures to reduce the risk of co-morbid physical health problems may represent excellent value for money.MethodsTo conduct a systematic review to determine what is known about economic evaluations of actions to promote better physical health in individuals identified as having a clinically diagnosed mental disorder, but no physical co-morbidity. Systematic searches of databases were supplemented by hand searches of relevant journals and websites.ResultsOf 1970 studies originally assessed, 11 met our inclusion criteria. In addition, five protocols for other studies were also identified. Studies looked at exercise programmes, nutritional advice, smoking, alcohol and drug cessation, and reducing the risk of blood borne infectious diseases such as HIV/AIDS and hepatitis. All of the lifestyle and smoking cessation studies focused on people with depression and anxiety disorders. Substance abuse and infectious disease prevention studies focused on people with psychoses and bipolar disorder.ConclusionsThere is a very small, albeit growing, literature on the cost effectiveness of interventions to promote the physical health of people with mental health problems. Most studies suggest that value for money actions in specific contexts and settings are available. Given that the success or failure of health promoting interventions can be very context specific, more studies are needed in more settings, focused on different population groups with different mental health problems and reporting intermediate and long term outcomes. There is a need to better distinguish between resource use and costs in a transparent manner, including impacts outside of the health care system. Issues such as programme fidelity, uptake and adherence should also be accounted for in economic analysis. The role of behavioural psychological techniques to influence health behaviours might also be considered.

Implementing the NICE clinical guideline 91 (‘Depression in adults with a chronic physical health problem’) in a haematology department

The paper summarises the key points from the National Institute of Health and Clinical Excellence Guidance 91 (‘Depression in adults with a chronic physical health problem’) and how screening has been implemented in a Haematology Department that has demonstrated significant levels of depression.