Community Sample Of People Research Articles

Circadian preferences, oxidative stress and inflammatory cytokines in bipolar disorder: A community study

ObjectiveTo assess circadian preference among a community sample of people with bipolar disorder, major depression and without any mood disorders. Secondly, we investigated the association of circadian preference with cytokines interleukin-6 (IL-6), interleukin-10 (IL-10) and, tumor necrosis factor alpha (TNF-α) and oxidative stress assessed by thiobarbituric acid reactive substances (TBARS), uric acid and Protein Carbonyl Content (PCC). MethodA cross-sectional study nested in a population-based sample. Caseness was confirmed with the Structured Clinical Interview for DSM-IV. A sample of 215 participants, in whom we measured circadian preferences, IL-6, IL-10, TNF-α, TBARS, uric acid, PCC. Biological rhythms were evaluated using the Biological Interview of Assessment in Neuropsychiatry. ResultsBipolar group presented a higher alteration in biological rhythms (40.40±9.78) when compared with the major depression group (36.35±9.18) and control group (27.61±6.89) p<0.001. Subjects with bipolar disorder who were active at night and had a day/night cycle reverse showed decreased levels of IL-6 (t, 44=2.096; p=0.042), (t, 44=2.213; p=0.032), respectively. In the bipolar disorder group subjects who presented day/night cycle reverse had lower TBARS levels (t, 41=2.612; p=0.013). TNF-α were decreased in subjects more active at night with bipolar disorder. ConclusionLower serum levels of IL-6, TNF-α and TBARS were associated with evening preference in bipolar disorder group. These findings suggest that chronotype may alter the levels of interleukins and oxidative stress levels in bipolar and healthy subjects. A better understanding of the role of circadian preferences in levels of interleukins and oxidative stress are needed.

Secondary conditions in a community sample of people with spinal cord damage

Objective: To compare secondary conditions in people with traumatic spinal cord injury (SCI) and non-traumatic spinal cord dysfunction (SCDys).Design: Survey; completed August 2012 – June 2013.Setting: Community, Australia.Participants: Adults with spinal cord damage from any cause.Interventions: Nil.Outcome Measures: Demographic and clinical variables and the SCI-Secondary Conditions Scale (SCI-SCS).Results: Survey completed by 150 people: 112 (74.7%) with traumatic SCI and 38 (25.3%) with non-traumatic SCDys a median of 10 years post onset. No significant difference (t = –0.6, P = 0.6) in the total SCI-SCS score between those with SCI (mean 13.7) and SCDys (mean 14.4). Except for bladder problems (SCDys mean = 1.5, SD = 1.1; SCI mean = 1.0, SD=1.1; t = –2.6, P = 0.01) there were no significant differences between the aetiology groups regarding the conditions comprising the SCI-SCS (all other P values >0.1). The most common significant or chronic problems from the SCI-SCS were: sexual problems 41%; chronic pain 24%; bladder dysfunction 17%; spasms 17%; joint and muscle pain 15%; bowel dysfunction 14%; circulation problems 14%; contractures 9%; urinary tract infections 9%; pressure ulcer 7% and postural hypotension 5%. A linear regression analysis found that tetraplegia and higher disability were the only variables that significantly influenced (R2 = 0.13; P = 0.005) the total SCI-SCS score and that sex, age, years post injury and etiology of spinal cord damage had no influence.Conclusions: Secondary conditions following spinal cord damage do not appear to be influenced by etiology. Prevention and management of secondary conditions following need to consider people with non-traumatic SCDys as well as those with traumatic SCI.

What factors contribute to the risk of depression in epilepsy?--Tasmanian Epilepsy Register Mood Study (TERMS).

To model the factors associated with depression in a community sample of people with epilepsy. The factors investigated were derived from proposed risk factors for depression from patients with epilepsy, other chronic illness, and the general population. Multivariate analysis using general linear regression models of factors associated with depression in the Tasmanian Epilepsy Register Mood Study (TERMS), a cross-sectional community sample of 440 patients with epilepsy. A model with acceptable fit was created that explained 66% of the variance of depression. Associated factors included in this model were neuroticism, physical functioning, social support, past history of depression, and stressful life events. In this cross-sectional study designed specifically to investigate depression in epilepsy, we showed that general risk factors for depression in other illness and in the general population are also important in patients with epilepsy, with little support for disease-related risk factors.

Adults with high social anhedonia have altered neural connectivity with ventral lateral prefrontal cortex when processing positive social signals.

Social anhedonia (SA) is a debilitating characteristic of schizophrenia, a common feature in individuals at psychosis-risk, and a vulnerability for developing schizophrenia-spectrum disorders. Prior work (Hooker et al., 2014) revealed neural deficits in the ventral lateral prefrontal cortex (VLPFC) when processing positive social cues in a community sample of people with high SA. Lower VLPFC neural activity was related to more severe self-reported schizophrenia-spectrum symptoms as well as the exacerbation of symptoms after social stress. In the current study, psycho-physiological interaction (PPI) analysis was applied to further investigate the neural mechanisms mediated by the VLPFC during emotion processing. PPI analysis revealed that, compared to low SA controls, participants with high SA exhibited reduced connectivity between the VLPFC and the motor cortex, the inferior parietal and the posterior temporal regions when viewing socially positive (relative to neutral) emotions. Across all participants, VLPFC connectivity correlated with behavioral and self-reported measures of attentional control, emotion management, and reward processing. Our results suggest that impairments to the VLPFC mediated neural circuitry underlie the cognitive and emotional deficits associated with social anhedonia, and may serve as neural targets for prevention and treatment of schizophrenia-spectrum disorders.

The use of paracetamol (acetaminophen) among a community sample of people with chronic non-cancer pain prescribed opioids.

The regular use of simple analgesics in addition to opioids such as paracetamol (or acetaminophen) is recommended for persistent pain to enhance analgesia. Few studies have examined the frequency and doses of paracetamol among people with chronic non-cancer pain including use above the recommended maximum daily dose. To assess (i) the prevalence of paracetamol use among people with chronic non-cancer pain prescribed opioids, (ii) assess the prevalence of paracetamol use above the recommended maximum daily dose and (iii) assess correlates of people who used paracetamol above the recommended maximum daily dose including: age, gender, income, education, pain severity and interference, use of paracetamol/opioid combination analgesics, total opioid dose, depression, anxiety, pain self-efficacy or comorbid substance use, among people prescribed opioids for chronic non-cancer pain. This study draws on baseline data collected for the Pain and Opioids IN Treatment (POINT) study and utilises data from 962 interviews and medication diaries. The POINT study is national prospective cohort of people with chronic non-cancer pain prescribed opioids. Participants were recruited from randomly selected pharmacies across Australia. Sixty-three per cent of the participants had used paracetamol in the past week (95% CI = 59.7-65.8). Among the paracetamol users 22% (95% CI = 19.3-24.6) had used paracetamol/opioid combination analgesics and 4.8% (95% CI = 3.6-6.3) had used paracetamol above the recommended maximum daily dose (i.e. > 4000 mg/day). Following binomial logistic regression (χ(2) = 25.98, df = 10, p = 0.004), people who had taken above the recommended maximum daily dose were less likely to have low income (AOR = 0.52, 95% CI = 0.27-0.99), more likely to use paracetamol/opioid combination analgesics (AOR = 2.01, 95% CI = 1.02-3.98) and more likely to take a higher opioid dose (AOR = 1.00, 95% CI = 1.00-1.01). The majority of people with chronic non-cancer pain prescribed opioids report using paracetamol appropriately. High income, use of paracetamol/opioid combination analgesics and higher opioid dose were independently associated with paracetamol use above the recommended maximum daily dose.

The Prevalence of Stereotype Self-concurrence and Habitual Self-stigma in a Community Sample of People with Mental Illness

Introduction Although many people with mental illness (PMI) may self-concur with negative stereotypes of mental illness ('stereotype self-concurrence”) at some point, they may have different degrees of habitual recurrence of such self-defeating perceptions (' habitual self-stigma ”), which could further exacerbate the experience of self-stigma and perpetuate its adverse effects on mental well-being. The present study evaluated the prevalence of stereotype self-concurrence and habitual self-stigma in a community sample of 187 PMI in Hong Kong. Methods Stereotype self-concurrence was assessed using the Self-Stigma Scale—Short Form. The 9-item SSS-SF was rated on a 6-point Likert scale from 1 ( strongly disagree ) to 6 ( strongly agree ). Categories of minimal ( 4) levels of stereotype self-concurrence were defined based on the mean scores of SSS-SF. Habitual self-stigma was assessed using the Self-stigmatizing Thinking’s Automaticity and Repetition (STAR) scale. The 8-item STAR was rated on a 5-point Likert scale from 1 ( strongly disagree ) to 5 ( strongly agree ). Categories of minimal ( 4) levels of habitual self-stigma were defined based on the mean scores of STAR. Results Stereotype self-concurrence was minimal in 40.1% of participants, mild in 9.1%, moderate in 16.6%, and severe in 34.2%. Among participants with mild-to-severe stereotype self-concurrence, the prevalence of minimal, mild, moderate, and severe habitual self-stigma was, respectively, 2.7%, 33%, 56.3%, and 8%. Conclusions Self-stigma appears to be a common experience among PMI. The development of interventions to target stereotype self-concurrence and habitual self-stigma deserves high priority in research efforts.

The social context of anxiety and depression: Exploring the role of anxiety and depression in the lives of Australian adults with epilepsy

AimTo examine key determinants of anxiety and depression in a community sample of people with epilepsy. MethodData were analyzed from the 2010 Australian Epilepsy Longitudinal Survey, examining living with epilepsy in Australia. The HADS was analyzed, and Pearson correlations and block recursive regression were undertaken to identify key associations between anxiety, depression, and a range of variables and to identify key determinants of anxiety and depression. ResultsKey factors to influence anxiety were social aspects of stigma, effectiveness of seizure control, whether in employment, and the number of different epilepsy drugs. Determinants for depression were social aspects of stigma, whether in employment, and the effectiveness of seizure control. Stigma was also found to be an important mediating variable for employment, control, and the number of drugs. ConclusionUnderstanding the mechanisms involved in anxiety and depression in a community sample of people with epilepsy requires the inclusion of opportunities for paid employment and the effects of psychosocial factors such as stigma. Without this fuller social context, there are limitations on understanding factors that influence anxiety and depression and how to deal with the outcomes.

Longitudinal Relationships Between Depression and Functioning in People with Type 2 Diabetes

The reciprocal relationship between depression and functioning in people with chronic conditions is poorly understood. The aim of the present study was to analyze the dynamic relationship between depression and functioning in a community sample of people with diabetes. Participants with diabetes were assessed at baseline and three yearly follow-up assessments (n = 1,403). Depression was assessed using the Patient Health Questionnaire. Global functioning was assessed using the World Health Organization Disability Assessment Schedule II. Path analysis suggested a reciprocal relationship between depression and functioning. Baseline depression was associated with functioning at 3 years follow-up through depression and functioning at 1 and 2 years follow-up assessments. Depression and functioning might interact with each other in a dynamic way: depression at one assessment point might predict poor functioning at the next assessment point, which in turn might predict depression at the next assessment point. This should be taken into account in both treatment and research programs.

The pattern of depressive symptoms in people with type 2 diabetes: A prospective community study

ObjectiveThe aim of the present study was to identify and describe longitudinal patterns of depression in a community sample of people with type 2 diabetes in Quebec, Canada. MethodsA prospective community based study in Quebec, Canada, was carried out between 2008 and 2011. Participants with diabetes were assessed at baseline and at 1, 2 and 3years follow-up (n=1388). Depression was assessed using the Patient Health Questionnaire (PHQ-9). ResultsLongitudinal latent class analysis yielded four clusters representing different longitudinal patterns of depression: Cluster 1 (“no depression”; 67%): participants had neither minor nor major depression over time. Cluster 2 (“slowly increasing prevalence of minor and major depression over time”; 20%): participants had low levels of depression at baseline but increasing levels of minor and major depression over time; while most of the Cluster 3 (“increasing major depression”; 6%) participants had high and increasing levels of major depression over time. Participants in Cluster 4 (“improved depression”; 7%) started with high levels of depression but progressed to low levels of depression. ConclusionsOur results provide important evidence of different longitudinal patterns of depression in people with type 2 diabetes. Identification of four distinct groups of participants might improve our understanding of the course of depression and may provide a basis of classification for intervention.

Relationships Between Objective Sleep Indices and Symptoms in a Community Sample of People With Tetraplegia

Berlowitz DJ, Spong J, Gordon I, Howard ME, Brown DJ. Relationships between objective sleep indices and symptoms in a community sample of people with tetraplegia. ObjectiveTo examine the relationships between injury severity, quality of life, sleep symptoms, objectively measured sleep, and sleep disorders in chronic tetraplegia. DesignCross-sectional survey. SettingCommunity. ParticipantsPeople with tetraplegia (N=78; 59 men, 35 with motor and sensory complete tetraplegia; mean age ± SD, 43±12.1; age range 18–70y), living in the state of Victoria, Australia, who were not currently being treated for sleep disorders and who completed both questionnaires and sleep studies comprised the study cohort. InterventionQuestionnaire battery mailed to potential participants. Returned questionnaires were followed with full, home-based polysomnography. Main Outcome MeasuresDemographics and questionnaire responses. ResultsQuality of life (Assessment of Quality of Life instrument) was worse in the group with complete lesions compared with incomplete lesions (P=.001; median=16; interquartile range, 9 vs 12 [12]), and the Apnea-Hypopnea Index was higher (P=.002; interquartile range, 32.0 [25.2] vs 13.2 [24.8]). Ninety-one percent of those with complete lesions had obstructive sleep apnea (Apnea-Hypopnea Index >10) versus 55.8% of those with incomplete tetraplegia. No effect of lesion level on the Apnea-Hypopnea Index was observed (r=–.04, P=.73). In the complete group, the time taken from sleep onset until the first rapid eye movement sleep period was significantly delayed at over 2 hours. Multiple regression analyses showed substantially stronger relationships between daytime sleep complaints and abnormalities observed in the sleep study in those with complete lesions. ConclusionsObstructive sleep apnea is a major problem, particularly in those with complete tetraplegia, and this single comorbidity is associated with reduced quality of life. In those with incomplete cervical lesions, the relationships between sleepiness, other sleep symptoms, and polysomnography indices are less precise.

Plasma B-Type Natriuretic Peptide Is Useful for Cardiovascular Risk Assessment in Community-Based Diabetes Subjects

Diabetes mellitus (DM) is a strong risk factor for cardiovascular (CV) disease. Plasma B-type natriuretic peptide (BNP) levels are elevated in various types of cardiac diseases. Increased plasma BNP levels have been reported to be associated with CV risk in apparently healthy individuals. However, no studies have yet examined the specific value of plasma BNP for predicting CV incidence in unselected DM subjects in a community-based population.In a community-based DM cohort (n = 1,059, mean = 66 years), baseline BNP levels were determined, and CV events were followed and captured prospectively. The cohort was divided by plasma BNP quintiles. The Cox proportional hazard model was used to determine the relative hazard ratios (HR) among the quintiles. In addition, the effects of adding the plasma BNP or urine albumin-to-creatinine ratio (UACR) to an established CV risk scoring model was examined by calculating the area under the receiver operating characteristic (ROC) curve (AUC).During the 5.7 year follow-up period, CV events were identified in 65 of the DM cohort. There was a significant association between plasma BNP levels and CV event rate (P < 0.001). HR was significantly increased in the highest quintile compared to the lowest (HR = 4.38; 95%CI 1.69 -11.84). The AUC generated from ROC analysis of the Framingham risk score for predicting general CV events was improved by adding BNP testing (from 0.66 to 0.74; P = 0.05), but not by adding UACR (from 0.66 to 0.67; P = 0.49).In a community sample of people with DM, plasma BNP levels above the 80 percentile are directly associated with CV risk, and measurement of plasma BNP alone or in conjunction with an established CV risk score is of value in predicting CV events in these subjects.

Testing integrated behavioural and biomedical models of activity and activity limitations in a population-based sample

Purpose: The predictive utility of an integrated model of disability is tested. The integrated model incorporates an impairment based model (International Classification of Functioning, Disability and Health (ICF)) and the behavioural models. Methods: Community dwelling adults (n = 628) completed a postal questionnaire measuring the integrated model. The ability of the model to predict disability in the form of activity limitations (ALs) and walking, in the full community sample and in respondents reporting chronic pain was tested. Results: In both the community and chronic pain samples each version of the integrated model explained a majority (55%–67%) of the variance in ALs but only 11%–29% of the variance in walking behaviour (WB). Impairment directly predicted ALs but did not directly predict WB. Control related cognitions were direct predictors, and mediators, of the relationship between bodily impairment and both ALs and WB. In addition, intentions and outcome expectancies predicted WB. Self-efficacy (SE) was the most consistent predictor of both ALs and WB. Conclusions: An integrated model which combines psychological constructs and impairment is required for an adequate understanding of ALs. By contrast, behavioural models, but not degree of impairment, are necessary to explain activity levels.Implications for RehabilitationActivity limitations are typically predicted by impairment based models, whereas activity is typically predicted by cognition based models of behaviour.This study examines whether a theoretical model that incorporated both cognition and impairment factors could predict the activity of walking and activity limitations in a community sample of people with and without chronic pain.An adequate understanding of activity limitations required a model that incorporated impairment and cognitions, whereas impairment factors were not required for an understanding of walking behaviour.Interventions to reduce or manage activity limitations might usefully incorporate techniques to change cognitions, especially self-efficacy perceptions.

Osteoporosis in people with intellectual disabilities: a review and a brief study of risk factors for osteoporosis in a community sample of people with intellectual disabilities

The population of people with intellectual disabilities (ID) is increasing and their health needs impact on primary and secondary healthcare specialities. One important aspect of their physical health is bone health as people with ID have increased risk factors associated with osteoporosis. It has been identified that this population has an increased prevalence of low bone mineral density (BMD), osteoporosis and osteopenia. The main contributory factors for low BMD are age, use of antiepileptics, immobility and diagnosis of Down's syndrome. A literature search of electronic databases was undertaken. Studies that included people with ID were reviewed for the prevalence of osteoporosis and osteopenia. A cross-sectional survey was conducted in a community sample (n = 149) to screen for risk factors for osteoporosis. The majority of studies identified increased prevalence of osteoporosis and osteopenia with associated low BMD. In most studies individuals with ID presented with more than two risk factors. In our survey, we identified an increased prevalence of risk factors associated with osteoporosis, namely use of antiepileptics (64%), immobility (23%), history of falls (20%) and fractures (11%). We found that 54% of our sample fulfilled the criteria for screening. Of those who went on to have scans, 55% had osteoporosis and 33% had osteopenia. We conclude that we should be screening for the risk factors associated with low BMD in adults with ID. If these are present further investigations should take place and those found to have osteoporosis and osteopenia should have treatment at an early stage to prevent morbidity and improve their quality of life.

Poster 134: Sleep Disorders in Multiple Sclerosis

Objective: To compare use of over-the-counter and prescription sleep medications in a community sample of people with multiple sclerosis (MS). To identify risk factors associated with sleep problems in the MS sample. Design: Survey study. Setting: Community-based sample in Seattle, Washington. Participants: Subjects with MS (N=473) from a longitudinal self-report survey. Interventions: Participants were asked to self-report on use of over-the-counter and prescription sleep medications. Main Outcome Measures: Participants completed the MOS Sleep scale and other common symptom measures.

Epidemiology of antidepressant medication use in the Canadian diabetes population

Depression has been shown to be a common co-morbidity in diabetes. From a public health point of view, there is a lack of population-based studies regarding the use of antidepressant medication in non-clinical samples of people with diabetes. The objective of the present study was to provide demographic and clinical information about the use of antidepressant medication in a representative community sample of people with diabetes. The Canadian Community Health Survey 1.2 (CCHS 1.2) is a cross-sectional survey that collects information related to health status, health-care utilization and health determinants of the Canadian general population. Diabetes presence was ascertained by self-report of physician diagnosis. Depression and anxiety were assessed using a modified version of the World Mental Health Composite International Diagnostic Interview. Antidepressant use was determined through self-report. The population prevalence of self-reported antidepressant use in the past 12 months was 8.4% (SE = 0.95) among people with diabetes (n = 1,662). People who took antidepressants had higher average body mass index (M = 32.6, SD = 6.5) than those not taking antidepressants (M = 29.2, SD = 5.7). The use of antidepressants was associated with poorer health status and higher number of co-morbid chronic conditions. Half of diabetes subjects who used antidepressant medication in the last year did not have a lifetime history of major depression. In a community sample of people with diabetes, the prevalence of antidepressant use exceeded the prevalence of major depression. Anxiety disorders and other somatic chronic conditions were associated with the prescription of antidepressant medication in people with diabetes, but without a history of major depression.

Association Between Neighborhood-Level Deprivation and Disability in a Community Sample of People With Diabetes

OBJECTIVEThe objective of the present study was to analyze the association between neighborhood deprivation and self-reported disability in a community sample of people with type 2 diabetes.RESEARCH DESIGN AND METHODSRandom digit dialing was used to select a sample of adults with self-reported diabetes aged 18–80 years in Quebec, Canada. Health status was assessed by the World Health Organization Disability Assessment Schedule II. Material and social deprivation was measured using the Pampalon index, which is based on the Canadian Census. Potential risk factors for disability included sociodemographic characteristics, socioeconomic status, social support, lifestyle-related factors (smoking, physical activity, and BMI), health care–related problems, duration of diabetes, insulin use, and diabetes-specific complications.RESULTSThere was a strong association between disability and material and social deprivation in our sample (n = 1,439): participants living in advantaged neighborhoods had lower levels of disability than participants living in disadvantaged neighborhoods. The means ± SD disability scores for men were 7.8 ± 11.8, 12.0 ± 11.8, and 18.1 ± 19.4 for low, medium, and high deprivation areas, respectively (P < 0.001). The disability scores for women were 13.4 ± 12.4, 14.8 ± 15.9, and 18.9 ± 16.2 for low, medium, and high deprivation areas, respectively (P < 0.01). Neighborhood deprivation was associated with disability even after controlling for education, household income, sociodemographic characteristics, race, lifestyle-related behaviors, social support, diabetes-related variables, and health care access problems.CONCLUSIONSThe inclusion of neighborhood characteristics might be an important step in the identification and interpretation of risk factors for disability in diabetes.

The Influence of Religiosity on Depression among Low-Income People with Diabetes

People with diabetes experience depression at a significantly higher rate than do their nondiabetic counterparts. The purpose of this study was to examine the impact of multiple dimensions of religiosity on depression among a lower income population of people with diabetes. Using a cross-sectional design, the study focused on a combined clinical and community sample of people with diabetes from low-income neighborhoods. On the basis of previous studies and confirmatory factor analyses of study data, five distinct dimensions of religiosity emerged: religious belief, reading religious materials, prayer, religious attendance, and engaging others in religious discourse. Bivariate correlation and hierarchical linear regression revealed robust and inverse associations between four of the five dimensions of religiosity and level of depression. Prayer, religious reading, religious attendance, and religious belief proved protective against depressive symptoms. Although it correlated with the other measures of religiosity, engaging in religious discourse was not distinctly associated with levels ofdepression. The analyses suggest that religious resources increase psychological resiliency among those managing the chronic stress of diabetes. Pedagogical and practice implications are discussed.

Psychological distress and short-term disability in people with diabetes: Results from the Canadian Community Health Survey

Objectives Psychological distress may have different effects on short-term disability depending on individual disease severity, which can affect daily life activities. The objective of this study was to evaluate the interaction between psychological distress and activity limitations in daily life, in relation to self-reported disability days in a community sample of people with diabetes. Methods The responses of 3082 adults with self-reported diabetes to the Canadian Community Health Survey Cycle 3.1 were analyzed. Results Prevalence of disability days was higher in diabetic subjects with coexisting psychological distress and activity limitations (67%) than in individuals with either activity limitations in daily life (38%) or psychological distress (30%) alone. With no psychological distress and no activity limitations as reference and after adjusting for relevant covariates, the odds ratio of disability was 2.63 [95% confidence interval (95% CI)=1.60–4.33] for psychological distress, 5.57 (95% CI=3.86–8.05) for activity limitations, and 19.4 (95% CI=11.7–31.9) for activity limitations and comorbid psychological distress. Conclusions The results suggest that there is a joint effect of psychological distress and activity limitations on short-term disability. Detecting and managing psychological distress might be particularly beneficial for persons with diabetes.

Audit on the Use of Antipsychotic Medication in a Community Sample of People with Learning Disability

(2007). Audit on the Use of Antipsychotic Medication in a Community Sample of People with Learning Disability. The British Journal of Development Disabilities: Vol. 53, No. 104, pp. 47-51.

Outcomes of an effectiveness trial of cognitive–behavioural intervention by mental health nurses in schizophrenia

Little is known about the medium-term durability of cognitive-behavioural therapy (CBT) in a community sample of people with schizophrenia. To investigate whether brief CBT produces clinically important outcomes in relation to recovery, symptom burden and readmission to hospital in people with schizophrenia at 1-year follow-up. Participants (336 of 422 randomised at baseline) were followed up at a mean of 388 days (s.d. = 53) by raters masked to treatment allocation (CBT or usual care). At 1-year follow-up, participants who received CBT had significantly more insight (P = 0.021) and significantly fewer negative symptoms (P = 0.002). Brief therapy protected against depression with improving insight and against relapse; significantly reduced time spent in hospital for those who did relapse and delayed time to admission. It did not improve psychotic symptoms or occupational recovery, nor have a lasting effect on overall symptoms or depression at follow-up. Mental health nurses should be trained in brief CBT for schizophrenia to supplement case management, family interventions and expert therapy for treatment resistance.