Category Archives: Social Psychiatry Article Review

Integrating Care for Older Adults

Minister for Care and Support Norman Lamb discusses some of the UK Department of Health’s plans to integrate care for older adults with long term health conditions. The address for a site for comments/feedback is shown at the end of the video.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

The Epidemiology of Alzheimer’s Disease

Povova and colleagues have a paper in the journal ‘Biomedical Papers’ titled ‘Epidemiology of and Risk Factors for Alzheimer’s Disease: A Review’ which is freely available here. I found the paper interesting for the coverage of two areas

1. Prevalence and incidence rates. The authors have gathered data from numerous studies. Prevalence data will vary according to the study methodology and the characteristics of the target population. The authors refer to a 2005 Delphi Study published in the Lancet with an estimated prevalence globally of 3.9% in people over 60 years of age. However the prevalence varies considerably between countries. For the incidence of Dementia, the authors look at a number of prospective studies and express the findings in 1000 person-years. From the data it is clear that the sampling method is critical for the interpretation of the results. Although two studies may calculate the incidence of Alzheimer’s Disease in people over the age of 65 the average age of the sampled population as well as many other variables are critical in generalising these findings to other populations. Nevertheless regardless of the methodology, with figures ranging from 6.3 to 86.7 per 1000 person years it is clear that there is a significant disease burden in the sampled populations.

2. Prevention. The authors look at prevention focusing on primary, secondary and tertiary prevention strategies highlighting the role that medication, diagnosis and modifiable risk factors play in prevention.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Does Befriending Help with Depressive Symptoms?

There is an open-access article in the British Journal of Psychiatry by Mead and colleagues titled ‘Effects of befriending on depressive symptoms and distress: systematic review and meta-analysis‘. The researchers cite evidence that suggests over 500 voluntary sector organisations and charities in the UK offer befriending service. That’s a very impressive number. So what did the researchers conclude? Essentially the researchers thought that befriending benefits those with depressive symptoms in both the short and long term.

The researchers look at studies which included people over the age of 14. This was a very broad age range. The befriending needed to be provided as a free service regardless of whether the befrienders were paid or unpaid. The researchers wanted to ensure that befriending focused on the relationship and that it was emotionally supportive. They contacted authors of the included studies regarding these factors. There were various comparison groups which included treatment as usual.

The researchers considered allocation masking as one quality indicator. In other words the researchers in the included studies did not know which people would be included in which arm of the study.  This is used to avoid selection bias. The other indicator was that follow-up results were recorded in at least 80% of the participants. Short term was classed as less than 12 months and long-term more than 12 months. 24 studies were included. Befriending was delivered mainly as face-to-face contact but telephone contact was also used in some studies.

The studies included diverse populations across the lifespan which the authors also comment on. The included studies used various measures of depression including the Beck Depression Inventory and the Geriatric Depression Scale. The Funnel Plot for the change in depressive symptoms was asymmetrical and favoured a benefit for the befriending. Indeed for befriending versus usual care the standardised mean difference was -0.27 (95% CI -0.48 to -0.06). Befriending was less effective on the depressive symptom outcome measure than Cognitive Behavioural Therapy.

Five studies looked at the longer term benefit for befriending on depressive symptoms. The standardised mean difference for depressive symptoms between befriending and treatment as usual was -0.18 (95% CI -0.32 to -0.05) for the longer term.

The researchers have shown a significant difference between the groups. There were more complex results when social outcome measures were used and when different comparator groups were analysed. These results tended to be very specific to the populations being examined. In summary however the researchers have identified an overall benefit across the investigated populations. The main difficulty however is that depressive symptoms are not the same as depression. Thus its possible to score highly on depressive symptoms on an assessment tool without being depressed. Similarly an improvement in the depressive symptoms is not the same as remission. Comparing different outcome measures is also difficult but has been statistically managed through the use of the standardised mean difference.

The study does provide evidence of a benefit for befriending which fits with an understanding of the wider benefits of social networks whilst at the same time highlighting the importance of the nature of the relationships also.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.