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Recovery from depression: a systematic review of perceptions and associated factors
- Authors:
- RICHARDSON Kathryn, BARKHAM Michael
- Journal article citation:
- Journal of Mental Health, 29(1), 2020, pp.103-115.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Background: Despite extensive literature examining perceptions of recovery from severe mental illness, literature focusing on recovery from depression in adults is limited. Aim: Systematically review the existing literature investigating patients’ and clinicians’ perceptions of, and factors associated with, recovery from depression. Method: Studies investigating perceptions of, and factors associated with, recovery from depression in adults were identified through database searches. Studies were assessed against inclusion criteria and quality rating checklists. Results: Fourteen studies met the inclusion criteria. Recovery from depression is perceived as a complex, personal journey. The concept of normalised, biomedical definitions of recovery is not supported, with the construction of self and societal gender expectations identified by women as central to recovery. Recovery from depression was associated with higher levels of perceived social support and group memberships. A range of factors are identified as influencing recovery. However, physicians and patients prioritise different factors assessing what is important in being “cured” from depression. Conclusions: Recovery from depression is perceived by patients as a complex, personal process, influenced by a range of factors. However, greater understanding of clinicians’ perceptions of client recovery from depression is essential to inform clinical practice and influence future research. (Publisher abstract)
The CORE-10: a short measure of psychological distress for routine use in the psychological therapies
- Authors:
- BARKHAM Michael, et al
- Journal article citation:
- Counselling and Psychotherapy Research, 13(1), 2013, pp.3-13.
- Publisher:
- Wiley
Background: There is a need for a generic, short, and easy-to-use assessment measure for common presentations of psychological distress in UK primary care mental health settings. This paper sets out the development of the CORE-10 in response to this need. Method: Items were drawn from the CORE-OM and 10 items were selected according to a combination of usefulness, coverage of item clusters, and statistical procedures. Three CORE-OM datasets were employed in the development phase: (1) a primary care sample, (2) a sample from an MRC platform trial of enhanced collaborative care of depression in primary care, and (3) a general population sample derived from the Office of National Statistics Psychiatric Morbidity Follow-up survey. A fourth dataset comprising a sample from an occupational health setting was used to evaluate the CORE-10 in its standalone format. Results: The internal reliability (alpha) of the CORE-10 was .90 and the score for the CORE-10 correlated with the CORE-OM at .94 in a clinical sample and .92 in a non-clinical sample. The clinical cut-off score for general psychological distress was 11.0 with a reliable change index (90% CI) of 6. For depression, the cut-off score for the CORE-10 was 13 and yielded sensitivity and specificity values of .92 (CI=.83–1.0) and 0.72 (CI=.60–.83) respectively. Conclusion: The CORE-10 is an acceptable and feasible instrument that has good psychometric properties and is practical to use with people presenting with common mental health problems in primary care settings. (Publisher abstract)
Effects of psychological therapies in randomized trials and practice-based studies
- Authors:
- BARKHAM Michael, et al
- Journal article citation:
- British Journal of Clinical Psychology, 47(4), November 2008, pp.397-415.
- Publisher:
- Wiley
Randomized trials of the effects of psychological therapies seek internal validity via homogeneous samples and standardized treatment protocols. In contrast, practice-based studies aim for clinical realism and external validity via heterogeneous samples of clients treated under routine practice conditions. This study compared indices of treatment effects in these two types of studies. Using published transformation formulas, the Beck Depression Inventory (BDI) scores from five randomized trials of depression (N = 477 clients) were transformed into Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) scores and compared with CORE-OM data collected in four practice-based studies (N = 4,196 clients). Conversely, the practice-based studies' CORE-OM scores were transformed into BDI scores and compared with randomized trial data. Randomized trials showed a modest advantage over practice-based studies in amount of pre-post improvement. This difference was compressed or exaggerated depending on the direction of the transformation but averaged about 12%. There was a similarly sized advantage to randomized trials in rates of reliable and clinically significant improvement (RCSI). The largest difference was yielded by comparisons of effect sizes which suggested an advantage more than twice as large, reflecting narrower pre-treatment distributions in the randomized trials. Outcomes of completed treatments for depression in randomized trials appeared to be modestly greater than those in routine care settings. The size of the difference may be distorted depending on the method for calculating degree of change. Transforming BDI scores into CORE-OM scores and vice versa may be a preferable alternative to effect sizes for comparisons of studies using these measures.
A core approach to practice-based evidence: A brief history of the origins and applications of the CORE-OM and CORE System
- Authors:
- BARKHAM Michael, et al
- Journal article citation:
- Counselling and Psychotherapy Research, 6(1), March 2006, pp.3-15.
- Publisher:
- Wiley
This article reviews the development of the CORE-OM and CORE System from 1995 to 2005 in the context of the need to measure, monitor, and manage the delivery of counselling and the psychological therapies in service of providing best quality care for clients. The origins and philosophy of these tools are summarised and practical aspects of how to use them in routine service settings are set out, including an easy to use look-up table of differing ways of presenting CORE-OM scores and their associated meaning. The wider family of CORE outcome measures is briefly outlined to show the relationship between the various versions and how each is designed for a specific purpose. These outcome tools are set within the broader context of the CORE System. In turn, the CORE-OM and CORE System are placed within the paradigm of practice-based evidence and examples are provided of how these tools have been applied in routine as well as more traditional evaluative settings.
Suitability and utility of the CORE-OM and CORE-A for assessing severity of presenting problems in psychological therapy services based in primary and secondary care settings
- Authors:
- BARKHAM Michael, et al
- Journal article citation:
- British Journal of Psychiatry, 186(3), March 2005, pp.239-246.
- Publisher:
- Cambridge University Press
There is a need for reliable assessment tools that are suitable for counselling and psychological therapy services in primary and secondary care settings. This study tested the suitability and utility of the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) and CORE-Assessment (CORE-A) assessment tools. Service intake data were analysed from counselling and psychological therapy services in 32 primary care and 17 secondary care settings. Completion rates exceeded 98% in both the settings sampled. Intake severity levels were similar but secondary care patients were more likely to score above the risk cut-off and the severe threshold and to have experienced their problems for a greater duration. The CORE-OM and CORE-A are suitable assessment tools that show small but logical differences between psychological therapy services in primary- and secondary-based care.
Challenges to addressing student mental health in embedded counselling services: a survey of UK higher and further education institutions
- Authors:
- BROGLIA Emma, MILLINGS Abigail, BARKHAM Michael
- Journal article citation:
- British Journal of Guidance and Counselling, 46(4), 2018, pp.441-455.
- Publisher:
- Taylor and Francis
With reports continually demonstrating increased demand and severity of student mental health needs, it is important to gain a fuller understanding of the impact on embedded student counselling services. The aims of this research were to identify (a) service similarities, (b) factors which impact on services, (c) characteristics of service users, and (d) the use of therapeutic technology (e.g. online self-help). An online survey was completed by 113 heads of UK student counselling services across Higher Education (HE), Further Education (FE), and Sixth Form Colleges (SFCs), to capture service data from the academic year 2013/14. Students predominantly received high-intensity support (e.g. counselling) and referrals increased over 3 years. Challenges to embedded counselling services and their implications for development are discussed. (Edited publisher abstract)
Practice-based supervision research: a network of researchers using a common toolkit
- Authors:
- WHEELER Sue, AVELINE Mark, BARKHAM Michael
- Journal article citation:
- Counselling and Psychotherapy Research, 11(2), June 2011, pp.88-96.
- Publisher:
- Wiley
In 2008, a group of academics from the universities of Leicester, Sheffield, and Coventry was awarded a grant to support and encourage practitioner research related to supervision and to set up a Supervision Research Practice Network (SuPReNet). This article describes the work carried out by the Network Steering Group set up to carry forward the work. The vision was to enable a facilitating infrastructure with practitioners and researchers working together, using a common set of measures whose data would be easy to collect and score routinely. Four initiatives were worked on to achieve this: espousing a paradigm that seemed most promising for the future development of supervision research; identifying candidate tools to recommend for routine use; establishing a sustainable method for collecting data; and developing a forum for research collaborators in the field of supervision research. This appraisal yielded 5 core measures, free for anyone to use, and accessible through the SuPReNet website. The measures are being piloted through a practice research network at a university counselling and psychotherapy research clinic where supervision data are being collected through a special module of CORE Net. The potential yield from this initiative for practitioners, researchers, and the developing evidence-base is discussed and a model proposed for the next generation of research on supervision.
Systematic review of practice-based research on psychological therapies in routine clinic settings
- Authors:
- CAHILL Jane, BARKHAM Michael, STILES William B.
- Journal article citation:
- British Journal of Clinical Psychology, 49(4), November 2010, pp.421-453.
- Publisher:
- Wiley
Published material on practice-based research was reviewed to compare results with benchmarks derived from efficacy studies. Database searches were undertaken to identify research published in English between January 1990 and December 2008, and screening processes resulted in the selection of 31 eligible studies to be included in the quality review. These were quality assessed using an adapted version of a checklist designed for the appraisal of both randomised and non-randomised studies of healthcare interventions, and the article includes a table listing the studies, their main features and quality ratings. The authors concluded that the results showed that psychological treatment conducted in routine clinic settings is effective for a range of client problems, particularly common mental health problems, but that the result of comparisons with efficacy benchmarks is dependent on the outcome index used.
Self-help books for people with depression: a scoping review
- Authors:
- RICHARDSON Rachel, RICHARDS David A, BARKHAM Michael
- Journal article citation:
- Journal of Mental Health, 17(5), October 2008, pp.543-552.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
A scoping review was conducted to identify the number of self-help books for people with depression or mixed anxiety and depression that are available in the UK and to describe their principle characteristics. After the books were located data were extracted that included descriptive information (including the psychological approach used), readability statistics and popularity measures. Data were analysed from 97 books. These publications were diverse in both structure and content. Structure and readability data illustrated that many potential readers may have difficulty using some of them. Popularity proved to be an unreliable way of locating books that would fulfil NICE guidance for a CBT based self-help programme. It is concluded that many of the available books are complex to read in terms of literacy levels and may present additional problems given the concentration problems of people with depression. There is no relationship between popularity and a book being evidence-based or readable.
The effectiveness of UK student counselling services: an analysis using the CORE System
- Authors:
- CONNELL Janice, BARKHAM Michael, MELLOR-CLARK John
- Journal article citation:
- British Journal of Guidance and Counselling, 36(1), February 2008, pp.1-18.
- Publisher:
- Taylor and Francis
Despite concern surrounding the mental health of students, brought about by the government's policy of widening participation and increasing demands upon students, the effectiveness of student counselling has been a neglected research area. This study examines data from seven UK student counselling services using the CORE System in the routine evaluation of their services. Results indicate that counselling is effective, with 70% (service range 67% to 83%) of clients with outcome measures available showing reliable improvement on the CORE-OM from pre- to post-therapy. However, students who complete a course of counselling show significantly greater improvement, according to practitioner pre- and post-therapy severity ratings of depression and anxiety, than those clients who drop out or have an unplanned therapy ending (effect size 1.03, 0.85, respectively). The stage at which students drop out of therapy is important, with those students dropping out of therapy before the third session being the most vulnerable. The implications of these findings are discussed.