British Journal of Psychiatry, 202(2), 2013, pp.108-114.
Publisher:
Cambridge University Press
Offspring of mothers with depression are at heightened risk of psychiatric disorder. Many mothers with depression have comorbid psychopathology. How these co-occurring problems affect child outcomes has rarely been considered. This study considers whether the overall burden of co-occurring psychopathology in mothers with recurrent depression predicts new-onset psychopathology in offspring. Parents were recruited predominantly from primary care in South Wales, UK. Mothers with recurrent depression and their adolescent offspring (9–17 years at baseline) were assessed in 2007 and on two further occasions up to 2011. Mothers completed questionnaires assessing depression severity, anxiety, alcohol problems and antisocial behaviour. Psychiatric disorder in offspring was assessed using the Child and Adolescent Psychiatric Assessment. The number of co-occurring problems in mothers (0, 1 or 2+) predicted new-onset offspring disorder. Rates varied from 15.7 to 34.8% depending on the number of co-occurring clinical problems. This remained significant after controlling for maternal depression severity. The burden of co-occurring psychopathology among mothers with recurrent depression indexes increased risk of future onset of psychiatric disorder for offspring. This knowledge can be used in targeting preventive measures in children at high risk of psychiatric disorder.
(Edited publisher abstract)
Offspring of mothers with depression are at heightened risk of psychiatric disorder. Many mothers with depression have comorbid psychopathology. How these co-occurring problems affect child outcomes has rarely been considered. This study considers whether the overall burden of co-occurring psychopathology in mothers with recurrent depression predicts new-onset psychopathology in offspring. Parents were recruited predominantly from primary care in South Wales, UK. Mothers with recurrent depression and their adolescent offspring (9–17 years at baseline) were assessed in 2007 and on two further occasions up to 2011. Mothers completed questionnaires assessing depression severity, anxiety, alcohol problems and antisocial behaviour. Psychiatric disorder in offspring was assessed using the Child and Adolescent Psychiatric Assessment. The number of co-occurring problems in mothers (0, 1 or 2+) predicted new-onset offspring disorder. Rates varied from 15.7 to 34.8% depending on the number of co-occurring clinical problems. This remained significant after controlling for maternal depression severity. The burden of co-occurring psychopathology among mothers with recurrent depression indexes increased risk of future onset of psychiatric disorder for offspring. This knowledge can be used in targeting preventive measures in children at high risk of psychiatric disorder.
(Edited publisher abstract)
Subject terms:
risk, mental health problems, mothers, depression, young people, comorbidity;
The treatment needs of those suffering from symptoms of post-traumatic stress disorder (PTSD) following a single traumatic event are clearly outlined in NICE guidelines. However, these guidelines still fail to address adequately the more diverse effects of prolonged, repeated trauma. Examples of such multiple trauma include child sexual abuse, long-term domestic violence, long-term isolated captivity and torture. This condition is now referred to by clinicians as complex PTSD (C-PTSD) as opposed to simple PTSD. C-PTSD is characterised by severe psychological harm and extensive co-morbidity. Some of its core characteristics include psychological fragmentation, the loss of a sense of safety, trust and self-worth, and the loss of a coherent sense of self. This article discusses the difficulty in uncovering trauma in patients, the idea of C-PTSD as a diagnostic framework, and the need to develop effective treatment approaches for those suffering from C-PTSD.
The treatment needs of those suffering from symptoms of post-traumatic stress disorder (PTSD) following a single traumatic event are clearly outlined in NICE guidelines. However, these guidelines still fail to address adequately the more diverse effects of prolonged, repeated trauma. Examples of such multiple trauma include child sexual abuse, long-term domestic violence, long-term isolated captivity and torture. This condition is now referred to by clinicians as complex PTSD (C-PTSD) as opposed to simple PTSD. C-PTSD is characterised by severe psychological harm and extensive co-morbidity. Some of its core characteristics include psychological fragmentation, the loss of a sense of safety, trust and self-worth, and the loss of a coherent sense of self. This article discusses the difficulty in uncovering trauma in patients, the idea of C-PTSD as a diagnostic framework, and the need to develop effective treatment approaches for those suffering from C-PTSD.
Subject terms:
needs, post traumatic stress disorder, psychotherapy, severe mental health problems, treatment, therapy and treatment, comorbidity;
Older age is one stage of the lifecourse where dignity maybe threatened due to the vulnerability created by increased incapacity, frailty and cognitive decline in combination with a lack of social and economic resources. Evidence suggests that it is in contact with health and welfare services where dignity is most threatened. This study explored the experiences of older people in acute National Health Service (NHS) Trusts in relation to dignified care and the organisational, occupational and cultural factors that affect it. These objectives were examined through an ethnography of four acute hospital Trusts in England and Wales, which involved interviews with older people (65+) recently discharged from hospital, their relatives/carers, and Trust managers, practitioners and other staff, complemented by evidence from non-participant observation. The picture which emerged was of a lack of consistency in the provision of dignified care which appears to be explained by the dominance of priorities of the system and organisation tied together with the interests of ward staff and clinicians. The emphasis on clinical specialism meant that staff often lacked the knowledge and skills to care for older patients whose acute illness is often compounded by physical and mental co-morbidities. The physical environment of acute wards was often poorly designed, confusing and inaccessible, and might be seen as ‘not fit for purpose’ to treat their main users, those over 65 years, with dignity. Informants generally recognised this but concluded that it was the older person who was in the ‘wrong place’, and assumed that there must be a better place for ‘them’. Thus, the present system in acute hospitals points to an inbuilt discrimination against the provision of high-quality care for older people. There needs to be a change in the culture of acute medicine so that it is inclusive of older people who have chronic co-morbidities and confusion as well as acute clinical needs.
(Publisher abstract)
Older age is one stage of the lifecourse where dignity maybe threatened due to the vulnerability created by increased incapacity, frailty and cognitive decline in combination with a lack of social and economic resources. Evidence suggests that it is in contact with health and welfare services where dignity is most threatened. This study explored the experiences of older people in acute National Health Service (NHS) Trusts in relation to dignified care and the organisational, occupational and cultural factors that affect it. These objectives were examined through an ethnography of four acute hospital Trusts in England and Wales, which involved interviews with older people (65+) recently discharged from hospital, their relatives/carers, and Trust managers, practitioners and other staff, complemented by evidence from non-participant observation. The picture which emerged was of a lack of consistency in the provision of dignified care which appears to be explained by the dominance of priorities of the system and organisation tied together with the interests of ward staff and clinicians. The emphasis on clinical specialism meant that staff often lacked the knowledge and skills to care for older patients whose acute illness is often compounded by physical and mental co-morbidities. The physical environment of acute wards was often poorly designed, confusing and inaccessible, and might be seen as ‘not fit for purpose’ to treat their main users, those over 65 years, with dignity. Informants generally recognised this but concluded that it was the older person who was in the ‘wrong place’, and assumed that there must be a better place for ‘them’. Thus, the present system in acute hospitals points to an inbuilt discrimination against the provision of high-quality care for older people. There needs to be a change in the culture of acute medicine so that it is inclusive of older people who have chronic co-morbidities and confusion as well as acute clinical needs.
(Publisher abstract)
Subject terms:
older people, dignity, hospitals, organisational culture, environment, carers, user views, patients, health care, comorbidity;
British Journal of Psychiatry, 197(3), September 2010, pp.219-226.
Publisher:
Cambridge University Press
... were on ACCT (Assessment, Care in Custody and Teamwork), the system for the care of prisoners at risk of suicide and self-harm in England and Wales. The cases had significantly greater levels of psychiatric morbidity than controls, and more comorbidity. The strongest associations with near-lethal self-harm were with current depression, the presence of 2 or more diagnoses, a history of psychiatric in-patient treatment, and previous attempted suicide, especially in prison. The only tested diagnoses not associated with near-lethal self-harm were antisocial personality disorder, substance use and eating disorders. This research underlines the importance of psychiatric risk factors for suicide in custody and in particular comorbidity. The finding that a formal care plan was in place for most cases
Female prisoners are 20 times more likely to die by suicide than women of the same age in the general population. This study aimed to investigate the prevalence of psychiatric disorders in women prisoners who had nearly died as a result of a suicide attempt compared with female prisoners who had never made a near-lethal attempt in prison. The study comprised semi-structured face-to-face interviews with 60 cases and 60 controls from all closed female prison establishments in England and Wales. In addition to gathering details of sociodemographic, criminological and clinical history, the interview assessed participants’ current and lifetime disorders using the Mini-International Neuropsychiatric Interview. The results showed that at the time of their near-lethal self-harm, 53 cases (88%) were on ACCT (Assessment, Care in Custody and Teamwork), the system for the care of prisoners at risk of suicide and self-harm in England and Wales. The cases had significantly greater levels of psychiatric morbidity than controls, and more comorbidity. The strongest associations with near-lethal self-harm were with current depression, the presence of 2 or more diagnoses, a history of psychiatric in-patient treatment, and previous attempted suicide, especially in prison. The only tested diagnoses not associated with near-lethal self-harm were antisocial personality disorder, substance use and eating disorders. This research underlines the importance of psychiatric risk factors for suicide in custody and in particular comorbidity. The finding that a formal care plan was in place for most cases at the time of their near-lethal act is indicative of good risk detection, but also suggests high levels of unmet need.
This report examines the economic and financial dimensions of social care in Wales – with a particular focus on care home provision for older people. In addition to outlining the current arrangements for financing care, it highlights four key issues with which future policy must grapple; namely the level of resourcing required to deliver effective care services, the currently fragmented nature of service provision, low pay and high staff turnover, and the difficulty in projecting and meeting future demand. The analysis shows that the number of people supported through formal care services has not kept pace with the growth in the over-65s population – informal care provided by friends and relatives is currently by far the largest source of adult care provision (an estimated replacement cost of £8 billion). There report also highlights the highly fragmented nature of formal service provision, particularly in residential care, where there are over 1,000 separate providers. Despite the critical role played by the residential care workforce, social care remains a relatively ‘low paid’ sector; fewer than half of the personal care workforce in Wales are paid the Real Living Wage, and care home workers have faced a decade of no relative improvement in pay. The study finds that there is some evidence that patterns of demand may be changing in favour of care at home with public funding increasingly directed at complex needs, frailty, and dementia. A strategy for future resourcing will need to take into account these complexities, what the future mix of care provision – including specialist provision – might be, and who will meet this cost.
(Edited publisher abstract)
This report examines the economic and financial dimensions of social care in Wales – with a particular focus on care home provision for older people. In addition to outlining the current arrangements for financing care, it highlights four key issues with which future policy must grapple; namely the level of resourcing required to deliver effective care services, the currently fragmented nature of service provision, low pay and high staff turnover, and the difficulty in projecting and meeting future demand. The analysis shows that the number of people supported through formal care services has not kept pace with the growth in the over-65s population – informal care provided by friends and relatives is currently by far the largest source of adult care provision (an estimated replacement cost of £8 billion). There report also highlights the highly fragmented nature of formal service provision, particularly in residential care, where there are over 1,000 separate providers. Despite the critical role played by the residential care workforce, social care remains a relatively ‘low paid’ sector; fewer than half of the personal care workforce in Wales are paid the Real Living Wage, and care home workers have faced a decade of no relative improvement in pay. The study finds that there is some evidence that patterns of demand may be changing in favour of care at home with public funding increasingly directed at complex needs, frailty, and dementia. A strategy for future resourcing will need to take into account these complexities, what the future mix of care provision – including specialist provision – might be, and who will meet this cost.
(Edited publisher abstract)
Subject terms:
adult social care, older people, financing, resource allocation, care workforce, wages, informal care, carers, long term conditions, home care, care homes, comorbidity;