Stigma: the hidden burden of infertility.

This study systematically examines the role of informal social response in the emergence of involuntary childlessness or infertility as a stigmatizing attribute. Seventy‐one involuntarily childless women provide detailed instances of perceived informal social sanctions related to their infertility. Subjects perceive that normals consider infertility to be caused by psychological or sexual malfunctioning, or by the woman in the dyad. Infertility is also seen by some to act as a master status. Subjects categorize other infertile individuals in terms of stigma and consider male infertility to be more stigmatizing than female infertility. Social sanctions and social control are shown to be relevant to an understanding of the experience of involuntary childlessness.

Perceptions of informal sanctioning and the stigma of involuntary childlessness

Background
The prevalence of mental health and psychosocial problems in primary care is high. Counselling is a potential treatment for these patients, but there is a lack of consensus over the effectiveness of this treatment in primary care.

Objectives
To assess the effectiveness and cost effectiveness of counselling for patients with mental health and psychosocial problems in primary care.

Search methods
To update the review, the following electronic databases were searched: the Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN) trials registers (to December 2010), MEDLINE, EMBASE, PsycINFO and the Cochrane Central Register of Controlled Trials (to May 2011).

Selection criteria
Randomised controlled trials of counselling for mental health and psychosocial problems in primary care.

Data collection and analysis
Data were extracted using a standardised data extraction sheet by two reviewers. Trials were rated for quality by two reviewers using Cochrane risk of bias criteria, to assess the extent to which their design and conduct were likely to have prevented systematic error. Continuous measures of outcome were combined using standardised mean differences. An overall effect size was calculated for each outcome with 95% confidence intervals (CI). Continuous data from different measuring instruments were transformed into a standard effect size by dividing mean values by standard deviations. Sensitivity analyses were undertaken to test the robustness of the results. Economic analyses were summarised in narrative form. There was no assessment of adverse events.

Main results
Nine trials were included in the review, involving 1384 randomised participants. Studies varied in risk of bias, although two studies were identified as being at high risk of selection bias because of problems with concealment of allocation. All studies were from primary care in the United Kingdom and thus comparability was high. The analysis found significantly greater clinical effectiveness in the counselling group compared with usual care in terms of mental health outcomes in the short-term (standardised mean difference -0.28, 95% CI -0.43 to -0.13, n = 772, 6 trials) but not in the long-term (standardised mean difference -0.09, 95% CI -0.27 to 0.10, n = 475, 4 trials), nor on measures of social function (standardised mean difference -0.09, 95% CI -0.29 to 0.11, n = 386, 3 trials). Levels of satisfaction with counselling were high. There was some evidence that the overall costs of counselling and usual care were similar. There were limited comparisons between counselling and other psychological therapies, medication, or other psychosocial interventions.

Authors' conclusions
Counselling is associated with significantly greater clinical effectiveness in short-term mental health outcomes compared to usual care, but provides no additional advantages in the long-term. Participants were satisfied with counselling. Although some types of health care utilisation may be reduced, counselling does not seem to reduce overall healthcare costs. The generalisability of these findings to settings outside the United Kingdom is unclear.

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Counselling for mental health and psychosocial problems in primary care

Pair-bond strength and stability and reproductive success.

Counselling in primary care in the UK is expanding rapidly, and its evidence base needs to be established. We present the rationale for conducting controlled trials of counselling in primary care, and suggest that a systematic review of controlled trials of counselling in primary care is timely. We describe the process of conducting the review in accordance with Cochrane Collaboration guidelines. The review aimed to assess the effectiveness and cost-effectiveness of counselling in primary care, by systematically reviewing cost and outcome data from randomised controlled trials and controlled patient preference trials of counselling interventions, for patients with psychological and psychosocial problems considered suitable for counselling. The search strategy, inclusion and exclusion criteria, data collection and data analysis are described. The results of the review are presented. The review included only controlled trials of counselling in which counsellors accredited by the British Association for Coun...

Counselling in primary care: A systematic review of the research evidence

As one of the surgeons who introduced Dr Stradling to the art of bronchoscopy and who actually witnessed him achieve his first successful solo bronchoscopy, I am delighted to see this book run to a third edition in 8 years. Regrettably, with inflation, the price has now soared to £15 but at 10 pence an illustration it is still cheaper than photography and the pictures are such that they will never be surpassed or outdated. The book is now essential for all those who have to teach the art of bronchoscopy to new residents and it makes a useful and memorable leaving present for any worthwhile houseman or registrar. One can forgive the occasional split infinitive-very often they prevent the text becoming too ponderous and 'bronchoscopically speaking' may well be a new form of speech, but why oh why must we continue to be subjected to oat-celled carcinoma and squamous-celled carcinoma when we mean oat cell and squamous carcinoma? The publishers are to be congratulated on the excellence of their printing and reproduction of illustrations and it is hoped that on this occasion they will profit from their previous experience and print thousands of copies so that one will no longer be told that the edition is sold out within a few years of its becoming available.

A handbook of treatment.

Counselling is becoming increasingly important in modern general practice and the relationship between counsellors and general practitioners varies in different places and in different countries. Through a Stanning Overseas Fellowship I had the opportunity of examining this relationship in several countries in Europe in order to compare and contrast arrangements.

John Cohen

Papers

A handbook of treatment.

Counselling in the European Economic Community.