Background: Depression is a prevalent and disabling condition in older persons (≥60 years) that increases the risk of mortality and negatively influences quality

/pdf/depression-and-quality-of-life-in-older-persons-a-review-1ndnuv1p2t.pdf

Depression and Quality of Life in Older Persons: A Review

Poverty in the United Kingdom

Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial

Moral Boundaries: A Political Argument for an Ethic of Care

Objectives To evaluate the effects of integrated treatment for patients with a first episode of psychotic illness.

Design Randomised clinical trial.

Setting Copenhagen Hospital Corporation and Psychiatric Hospital Aarhus, Denmark.

Participants 547 patients with first episode of schizophrenia spectrum disorder.

Interventions Integrated treatment and standard treatment. The integrated treatment lasted for two years and consisted of assertive community treatment with programmes for family involvement and social skills training. Standard treatment offered contact with a community mental health centre.

Main outcome measures Psychotic and negative symptoms (each scored from 0 to a maximum of 5) at one and two years' follow-up.

Results At one year's follow-up, psychotic symptoms changed favourably to a mean of 1.09 (standard deviation 1.27) with an estimated mean difference between groups of –0.31 (95% confidence interval –0.55 to –0.07, P = 0.02) in favour of integrated treatment. Negative symptoms changed favourably with an estimated difference between groups of –0.36 (–0.54 to –0.17, P < 0.001) in favour of integrated treatment. At two years' follow-up the estimated mean difference between groups in psychotic symptoms was –0.32 (–0.58 to –0.06, P = 0.02) and in negative symptoms was –0.45 (–0.67 to –0.22, P < 0.001), both in favour of integrated treatment. Patients who received integrated treatment had significantly less comorbid substance misuse, better adherence to treatment, and more satisfaction with treatment.

Conclusion Integrated treatment improved clinical outcome and adherence to treatment. The improvement in clinical outcome was consistent at one year and two year follow-ups.

https://www.bmj.com/content/bmj/331/7517/602.full.pdf

A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness

Background Based on experiences and empirical evidence gained in studies using the Lancashire Quality of Life Profile (LQLP), the Manchester Short Assessment of Quality of Life (MANSA) has been developed as a condensed and slightly modified instrument for assessing quality of life. Its properties have been tested in a sample of community care patients.Method Fifty-five randomly selected patients on the Care Programme Approach were interviewed using the LQLP, the MANSA and the Brief Psychiatric Rating Scale.Results Correlations between subjective quality of life scores on MANSA and LQLP were all 0.83 or higher (0.94 for the satisfaction mean score). Cronbach's alpha for satisfaction ratings was 0.74, and association with psychopathology was in line with results for LQLP as reported in the literature.Conclusions The MANSA is a brief instrument for assessing quality of life focusing on satisfaction with life as a whole and with life domains. Its psychometric properties appear satisfactory.

/pdf/application-and-results-of-the-manchester-short-assessment-1m0kpuy33t.pdf

Application and Results of the Manchester Short Assessment of Quality of Life (Mansa)

Background Previous research suggests that social workers experience high levels of stress and burnout but most remain committed to their work.

Aims To examine the prevalence of stress and burnout, and job satisfaction among mental health social workers (MHSWs) and the factors responsible for this.

Method A postal survey incorporating the General Health Questionnaire, Maslach Burnout Inventory, Karasek Job Content Questionnaire and a job satisfaction measure was sent to 610 MHSWs in England and Wales.

Results Eligible respondents ( n =237) reported high levels of stress and emotional exhaustion and low levels of job satisfaction; 111 (47%) showed significant symptomatology and distress, which is twice the level reported by similar surveys of psychiatrists. Feeling undervalued at work, excessive job demands, limited latitude in decision-making, and unhappiness about the place of MHSWs in modern services contributed to the poor job satisfaction and most aspects of burnout. Those who had approved social worker status had greater dissatisfaction.

Conclusions Stress may exacerbate recruitment and retention problems. Employers must recognise the demands placed upon MHSWs and value their contribution to mental health services.

/pdf/mental-health-burnout-and-job-satisfaction-among-mental-4pv2clv9kn.pdf

Mental health, burnout and job satisfaction among mental health social workers in England and Wales

Two-thirds of councils with social services responsibilities (CSSRs) took part in a UK survey of mental health social workers. A one in five sample of front line workers was drawn, and 237 respondents completed a questionnaire and diary about their work context and content, and their attitudes to their work, their employer, mental health policy and the place of mental health social work in modernized mental health services. The questions, that called for free-text responses, were completed in detail and at length. This paper reports the results of a qualitative analysis of these responses using NVIVO software. The paper is structured around the themes emerging from the analysis: pressure of work; staffing matters; job satisfaction and well-being; recruitment and retention issues; and being valued. The conclusions are that the social workers value face to face contact with service users, and that their commitment to service users is an important factor in staff retention. The most unsatisfactory aspects of their work context arise from not feeling valued by their employers and wider society, and some of the most satisfactory from the support of colleagues and supervisors. Without attention to these factors, recruitment and retention problems will remain an unresolved issue.

Stress and pressures in mental health social work: The worker speaks

Patient-centred outcomes such as quality of life (QOL) are valued and used extensively in mental healthcare evaluations, but concerns remain about their practical application due to perceived measurement issues, including responsiveness and relationships with objective indicators and depression. Evidence from general population studies challenge some assumptions, suggesting that measurement difficulties might relate to the characteristics of mental health samples, rather than measurement itself. This paper assesses the impact of mental illness on QOL and its measurement, examining whether the life-conditions, opportunities and QOL of different mental health-status groups vary, and if explanatory models of domain-specific and global QOL differ. Objective life-conditions, access to life-opportunities and subjective QOL were assessed over 2 years, using the same methodology in severe mental illness (SMI; n = 149 (baseline)/n = 126 (follow-up)), common mental disorder (CMD; n = 794/354) and no disorder (n = 1119/583) groups. Objective life-conditions were worse in the SMI group than in mentally healthy population and CMD groups, but the opportunities available to the SMI group were no more restricted than the CMD group. Subjective QOL ratings reflected this; SMI group scores were lower than the healthy population and in some life-domains the CMD group. Models of QOL suggested that life-quality was explained differently in the three groups. QOL studies combining mental health samples should control for health-status group, and domain-specific and global indicators of lifestyle and opportunity.

/pdf/the-impact-of-mental-illness-on-quality-of-life-a-comparison-1bj31cbseh.pdf

The impact of mental illness on quality of life: A comparison of severe mental illness, common mental disorder and healthy population samples

Objectives To produce a robust measure of social inclusion [Social and Community Opportunities Profile (SCOPE)] that is multidimensional and captures multiple life domains; incorporates objective and subjective indicators of inclusion; has sound psychometric properties including responsiveness; facilitates benchmark comparisons with normative general population and mental health samples [including common mental disorder (CMD) and severe mental illness groups]; can be used with people with mental health problems receiving support from mental health services or not; and can be used across a range of community service settings. Design Phase I: conceptual framework developed from a review of the literature and concept mapping. Phase II: questionnaire developed including UK national population surveys and other normative data. Pre-testing using cognitive appraisal and evaluation then pilot testing in a small convenience sample. Preliminary testing (following modification) in community (n = 252) and mental health service users (MHSUs) samples (n = 43). Data reduction including factor analysis and Mokken scaling for polytomous item response analysis then psychometric evaluation, including internal consistency and discriminant and construct validity. Test-retest reliability assessed in a convenience sample of students (n = 119). Final testing in clinical services including psychometric evaluation and responsiveness testing. Setting The community sample was set in participants' households across the UK. The MHSU sample was set in a south Wales resource centre. The student sample was set in a university. Participants The community sample was randomly selected from the postal address file in five areas in England and Wales. Forty people in this sample were subgrouped as having a CMD based on their responses to the Mental Health Index five items. Two MHSU samples were obtained from existing services. Results Psychometric testing on the field data from the SCOPE long version demonstrated good internal consistency of all scales (alpha ≥ 0.7), good construct validity, with SCOPE scales correlating highly with each other sharing between 40% and 61% of variance and a close but lesser association with community participation and social capital. Chi-squared tests on objective items and analysis of variance between groups on SCOPE scales demonstrated good discriminant validity between different mental health groups (and better than the Mokken scaling results). Acceptability was good, with 77% of the service user sample finding the SCOPE domains relevant. The number of items in SCOPE decreased from 121 to 48 following data reduction. Scales in the short version of SCOPE retained reasonable internal consistency (alpha between 0.60 and 0.75). Test-retest reliability demonstrated reliability over time, with strong associations between all items over a 2-week period. Repeating the discriminant validity tests on the short version demonstrates good discriminant validity between the mental health groups. Acceptability improved, with 90% of the sample describing questions as relevant to them. Conclusions The main aim of producing an instrument with good psychometric properties for use in research and clinical settings, namely the SCOPE short version, was achieved. Ongoing data collection will enable responsiveness testing in the future. Further research is needed including larger samples of minority and disadvantaged groups, including those with physical illnesses and disabilities, and specific mental health diagnostic groups. Funding The National Institute for Health Research Health Technology Assessment programme.

/pdf/development-of-a-social-inclusion-index-to-capture-3cm93f33yf.pdf

Sherrill Evans

Papers

Application and Results of the Manchester Short Assessment of Quality of Life (Mansa)

Mental health, burnout and job satisfaction among mental health social workers in England and Wales

Stress and pressures in mental health social work: The worker speaks

The impact of mental illness on quality of life: A comparison of severe mental illness, common mental disorder and healthy population samples

Development of a social inclusion index to capture subjective and objective life domains (Phase II): psychometric development study