Intervention with feedback using Outcome Questionnaire 45 (OQ-45) in a Swedish psychiatric outpatient population. A randomized controlled trial.

Aim: The objective of the study was to evaluate the efficacy of the Outcome Questionnaire 45 (OQ-45) with feedback in a Swedish psychiatric outpatient population using a randomized controlled design. Method: In all 1720 patients made at least one regular visit to the clinics in the period 12 February 2007 to 10 February 2008 and received information about the study. Of these, 374 patients (22%) agreed to participate. After written consent, 188 patients were randomized to the feedback group and 186 patients to the control group. Those constituted the intention-to-treat (ITT) group. Two hundred and sixty-two patients (70%) completed the OQ-45 questionnaire at least twice, and they were included in the per-protocol analysis. Those who improved less than expected and were at risk for treatment failure were called alerted patients. Results: There was a tendency that patients who received feedback improved more than the controls in OQ-45 total score. In the ITT analysis, the P-value was 0.061 and the effect size g = 0.21. In the per-protocol analysis the P-value was 0.076 and the effect size g = 0.24. In the intervention group, 27% of the patients were alerted because of risk of treatment failure vs. 28% in the control group (reaching level of alertness). The OQ-45 differences between the intervention and control groups did not significantly differ for patients who were alerted/reaching level of alertness and for non-alerted patients (g = 0.17 and g = 0.28, respectively). Conclusions: The feedback group had a tendency to improve more than the control group, possibly indicating that the method is effective, and the result (basically) supports previous findings

Alcohol problems in women; Gender characteristics relevant for identification in clinical and health screening settings.

This thesis presents data relating to gender differences of problem drinking. The aim was to increase the knowledge of characteristics of female problem drinking to enhance identification efficiency. Alcoholic patients, 214 women and 420 men, and subjects from the general population, 2939 women and 1880 men, in Malmö, Sweden were studied between 1983-1995. Lifetime prevalence rates of problem drinking in 42-year old Malmö residents were 4.6% in women and 15.5% in men out of which 2.1% and 8.6%, respectively, were already registered as patients at the Department of Alcohol Diseases (DAD). Sex ratios argued against hidden drinking being an exclusively female phenomenon. Convergence was dismissed. The response style to the revised Mm-MAST indicated gender differences. Reliability was poorer in the females than males (alphas 0.58 vs 0.69). Gamma-glutamyl-transferase was a blunt identification instrument in women; 2% were test positive of which 27% were problem drinkers. Elderly newly admitted patients at the DAD were clinically similar. However, women were significantly more often late onset problem drinkers compared to men. Sex ratios indicated a significant convergence of female patients to that of males during 1988-1992 compared to one decade earlier (1:3.4 and 1:7.8). Correlates of regular benzodiazepine use in 55-year old female Malmö residents were related to psychiatric symptoms rather than problem drinking and teetotalism. The immigrant women were more likely to endorse regular BZD use, early retirement, and multiple psychiatric symptoms. A new female oriented screening questionnaire, including four "female" items and the four CAGE items, was constructed based on the response style in a patient sample. The validation results from a health screening population indicate promising properties of the new scale, the AVI4+CAGE, although further development is required

Prevention of alcohol-related deaths in middle-aged heavy drinkers

BACKGROUND: Alcohol as a cause of death in middle-aged patients is well-known from clinical studies. A similarly important correlation in the general population of urban middle-aged men is highly underestimated. Health screening investigations have shown that mortality related to alcohol is five times more common in nonparticipants than in participants. From the mid-70s, the Malmoe Screening and Intervention Study (MSIS) commenced screening investigations including a large number of residents of Malmoe. One goal was to find intervention programs for individuals in an early development of problem drinking, thereby preventing development of serious complications of endstage alcoholism. Herein, we report on the mortality of heavy drinkers (drinking more than 40 g alcohol/day) who were randomized to an intervention or control procedure and whose median survival was 13 years postentry into the MSIS. METHODS: Health-screened men, aged 45-49 years at the initial screening examination and displaying serum gamma-glutamyltransferase (GT) in the top decentile of the GT distribution, were included. A total of 978 out of 11,257 participants met this criteria. A randomized intervention and control study was performed for four years and consisted of men (n = 667) who were born between 1927-1937 and who had two consecutive high GT values within 3 weeks along with heavy alcohol consumption. Half the individuals were informed of the test results and invited for further assessment by a senior physician (n = 365). The principles for brief intervention (DiClemente et al.,1991; Miller and Sanchez, 1993; National Institute of Alcohol Abuse and Alcoholism, 1999) were applied. The other half of the men (n = 302) were left with the information that they had a high GT value and were followed up with laboratory checkups every 2nd year. Mortality was followed up until 1991 and information on deaths was obtained from hospital and police records, necropsy reports, and death certificates. RESULTS: Long-term follow-up of mortality for 10-16 years (median, 13 years) showed that 124 of the 978 men had died (12.7%). Autopsy was performed in 96.5% of the cases. In 59 men (48%), death was alcohol-related. In the intervention group (n = 365), 38 (10.4%) men were dead and in the control group (n = 302), 42 (13.9%) men had died. There was a statistically significant difference (p = 0.026), with advantage for treatment. Less alcohol-related deaths and deaths occurring later during follow-up were found in the intervention group compared with the control group. The difference between the groups in total mortality, coronary heart disease, and cancer death was not statistically significant. CONCLUSIONS: These findings support previous results from the MSIS study indicating that long-term intervention in urban males with alcohol-induced GT increases may be beneficial in terms of survival