Asthma and depression: a pragmatic review of the literature and recommendations for future research

BACKGROUND: Although the association between asthma and psychosocial factors has long been recognised, it is only in the last decade that the impact of coexisting asthma and depression has become the focus of considerable research interest. However, the findings so far have been confusing and often contradictory. This paper sets out a methodical review and appraisal of the literature to date, including suggestions for future research. METHOD: PubMed and PsycINFO databases were used to search for English-language articles relating to asthma and depression research. The resulting articles were then reviewed and summarised, creating a report that was used to develop research recommendations. RESULTS: The main findings from this review included: (a) results are mixed as to whether persons with asthma are more likely to be depressed than those without asthma; (b) asthma and depression may have an 'additive' adverse effect on the normal asthma-related quality of life reductions; (c) subjective measures of asthma severity may be more strongly related to depression than objective measures; (d) specific asthma symptoms appear to be linked to depression; (e) sadness and depression can produce respiratory effects consistent with asthma exacerbations; (f) depression appears to be negatively related to asthma treatment compliance; (g) corticosteroid use in asthma treatment has been associated with depression, though it is unclear how common this problem is in real life; (h) interventions that address the physical, psychological, and social consequences of asthma are likely to lead to the most successful treatment outcomes; (i) treating the depression of individuals with asthma is likely to minimise the negative effects of the coexistence; and (j) a number of common methodological problems were observed in the literature. RECOMMENDATIONS: There is a large amount of research yet to be undertaken to clarify issues around asthma and depression, with the overdue next step being to design integrated treatment approaches, and carry out large-scale prospective studies to determine the impact of using such approaches to treat individuals with depression and asthma. Such studies will be the only way in which some fundamental questions about the development and coexistence of these two conditions will be answered

Identifying barriers to implementing a cardiovascular computerised decision support system (CDSS): a Delphi survey

Purpose This paper reports an evaluation of stakeholders' perspectives and recommendations for the dissemination of a cardiovascular computerised decision support system (CDSS) program. Methods A literature review of dissemination models for health information and decision support aids was undertaken to develop a semi-structured interview protocol outlining a range of dissemination models for distribution. A cross section of eight health professionals and three corporate managers were interviewed to provide as broad a view as possible of eight dissemination models. Data were collected via two questionnaires incorporating the Delphi technique. Perspectives from the corporate managers were collected by telephone interview. Results Financial incentive was the most highly rated disseminationmethod, followed by joint promotion with a professional body and undergraduate medical education. The lowest average rating was for dividing the program into separate components. Participants provided five other suggestions for dissemination. Suggestions for further exploration include the development of a multi-professional model comprising two or more approaches that is piloted and evaluated. Conclusion Our results provide beneficial information on the potential dissemination of computer decision support systems to health professionals whose uptake of CDSS has not previously been explored. Whether use of a shared decision aid impacts on the decisions made by health professionals working in a team is, however, less evident

Banding together: an investigation of post-surgery support groups for laparoscopic adjustable gastric banding patients

Though advocated as useful for patients, there is little in the literature regarding the use and effectiveness of bariatric support groups. This study investigated characteristics and experiences of bariatric patients who did and did not attend offered groups. Seventy-eight postoperative laparoscopic adjustable gastric banding patients from a private bariatric clinic completed mailed self-report questionnaires. Almost 60% reported having attended the clinic groups, with most wanting to meet other patients and obtain information rather than access psychological assistance. Participants reported generally positive experiences of attending. Nonattendance was often attributed to practical barriers. Satisfaction with support from others was not related to past or predicted future attendance, but higher psychological distress was related to and predictive of greater intention to attend future groups. Likely future attenders also held more positive beliefs about the groups than those who were unlikely to attend. Further research is required into potential positive and negative consequences of attendance, and characteristics of those who are likely to benefit or be harmed by attending. Interventions addressing stereotypes about support groups may help patients make informed decisions about whether to attend a bariatric support group