Effect of group psychoeducation for major depressive disorder: a systematic review

Background: Depression is a common mental disorder and a major contributor to the overall global burden of disease. Healthcare systems struggle to provide effective and acceptable treatment to meet the needs of the growing number of patients suffering from depression. Although there are some known, effective medical treatments for depression, far from all of those affected receive such treatments, and there is a corresponding patient- and stakeholder demand for drug-free alternatives to treat depression. Group psychoeducation is a low threshold, drug-free intervention which has proven to be beneficial in the treatment of other mental disorders and which can be adapted to different populations. Use of group psychoeducation for major depressive disorder (MDD) will increase the availability of treatment, if proven to be effective, because it allows for treating several patients in the same session and meets calls for drug-free treatment. Objective: To systematically review the effectiveness of group psychoeducation for adults with MDD, as sole treatment or in conjunction with treatment as usual (TAU), compared to pharmacological treatment and/or other psychological treatment. Included effect measures are quality of life, depression severity, mortality (suicide), psychosocial functioning, relapse, and compliance. Methods: The review was planned and described in a PROSPERO (CRD42017077110) registered protocol. The search strategy was executed by a search librarian and it was peer reviewed by another librarian. The search included electronic searches in MEDLINE, Embase, the Cochrane Library, PsycINFO, PubMed, CINAHL, Epistemonikos and a hand search of 29 systematic reviews. The search yielded a total of 4219 records, which were screened independently by two reviewers. We assessed eligible studies for risk of bias using the Cochrane risk of bias tool for RCTs. We conducted meta-analyses when studies were sufficiently similar in terms of design, population, intervention, and outcomes. Lastly, we evaluated the certainty of the body of evidence using the GRADE approach. Results: Nine randomized controlled studies (RCTs) with a total of 1249 patients met the inclusion criteria. The meta-analytic results showed that group psychoeducation in conjunction with TAU compared to TAU lead to a reduction in depression at 4-6 weeks, SMD= -0.32 (95% CI: -0.59 to -0.04), and 6 months, SMD= -0.21 (95% CI: -0.38 to -0.04). The effect of psychoeducation in conjunction with TAU was not significant at 12 months follow up, SMD= 0.22 (95% CI:-0.02 to 0.45). Family psychoeducation (groups including patient and caregiver) in conjunction with TAU showed a greater effect on depression than patient group psychoeducation. This was particularly prominent at 3 months follow-up, SMD= -1.21 (95% CI: -1.64 to -0.78). Family psychoeducation in conjunction with TAU also showed greater effect than TAU alone on psychosocial functioning at 3 months follow-up, SMD= 0.98 (95% CI: 0.56 to 1.40). The confidence in the certainty of the evidence varies from high to low. Results for psychosocial functioning was downgraded due to small sample size. Conclusions: While the current body of research on group psychoeducation shows promise for its effects on depression and psychosocial functioning, further evidence on the short- and long-term effects is needed. Family group psychoeducation seems to give better results than patient group psychoeducation. Robust studies to build a solid evidence on the effect of psychoeducation and knowledge on the effects for different patient groups in various socioeconomic- and cultural settings are necessary, prior to a generalised recommendation on this intervention for patients with major depressive disorder.

The house price development in Spain between 1997 and 2012 : an empirical analysis of the main drivers and the role of the government

The aim of this thesis is to consider a broad range of factors, both market based and policy based, which have contributed to the dramatic rise and fall in house prices in Spain between 1997 and the second quarter of 2012. We combine existing theories on drivers of house prices and available data on these drivers in a qualitative analysis. Our findings are then related to several empirical studies conducted by others. Finally, by considering the drivers that are related to government policy, we analyze the influence of the government on the house price development. Our findings suggest that the land on which the Spanish houses were built is the component that increased the most in value between 1997 and 2007. We also suggest that the low rental share in Spain might have contributed to the increase in house prices towards 2008. Important drivers of demand are income, unemployment rates, tax deductions for house purchase and credit growth. However, the most important driver, which explains both the surge in house prices as well as the decline after 2008, is the presence of irrational expectations. Our findings suggest that inconsistent housing policies and a lack of supervision of credit institutions after the entry to the EMU have had a significant effect in the creation of the Spanish housing bubble. We therefore suggest that the government influence on the house price development between 1997 and 2012 has been substantial

Organic constitution of the CO3 chondrites and implications for asteroidal processes

This paper reports the organic constitution of the CO3 chondrites identified by 4D TOFMS in order to decipher the composition, structure and alteration history of the CO3 parent asteroid

Norwegian missionaries and Zulu converts : a case for Bakhtinian dialogue

Peer reviewedFrom the arrival of the missionaries in 1844 to the outbreak of the Anglo-Zulu war in 1879, the results of the Norwegian missionary enterprise in Zululand were meagre. The British annexation of Zululand changed the situation, and the missionaries perceived the first decades of the 20th century as “a long great harvest”. A closer examination of the source material challenges this understanding. By using dialogical theory, as propounded by Mikhail M. Bakhtin, as a starting point, we may come closer to explaining the missionaries’ relative lack of success. Bakhtin stated that each utterance has an addressee and that the speaker formulates the utterance with the addressee and his/her future reactions in mind. If we envisage the encounter between Zulus and Norwegians accordingly, we find that the Norwegian missionaries failed to recognise that the two cultures were engaged in ongoing dialogue and negotiations.Research Institute for Theology and Religio

The Moss (CO3) meteorite: an integrated isotopic, organic and mineralogical study

The recent Moss meteorite fall presents a unique opportunity to investigate the processes that operated on the CO3 parent body. The results of an integrated study indicate that alteration on the CO3 asteroid was more complex than previously envisaged

Styring og ledelse av arbeid med kvalitetsutvikling av og i skoler

1. Problemområde / problemstilling: Vår hovedproblemstilling i masteroppgaven er følgende: Hvordan er forholdet mellom kommunal styring og autonomi på skolenivå relatert til arbeid med kvalitetsutvikling av og i skoler ? Undertittel:En komparativ studie av to kommuner i Østlandsområdet. Vår masterundersøkelse vil inngå som en delundersøkelse innenfor det internasjonale forsknings- og utviklingsprosjektet ASAP (Achieving School Accountability in Practice), nærmere bestemt ASAP 2.2. Innenfor ASAP 2.2 retter man fokuset mot kommunen som aktør i arbeidet med kvalitetsvurdering og kvalitetsutvikling. Man ønsker å beskrive og analysere hvordan kommuner styrer, støtter og resultatoppfølger skolene og hvordan dette virker i forhold til kvalitetssikring og kvalitetsutvikling av og i skoler. Vår forpliktelse ved å knytte oss til ASAP består i å bruke dette delprosjektets intervjuguide og deler av det samme teorigrunnlaget. Bakgrunnen for valg av vårt hovedtema er at vi som skoleledere er genuint opptatt av arbeid med kvalitetsutvikling i skolesammenheng. En av oss har også erfaring fra skolefaglig arbeid på kommunenivå. Vi er spesielt opptatt av forholdet mellom kommune- og skolenivået, både når det gjelder styring av kvalitetsutviklingsarbeidet, men også samarbeidsprosessen mellom nivåene i denne sammenheng. Spesielt i en tid hvor kommunene får økt ansvar for skoleområdet og mange kommuner har dårlig økonomi, kombinert med at mange kommuner gjennomgår store endringer av sin organisasjonsstruktur, er vi opptatt av hvordan disse forholdene virker inn på styringen av dette arbeidet. Vi har egne arbeidserfaringer fra de to kommunene som inngår i vår studie. Disse to kommunene har ulik kommunal organisasjonsstruktur, er veldig ulike politisk og har svært ulik økonomi. Dette er et interessant utgangspunkt for en komparativ studie. Teorigrunnlaget: NPM-litteratur ( Busch, Johnsen m.fl. 2001 ), styring, styringsstrategi og styringsmidler ( Karlsen 2002, Engeland 2000 ), ledelse og lederroller ( Nylehn 1997, Engeland 2000 ), kommunikativ ledelse ( Eriksen 1999 ), organisasjonsmodell for skole med overføringsverdi til kommune ( Dalin 1994 ), kommunen som en lærende organisasjon ( Roald 2004 ), organisatoriske perspektiver på kommunen ( Engeland 2000 ), en kommunal styringsmodell ( Engeland 2000 ) og to forskningsundersøkelser fra Nordlandsforskning (Madsen 2000, Finstad / Kvåle 2003 ). Vi har selv utviklet tre modeller: En som viser forholdet mellom kommunal styring og autonomi på skolenivå relatert til kvalitetsutviklingsarbeid i begge kommunene, en som illustrerer hvordan politisk styring, administrativ ledelse og autonomi fra skolenivået foregår knyttet til dette arbeidet og en modell som viser rektorrollen i disse to kommunene. 2. Metode: Vi velger en kvalitativ tilnærming i vår undersøkelse. Hovedtemaet i oppgaven er komplekst og egner seg til å få informasjon fra få informanter, hvor man kan gå mer i dybden innenfor aktuelle spørsmål. Vårt valg av kvalitativ metode består i delvis strukturert intervju og dokumentanalyse. Våre informantgrupper er rektorer, skolefaglig ansvarlige på kommunenivå og politikere i begge kommunene. Som intervjuform velges gruppeintervju. Informasjon fra kommunale dokumenter er tenkt å bekrefte, utdype, men kanskje også avsløre manglende samsvar mellom informasjon fra de to aktuelle informasjonskildene. Vårt valg av kvalitativ analysemetode er temasentrert tilnærming ( Thagaard 2003 : kap. 8 ). Kun analytisk generalisering kan foretas i vår undersøkelse ( Kvale 1997 : 161 ). 3. Data / kilder: Innsamlede data er av kvalitativ art, bestående av intervjudata fra gjennomførte intervjuer og utvalgte dokumenttekster fra relevante kommunale dokumenter. Intervjuene er først transkribert, og deretter er et gjennomarbeidet intervjusammendrag framstilt i to matriser, en for hver kommune. En hovedoppsummering av de utvalgte dokumenttekstene er supplert med en enkel matrise som utgjør en kortversjon av hovedoppsummeringen. 4. Resultater / hovedkonklusjoner: En hovedkonklusjon i forhold til problemstillingen vår er: I kommune A ( tonivåmodell ) er den kommunale styringen av arbeidet med kvalitetsutvikling svak og autonomien på skolenivået sterk. I kommune B ( trenivåmodell ) er den kommunale styringen av dette arbeidet sterk og autonomien på skolenivået tilsvarende svak. Innenfor begge kommunene styres og koordineres arbeidet med kvalitetsutvikling på kommunenivået sterkere av den skolefaglige administrasjonen enn av den politiske ledelsen. I tonivåkommunen er den skolefaglige kapasiteten og kompetansen på Rådhuset på et minimumsnivå, og rektorene går inn og tar over deler av skoleeierrollen knyttet til arbeid med kvalitetsutvikling, i tillegg til ledelse av dette arbeidet i egen virksomhet. Vi opererer med begrepet den myndiggjorte rektor. Denne kommunen har en svak skolefaglig støtteseksjon uten beslutningsmyndighet. I trenivåkommunen ivaretar en godt bemannet skoleetat dette arbeidet på en bedre måte, og rektorene leder kvalitetsutviklingsarbeidet på egen skole. Denne kommunen har en skolesjef med beslutningsmyndighet. Likevel uttrykker rektorene i trenivåkommunen at de ikke får nok drahjelp, støtte og veiledning i forhold til arbeid med kvalitetsutvikling. I tonivåkommunen sier rektorene at så godt som alt dette arbeidet er overlatt til dem selv. I begge kommunene er det en tendens til at rektorene svarer mer negativt på mange spørsmål enn informantene på kommunenivået, noe som stemmer med Madsens undersøkelse ( 2000 ). Et funn vi undrer oss over: Kommune A er en politisk rød kommune som har valgt en NPM-preget tonivåstruktur, og kommune B er en blå kommune som har valgt å beholde den tradisjonelle og mindre markedsliberalistiske trenivåstrukturen! I Kommuneplanen i tonivåkommunen er skole og undervisning godt synlig som et viktig område innenfor kommunens helhetlige tjenestetilbud. Helhetstenkning preger tonivåkommunen. I trenivåkommunen er dette området nesten usynlig, noe som kan ha med sektortenkningen i denne type kommuner å gjøre. Det som gjelder skole og undervisning, overlates til egne skolerelaterte planer i kommunen. Kommune A har en meget sterk økonomistyring, og kommunens økonomiske situasjon er kriserammet. Denne styringen er ikke så sterk i kommune B som har en langt sunnere økonomi. Politikerne i begge kommunene driver overordnet politisk styring. Iverksetting og oppfølging av kvalitetsutviklingstiltak delegeres til kommuneadministrasjonen, som igjen delegerer videre ned til skolenivået. Fra kommunenivået foregår det en mer utstrakt delegering til skolenivået i kommune A enn i kommune B. I sistnevnte kommune ivaretas mer av dette arbeidet av kommunenivået

Narcissism in patients admitted to psychiatric acute wards: its relation to violence, suicidality and other psychopathology

<p>Abstract</p> <p>Background</p> <p>The objective was to examine various aspects of narcissism in patients admitted to acute psychiatric wards and to compare their level of narcissism to that of an age- and gender-matched sample from the general population (NORM).</p> <p>Methods</p> <p>This cross-sectional study interviewed 186 eligible acute psychiatric patients with the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). The patients filled in the Narcissistic Personality Inventory-21 item version (NPI-21), The Hospital Anxiety and Depression Scale (HADS) and the Rosenberg Self-Esteem Scale. High and low narcissism was defined by the median of the total NPI-21 score. An age- and gender-matched control sample from the general population also scored the NPI-21 (NORM).</p> <p>Results</p> <p>Being male, involuntary admitted, having diagnosis of schizophrenia, higher self-esteem, and severe violence were significantly associated with high narcissism, and so were also low levels of suicidality, depression, anxiety and GAF scores. Severe violence and high self-esteem were significantly associated with high narcissism in multivariable analyses. The NPI-21 and its subscales showed test-retest correlations ≥0.83, while the BPRS and the HADS showed lower correlations, confirming the trait character of the NPI-21. Depression and suicidality were negatively associated with the NPI-21 total score and all its subscales, while positive association was observed with grandiosity. No significant differences were observed between patients and NORM on the NPI-21 total score or any of the NPI subscales.</p> <p>Conclusion</p> <p>Narcissism in the psychiatric patients was significantly associated with violence, suicidality and other symptoms relevant for management and treatment planning. Due to its trait character, use of the NPI-21 in acute psychiatric patients can give important clinical information. The similar level of narcissism found in patients and NORM is in need of further examination.</p

Social psychiatry and psychiatric epidemiology functional impairment among people with severe and enduring mental disorder in rural Ethiopia: a cross-sectional study

Purpose: Evidence regarding functional impairment in people with severe mental disorders (SMD) is sparse in low and middle-income countries. The aim of this study was to identify factors associated with functional impairment in people with enduring SMD in a rural African setting. Methods: A cross-sectional study was conducted at the baseline of a health service intervention trial. A total of 324 participants were recruited from an existing communityascertained cohort of people with SMD (n= 218), and attendees at the Butajira General Hospital psychiatric clinic (n= 106). Inclusion criteria defined people with SMD who had ongoing need for care: those who were on psychotropic medication, currently symptomatic or had a relapse in the preceding two years. The World Health Organization Disability Assessment schedule (WHODAS-2.0) and the Butajira Functioning Scale (BFS), were used to assess functional impairment. Multivariable negative binomial regression models were fitted to investigate the association between demographic, socio-economic and clinical characteristics, and functional impairment. Results: Increasing age, being unmarried, rural residence, poorer socio-economic status, symptom severity, continuous course of illness, medication side effects and internalized stigma were associated with functional impairment across self reported and caregiver responses for both the WHODAS and the BFS. Diagnosis per se was not associated consistently with functional impairment. Conclusion: To optimize functioning in people with chronic SMD in this setting, services need to target residual symptoms, poverty, medication side effects and internalized stigma. Testing the impact of community interventions to promote recovery will be useful. Advocacy for more tolerable treatment options is warranted

A Novel Approach to Determining Violence Risk in Schizophrenia: Developing a Stepped Strategy in 13,806 Discharged Patients

Clinical guidelines recommend that violence risk be assessed in schizophrenia. Current approaches are resource-intensive as they employ detailed clinical assessments of dangerousness for most patients. An alternative approach would be to first screen out patients at very low risk of future violence prior to more costly and time-consuming assessments. In order to implement such a stepped strategy, we developed a simple tool to screen out individuals with schizophrenia at very low risk of violent offending. We merged high quality Swedish national registers containing information on psychiatric diagnoses, socio-demographic factors, and violent crime. A cohort of 13,806 individuals with hospital discharge diagnoses of schizophrenia was identified and followed for up to 33 years for violent crime. Cox regression was used to determine risk factors for violent crime and construct the screening tool, the predictive validity of which was measured using four outcome statistics. The instrument was calibrated on 6,903 participants and cross-validated using three independent replication samples of 2,301 participants each. Regression analyses resulted in a tool composed of five items: male sex, previous criminal conviction, young age at assessment, comorbid alcohol abuse, and comorbid drug abuse. At 5 years after discharge, the instrument had a negative predictive value of 0.99 (95% CI = 0.98–0.99), meaning that very few individuals who the tool screened out (n = 2,359 out of original sample of 6,903) were subsequently convicted of a violent offence. Screening out patients who are at very low risk of violence prior to more detailed clinical assessment may assist the risk assessment process in schizophrenia