The effect of environmental change, planned and unplanned life events on the long-term outcome of common mental disorders

PURPOSE: To examine the nature of positive and negative environmental change on clinical outcome in 210 patients presenting with anxiety and depression and followed up over 30 years. METHODS: In addition to clinical assessments, major environmental changes, particularly after 12 and 30 years, were recorded in all patients by a combination of self-report and taped interviews. Environmental changes were separated into two major groups, positive or negative, determined by patient opinion. RESULTS: In all analyses positive changes were found to be associated with better outcome at 12 years with respect to accommodation (P = 0.009), relationships (P = 007), and substance misuse (P = 0.003), with fewer psychiatric admissions (P = 0.011) and fewer social work contacts at 30 years (P = 0.043). Using a consolidated outcome measure positive changes were more likely than negative ones to be associated with a good outcome at 12 and 30 years (39% v 3.6% and 30.2% v 9.1%, respectively). Those with personality disorder at baseline had fewer positive changes (P = 0.018) than others at 12 years and fewer positive occupational changes at 30 years (P = 0.041). Service use was greatly reduced in those with positive events with 50-80% more time free of all psychotropic drug treatment (P < 0.001). Instrumental positive change had greater effects than imposed changes. CONCLUSIONS: Positive environmental change has a favourable impact on clinical outcome in common mental disorders. Although studied naturalistically in this study the findings suggest that if harnessed as a therapeutic intervention, as in nidotherapy and social prescribing, it would yield therapeutic dividends

Energy Efficiency in Buildings and Excess Summer Mortality in the UK

One of the main objective of the building design is to provide comfort and safety to occupants, particularly during adverse weather conditions. In most part of the world, people stay indoors during adverse weather conditions, thus increasing energy consumption. In UK, vulnerable people such as the elderly are highly affected with mortality rate during extreme weather conditions. The 2003 heatwave reached average of 38.5° C in the UK resulting in the death toll of 2,234. The 10 days period of extreme heat is thought to be the warmest about the last 500 years. Across Europe, the 2003 heatwave resulted in 20,000 deaths; in France alone, the number reached 15,000. Similarly, the 2018 summer heatwaves, reached 35.5°C contributing to 863 deaths. Yet, there is little research regarding impact of energy efficiency in building and deaths caused by excessive heatwaves in the UK. The study aims to investigate the impact of energy efficiency in buildings and excessive heatwave deaths among elderly people in the UK. Research question asked is; do energy efficiency programmes and policies contribute to excessive summer deaths in the UK? .The study adopted quantitative research method with participants drawn from low/average income households, in west midlands part of UK, between 2003/04 to 2017/18. Initial findings show that there is a significant relationship between energy efficiency adoption, government policies and excessive summer deaths

Impact of personality status on the outcomes and cost of cognitive–behavioural therapy for health anxiety

BACKGROUND: Health anxiety, hypochondriasis and personality disturbance commonly coexist. The impact of personality status was assessed in a secondary analysis of a randomised controlled trial (RCT). AIMS: To test the impact of personality status using ICD-11 criteria on the clinical and cost outcomes of treatment with cognitive-behavioural therapy for health anxiety (CBT-HA) and standard care over 2 years. METHOD: Personality dysfunction was assessed at baseline in 444 patients before randomisation and independent assessment of costs and outcomes made on four occasions over 2 years. RESULTS: In total, 381 patients (86%) had some personality dysfunction with 184 (41%) satisfying the ICD criteria for personality disorder. Those with no personality dysfunction showed no treatment differences (P = 0.90) and worse social function with CBT-HA compared with standard care (P<0.03) whereas all other personality groups showed greater improvement with CBT-HA maintained over 2 years (P<0.001). Less benefit was shown in those with more severe personality disorder (P<0.05). Costs were less with CBT-HA except for non-significant greater differences in those with moderate or severe personality disorder. CONCLUSIONS: The results contradict the hypothesis that personality disorder impairs response to CBT in health anxiety in both the short and medium term