The TrueBlue study : is practice nurse-led collaborative care effective in the management of depression for patients with heart disease or diabetes?

Background: In the presence of type 2 diabetes (T2DM) or coronary heart disease (CHD), depression is under diagnosed and under treated despite being associated with worse clinical outcomes. Our earlier pilot study demonstrated that it was feasible, acceptable and affordable for practice nurses to extend their role to include screening for and monitoring of depression alongside biological and lifestyle risk factors. The current study will compare the clinical outcomes of our model of practice nurse-led collaborative care with usual care for patients with depression and T2DM or CHD.

Methods: This is a cluster-randomised intervention trial. Eighteen general practices from regional and metropolitan areas agreed to join this study, and were allocated randomly to an intervention or control group. We aim to recruit 50 patients with co-morbid depression and diabetes or heart disease from each of these practices. In the intervention group, practice nurses (PNs) will be trained for their enhanced roles in this nurse-led collaborative care study. Patients will be invited to attend a practice nurse consultation every 3 months prior to seeing their usual general practitioner. The PN will assess psychological, physiological and lifestyle parameters then work with the patient to set management goals. The outcome of this assessment will form the basis of a GP Management Plan document. In the control group, the patients will continue to receive their usual care for the first six months of the study before the PNs undergo the training and switch to the intervention protocol. The primary clinical outcome will be a reduction in the depression score. The study will also measure the impact on physiological measures, quality of life and on patient attitude to health care delivered by practice nurses.

Conclusion: The strength of this programme is that it provides a sustainable model of chronic disease management with monitoring and self-management assistance for physiological, lifestyle and psychological risk factors for high-risk patients with co-morbid depression, diabetes or heart disease. The study will demonstrate whether nurse-led collaborative care achieves better outcomes than usual care.

Subjective wellbeing, homeostatically protected mood and depression : a synthesis

This paper concerns the idea that Subjective Wellbeing (SWB) is managed by a system of psychological devices which have evolved for this purpose. It is proposed that this management is actually directed at the protection of Homeostatically Protected Mood, as the major component of SWB. We normally experience HPMood as a combination of contentment, happiness and positive arousal. A theoretical description of this construct is offered that can account for many of the commonly observed empirical characteristics of SWB data. It is further proposed that when homeostasis fails, due to the overwhelming nature of a negative challenge, people lose contact with HPMood and experience the domination of negative rather than positive affect. If this condition is chronic, people experience the clinical condition we call depression.

Understanding anxiety and depression : a dimensional and categorical approach

Three studies were conducted to understand the strong relationship between anxiety and depression. Common indicators of each disorder including critical attitudes towards self and others, negative childhood experiences, low social support and use of emotion as a coping strategy were found. Another important finding is that unremitted anxiety leads to depression in approximately 50% of cases. Implications of these findings for intervention and treatment were presented.

Exploration of depressive realism in depression, depression in remission, and dysphoria

This study compared how people with different levels of depression judged their control over a task. People with more severe depression were more accurate in judging their control than were people with less severe depression whilst nondepressed individuals overestimated their control over the task.

Depression and anxiety in patients with cancer and their families

This thesis identified aspects of family relationships and the patients' illness that were associated with depression and anxiety in patients and their relatives after a cancer diagnosis and during treatment. It also tested the ability of a measure of family relationships to identify psychological distress in these families.

Anger and aggression in the presence of anxiety and depression

This portfolio considers major theories of aggression and relates them to four individual case studies. Each client has difficulties with anger and aggression and all had additional emotional difficulties, specifically depression and anxiety.

A peer-focused depression prevention program for preadolescent children

This thesis develops and evaluates the effectiveness of a peer-focused cognitive-behavioural depression prevention program (Kool Kids Program [KKP]) for preadolescent children. It was demonstrated that the KKP was partially effective at reducing depressive symptoms and improving the psychosocial functioning of preadolescent children up to 6 months following intervention. The professional portfolio discusses the unique role of clinical psychologists within multidisciplinary teams and the contribution they make to interdisciplinary collaboration. Four case studies are presented.

Effects of physical activity on depression and anxiety in children

This thesis study examined the direct and indirect effects of physical activity, self-efficacy and peer relations in depression and anxiety in children. No direct relationships between physical activity and symptoms of depression or anxiety were found for either sex. The portfolio, using four clinical health psychology case studies, provides an illustration of the clinical application of the transtheoretical model to four different health issues.

Impact of depression on intimate relationships

Three studies were designed to investigate the intimate relations of people with depression. The results indicated that people with depression and partners of people with depression reported a lower: sexual frequency, sexual satisfaction, relationship satisfaction, level of communication and engagement, positive view of their partner, and more stressors and sexual dysfunctions than the non-depressed comparison group.

Depression in temporal lobe epilepsy surgery patients : an FDG-PET study

Summary: Purpose: Depression is common in temporal lobe epilepsy (TLE) and after temporal lobectomy, and its etiology is obscure. In nonepileptic depression (including depression associated with other neurologic disorders), a consistent PET imaging finding is frontal lobe hypometabolism. Many TLE patients have hypometabolism involving frontal regions. Thus in data available from routine clinical assessments in an epilepsy surgery unit, we tested the hypothesis that the pattern of hypometabolism, particularly in the frontal lobe, may be associated with the depression seen in patients with TLE and TLE surgery.

Methods: We studied 23 medically refractory TLE patients who underwent anterior temporal lobectomy and who had preoperative FDG-PET scanning. All patients had pre- and postoperative psychiatric assessment. By using statistical parametric mapping (SPM-99), patterns of hypometabolism were compared between patients who had a preoperative history of depression (n = 9) versus those who did not (n = 14) and between those in whom postoperative depression developed (n = 13) versus those in whom it did not (n = 10). A significant region of hypometabolism was set at p < 0.001 for a cluster of ≥20 contiguous voxels.

Results: Patients with a history of depression at any time preoperatively showed focal hypometabolism in ipsilateral orbitofrontal cortex compared with those who did not (t= 4.64; p < 0.001). Patients in whom depression developed postoperatively also showed hypometabolism in the ipsilateral orbitofrontal region (t= 5.10; p < 0.001).

Conclusions: Although this study is methodologically limited, and other explanations merit consideration, orbitofrontal cortex dysfunction, already implicated in the pathophysiology of nonepileptic depression, may also be relevant to the depression of TLE and temporal lobectomy.

Detecting and treating depression in people with mild intellectual disability : the views of key stakeholders

There is a pressing need for the development of programs for the early identification and treatment of depression in individuals with mild intellectual disability. The aim of this study was to ascertain the perspective of 64 key stakeholders (people with intellectual disability, healthcare professionals, family/caregivers & support workers) regarding the risk factors and characteristics of depression, the support and service needs of individuals with intellectual disability/depression and those who care for them. Findings enhance our understanding of depression and its risk factors in people with mild intellectual disability and endorse the need for the development of screening and intervention programs suitable for delivery by staff in agencies providing services to people with mild intellectual disability.