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1.  Seeking informal and formal help for mental health problems in the community: a secondary analysis from a psychiatric morbidity survey in South London 
BMC Psychiatry  2014;14(1):275.
Only 30-35% of people with mental health problems seek help from professionals. Informal help, usually from friends, family and religious leaders, is often sought but is under-researched. This study aimed to contrast patterns of informal and formal help-seeking using data from a community psychiatric morbidity survey (n=1692) (South East London Community Health (SELCOH) Study).
Patterns of help-seeking were analysed by clinical, sociodemographic and socioeconomic indicators. Factors associated with informal and formal help-seeking were investigated using logistic regression. Cross-tabulations examined informal help-seeking patterns from different sources.
‘Cases’ (n = 386) were participants who had scores of ≥ 12 on the Revised Clinical Interview Schedule (CIS-R), indicating a common mental disorder. Of these, 40.1% had sought formal help, (of whom three-quarters (29%) had also sought informal help), 33.6% had sought informal help only and only 26.3% had sought no help. When controlling for non-clinical variables, severity, depression, suicidal ideas, functioning and longstanding illnesses were associated with formal rather than informal help-seeking. Age and ethnic group influenced sources of informal help used. Younger people most frequently sought informal help only whereas older people tended to seek help from their family. There were ethnic group differences in whether help was sought from friends, family or religious leaders.
This study has shown how frequently informal help is used, whether in conjunction with formal help or not. Among the ‘cases’, over 60% had sought informal help, whether on its own or together with formal help. Severity was associated with formal help-seeking. Patterns of informal help use have been found. The use and effectiveness of informal help merit urgent research.
PMCID: PMC4195997  PMID: 25292287
Informal help; Formal help-seeking; Depression; Functioning; Friends; Family; Community psychiatric survey; Mental health
2.  ‘You feel you've been bad, not ill’: Sick doctors’ experiences of interactions with the General Medical Council 
BMJ Open  2014;4(7):e005537.
To explore the views of sick doctors on their experiences with the General Medical Council (GMC) and their perception of the impact of GMC involvement on return to work.
Qualitative study.
Doctors who had been away from work for at least 6 months with physical or mental health problems, drug or alcohol problems, GMC involvement or any combination of these, were eligible for inclusion into the study. Eligible doctors were recruited in conjunction with the Royal Medical Benevolent Fund, the GMC and the Practitioner Health Programme. These organisations approached 77 doctors; 19 participated. Each doctor completed an in-depth semistructured interview. We used a constant comparison method to identify and agree on the coding of data and the identification of central themes.
18 of the 19 participants had a mental health, addiction or substance misuse problem. 14 of the 19 had interacted with the GMC. 4 main themes were identified: perceptions of the GMC as a whole; perceptions of GMC processes; perceived health impacts and suggested improvements. Participants described the GMC processes they experienced as necessary, and some elements as supportive. However, many described contact with the GMC as daunting, confusing and anxiety provoking. Some were unclear about the role of the GMC and felt that GMC communication was unhelpful, particularly the language used in correspondence. Improvements suggested by participants included having separate pathways for doctors with purely health issues, less use of legalistic language, and a more personal approach with for example individualised undertakings or conditions.
While participants recognised the need for a regulator, the processes employed by the GMC and the communication style used were often distressing, confusing and perceived to have impacted negatively on their mental health and ability to return to work.
PMCID: PMC4120406  PMID: 25034631
3.  Patterns of physical co-/multi-morbidity among patients with serious mental illness: a London borough-based cross-sectional study 
BMC Family Practice  2014;15:117.
Serious mental illness (SMI) is associated with elevated mortality compared to the general population; the majority of this excess is attributable to co-occurring common physical health conditions. There may be variation within the SMI group in the distribution of physical co/multi-morbidity. This study aims to a) compare the pattern of physical co- and multi-morbidity between patients with and without SMI within a South London primary care population; and, b) to explore socio-demographic and health risk factors associated with excess physical morbidity among the SMI group.
Data were obtained from Lambeth DataNet, a database of electronic patient records derived from general practices in the London borough of Lambeth. The pattern of 12 co-morbid common physical conditions was compared by SMI status. Multivariate ordinal and logistic regression analyses were conducted to assess the strength of association between each condition and SMI status; adjustments were made for potentially confounding socio-demographic characteristics and for potentially mediating health risk factors.
While SMI patients were more frequently recorded with all 12 physical conditions than non-SMI patients, the pattern of co-/multi-morbidity was similar between the two groups. Adjustment for socio-demographic characteristics – in particular age and, to a lesser extent ethnicity, considerably reduced effect sizes and accounted for some of the associations, though several conditions remained strongly associated with SMI status. Evidence for mediation by health risk factors, in particular BMI, was supported.
SMI patients are at an elevated risk of a range of physical health conditions than non-SMI patients but they do not appear to experience a different pattern of co-/multimorbidity among those conditions considered. Socio-demographic differences between the two groups account for some of the excess in morbidity and known health risk factors are likely to mediate the association. Further work to examine a wider range of conditions and health risk factors would help determine the extent of excess mortality attributable to these factors.
PMCID: PMC4062514  PMID: 24919453
Serious mental illness; Mental health; Physical health; Comorbidity; Multimorbidity
4.  Job Strain, Health and Sickness Absence: Results from the Hordaland Health Study 
PLoS ONE  2014;9(4):e96025.
While it is generally accepted that high job strain is associated with adverse occupational outcomes, the nature of this relationship and the causal pathways involved are not well elucidated. We aimed to assess the association between job strain and long-term sickness absence (LTSA), and investigate whether any associations could be explained by validated health measures.
Data from participants (n = 7346) of the Hordaland Health Study (HUSK), aged 40–47 at baseline, were analyzed using multivariate Cox regression to evaluate the association between job strain and LTSA over one year. Further analyses examined whether mental and physical health mediated any association between job strain and sickness absence.
A positive association was found between job strain and risk of a LTSA episode, even controlling for confounding factors (HR = 1.64 (1.36–1.98); high job strain exposure accounted for a small proportion of LTSA episodes (population attributable risk 0.068). Further adjustments for physical health and mental health individually attenuated, but could not fully explain the association. In the fully adjusted model, the association between high job strain and LTSA remained significant (HR = 1.30 (1.07–1.59)).
High job strain increases the risk of LTSA. While our results suggest that one in 15 cases of LTSA could be avoided if high job strain were eliminated, we also provide evidence against simplistic causal models. The impact of job strain on future LTSA could not be fully explained by impaired health at baseline, which suggests that factors besides ill health are important in explaining the link between job strain and sickness absence.
PMCID: PMC3995988  PMID: 24755878
5.  Shame! Self-stigmatisation as an obstacle to sick doctors returning to work: a qualitative study 
BMJ Open  2012;2(5):e001776.
To explore the views of sick doctors on the obstacles preventing them returning to work.
Qualitative study.
Single participating centre recruiting doctors from all over the UK.
Doctors who had been away from work for at least 6 months with physical or mental health problems, drug or alcohol problems, General Medical Council involvement or any combination of these, were eligible. Eligible doctors were recruited in conjunction with the Royal Medical Benevolent Fund, the General Medical Council and the Practitioner Health Programme. These organisations approached 77 doctors; 19 participated. Each doctor completed an in-depth semistructured interview. We used a constant comparison method to identify and agree on the coding of the data and the identification of a number of central themes.
The doctors described that being away from work left them isolated and sad. Many experienced negative reactions from their family and some deliberately concealed their problems. Doctors described a lack of support from colleagues and feared a negative response when returning to work. Self-stigmatisation was central to the participants’ accounts; several described themselves as failures and appeared to have internalised the negative views of others.
Self-stigmatising views, which possibly emerge from the belief that ‘doctors are invincible’, represent a major obstacle to doctors returning to work. From medical school onwards cultural change is necessary to allow doctors to recognise their vulnerabilities so they can more easily generate strategies to manage if they become unwell.
PMCID: PMC3488732  PMID: 23069770
Mental Health; Occupational & Industrial Medicine; Qualitative Research
6.  A Lifecourse Approach to Long-Term Sickness Absence—A Cohort Study 
PLoS ONE  2012;7(5):e36645.
Most research on long-term sickness absence has focussed on exposure to occupational psychosocial risk factors such as low decision latitude. These provide an incomplete explanation as they do not account for other relevant factors. Such occupational risk factors may be confounded by social or temperamental risk factors earlier in life.
We analysed data from the 1958 British Birth Cohort. Long-term sickness absence was defined as receipt of Incapacity Benefit/Severe Disablement Allowance at age 42. In those in employment aged 33 we examined the effects of psychological distress, musculoskeletal symptoms, and low decision latitude. These were then adjusted for IQ, educational attainment, and the presence of early life somatic and neurotic symptoms.
Low decision latitude predicted subsequent long-term absence, and this association remained, albeit reduced, following adjustment for psychological distress and musculoskeletal symptoms at age 33. Low decision latitude was no longer associated with long-term absence when IQ and educational attainment were included. Adjusting for early life somatic and neurotic symptoms had little impact.
A greater understanding of the ways in which occupational risk factors interact with individual vulnerabilities across the life-course is required. Self reported low decision latitude might reflect the impact of education and cognitive ability on how threat, and the ability to manage threat, is perceived, rather than being an independent risk factor for long-term sick leave. This has implications for policy aimed at reducing long-term sick leave.
PMCID: PMC3343027  PMID: 22570734
7.  The association between childhood cognitive ability and adult long-term sickness absence in three British birth cohorts: a cohort study 
BMJ Open  2012;2(2):e000777.
The authors aimed to test the relationship between childhood cognitive function and long-term sick leave in adult life and whether any relationship was mediated by educational attainment, adult social class or adult mental ill-health.
Cohort study.
The authors used data from the 1946, 1958 and 1970 British birth cohorts. Initial study populations included all live births in 1 week in that year. Follow-up arrangements have differed between the cohorts.
The authors included only those alive, living in the UK and not permanent refusals at the time of the outcome. The authors further restricted analyses to those in employment, full-time education or caring for a family in the sweep immediately prior to the outcome. 2894 (1946), 15 053 (1958) and 14 713 (1970) cohort members were included. Primary and secondary outcome measures: receipt of health-related benefits (eg, incapacity benefit) in 2000 and 2004 for the 1958 and 1970 cohorts, respectively, and individuals identified as ‘permanently sick or disabled’ in 1999 for 1946 cohort.
After adjusting for sex and parental social class, better cognitive function at age 10/11 was associated with reduced odds of being long-term sick (1946: 0.70 (0.56 to 0.86), p=0.001; 1958: 0.69 (0.61 to 0.77), p<0.001; 1970: 0.80 (0.66 to 0.97), p=0.003). Educational attainment appeared to partly mediate the associations in all cohorts; adult social class appeared to have a mediating role in the 1946 cohort.
Long-term sick leave is a complex outcome with many risk factors beyond health. Cognitive abilities might impact on the way individuals are able to develop strategies to maintain their employment or rapidly find new employment when faced with a range of difficulties. Education should form part of the policy response to long-term sick leave such that young people are better equipped with skills needed in a flexible labour market.
Article summary
Article focus
To what extent does cognitive function in childhood predict long-term sick leave.
To what extent might any association be mediated through educational attainment, adult social class or adult mental ill-health.
Key messages
There is a clear dose–response relationship between lower cognitive function in childhood and increased odds of being on long-term sick leave in adulthood.
This association applies to younger as well as older workers and holds true irrespective of the decade of birth.
This association is mediated in part by education attainment suggesting improved education, especially for those with lower cognitive abilities, may help inoculate them from the risk of long-term sickness absence.
Strengths and limitations of this study
Three large birth cohorts with data from across 50 years.
Cohorts broadly representative of the UK population born in that year.
Cognitive function assessed using well-recognised tools.
Different measures of cognitive function, long-term sickness absence and depression used across the cohorts.
PMCID: PMC3323804  PMID: 22466159
8.  Psychiatric disorder in early adulthood and risk of premature mortality in the 1946 British Birth Cohort 
BMC Psychiatry  2011;11:37.
Few studies of the association between psychiatric disorder and premature death have adjusted for key confounders and used structured psychiatric interviews. We aimed to investigate if psychiatric disorder was associated with a higher risk of mortality and whether any excess mortality was due to suicide, or explained by other health or socioeconomic risk factors.
We used data from the MRC National Survey of Health and Development, a nationally representative UK birth cohort. 3283 men and women completed the Present State Examination at age 36. The main outcome measure was all-cause mortality before age 60.
Those with psychiatric disorder at age 36 had a higher risk of death even after adjusting for potential confounders (Hazard ratio = 1.84, 95% C.I. 1.22-2.78). Censoring violent deaths and suicides led to similar results.
Psychiatric disorder was associated with excess premature mortality not explained by suicide or other health or socioeconomic risk factors.
PMCID: PMC3062592  PMID: 21385445
9.  Invited Commentary: Stress and Mortality 
American Journal of Epidemiology  2008;168(5):492-495.
In this issue of the Journal, Nielsen et al. (Am J Epidemiol 2008;168:481−91) use data from a large Danish study to provide evidence that self-reported stress is associated with increased all-cause mortality over the next 20 years. The finding is remarkable. In this commentary, the authors explore what is really meant by stress; they argue that it would be naïve to view stress as reported in this way, with some external exposure. It has to be seen through the lens of the participant's personal experience, and this lens is likely to be clouded by personality, coping styles, and the common mental disorders—depression and anxiety. The authors discuss a wider literature concerning similar findings associating depression with mortality, suggesting three broad reasons for the association. First, the findings might be explained by the impact of stress or distress on well-established risk factors for cardiovascular disease and cancer. Second, there might be direct, underlying psychosomatic pathways by which stress or distress can affect immune or autonomic function. Third, there might be common causal pathways—shared genes or early adversities that predict both stress and mortality from other causes independently. The authors suggest that life course epidemiologic research is required to test these competing hypotheses.
PMCID: PMC2519112
cause of death; depressive disorder; mortality; prospective studies; stress, psychological
10.  Long term sickness absence 
BMJ : British Medical Journal  2005;330(7495):802-803.
PMCID: PMC556060  PMID: 15817531

Results 1-10 (10)