Patients who consult with tiredness: frequency of consultation, perceived causes of tiredness and its association with psychological distress.

BACKGROUND: Few prospective studies have been carried out in primary care on patients presenting with tiredness. AIM: A study was undertaken to describe patients whose main complaint was fatigue or of being "tired all the time'. METHOD: Over one year, doctors in four practices in Lancashire, Mid-Glamorgan, Suffolk and Surrey recruited 220 patients aged 16 years or more presenting with fatigue, and matched them with a comparison group from their lists. The general health questionnaire, a fatigue questionnaire and an attribution questionnaire were used to measure outcomes over six months. General practice records of consultations were also examined. RESULTS: Patients consulting for tiredness attended the doctor significantly more frequently than the comparison group both in the six months before and after entering the study. The frequency of attending could not be related to the duration or severity of fatigue alone. The majority consulting with tiredness scored highly on the general health questionnaire but so also did patients with equivalent fatigue scores in the comparison group. The correlation between fatigue and general health questionnaire scores was close for those patients who still had high fatigue scores six months later than it was for patients on entry to the study. Six months following study entry 61% of patients perceived the cause of the tiredness to be physical, while 57% of doctors viewed the problem as psychological. A small number of patients changed their views during the six months follow up from physical to psychological attributions. CONCLUSION: Patients consulting for tiredness are likely to report symptoms of psychological distress and attend more frequently than other patients. They tend to view the problem as physical while their doctors view the problem as psychological. Having established that there is no physical problem, doctors may need to focus more on sharing ideas and explanations when patients complain of being "tired all the time'.     

Do the attitudes and beliefs of young teenagers towards general practice influence actual consultation behaviour?

BACKGROUND: Teenagers are believed to have health concerns that are not adequately addressed in primary care because of perceived barriers that inhibit them from consulting a general practitioner (GP). We report the results of a study examining links between potential attitudinal barriers and actual help-seeking behaviour. AIM: To determine whether the attitudes of teenagers towards general practice are associated with differences in consultation patterns. METHOD: Results of a postal questionnaire survey of attitudes to general practice, performed among teenage patients aged 13 to 15 years registered with five general practices in the East Midlands, were analysed in relation to consultation data from retrospective casenote analysis for the preceding 12 months. RESULTS: Matched questionnaire and consultation data were available for 678 teenagers. We found few significant differences in overall consultation rates between teenagers expressing differing attitudes about aspects of general practice. Differences did exist in relation to perceived difficulty in getting an appointment, feeling able to confide in a GP, and perception of adequate time being given in the consultation. Fear of embarrassment was associated with lower consultation rates for gynaecological problems and contraception. CONCLUSIONS: Negative perceptions of general practice by teenagers may have less of an influence on actual consultation behaviour than previously believed. However, there are some aspects of care that merit further attention if teenagers are to feel able to consult their GP more easily.     

How do teenagers and primary healthcare providers view each other? An overview of key themes.

BACKGROUND: Teenagers have often been asked for their opinions about health services. However, relatively few studies have involved quantitative and qualitative methods of assessing them. Furthermore, there have been no United Kingdom studies of providers' views on the health of teenagers or of providers' opinions about their role in teenage health. AIM: To determine how teenagers view primary care, to discover how primary care providers view teenage patients, and to note any differences in opinions between the two groups. DESIGN OF STUDY: Questionnaire survey, focus group discussions, and semi-structured interviews. SETTING: Two thousand two hundred and sixty-five teenage patients, 16 general practitioners (GPs), 12 practice nurses, and 12 general practice receptionists in South Wales valley communities. METHOD: Selected practices provided age-sex registers of patients aged between 14 and 18 years and questionnaires were sent to these patients. Focus groups were assembled from those teenagers who had completed and returned the questionnaire. Semi-structured interviews between one member of the study team and GP surgery staff, chosen randomly from staff lists in the selected surgeries. RESULTS: The teenagers reported a lack of knowledge of services available from primary care, a feeling of a lack of respect for teenage health concerns, poor communication skills in GPs, and a poor understanding of confidentiality issues. The providers did not always share these concerns and they also had differing views on communication and confidentiality issues. CONCLUSION: The data demonstrated important findings about how teenagers would like primary care services to be improved. There was an apparent gulf between teenagers' own opinions about health care and the opinions held by primary care providers.     

How do teenagers manage their food allergies?

Background The peak incidence of deaths from anaphylaxis associated with nut allergy occurs in teenagers and young adults. During adolescence, the management of food allergy shifts from being the responsibility of parents to that of the young person. This is a group who therefore need special attention in the clinic. Objective This study aimed to understand the practical challenges that teenagers with food allergy experience using a qualitative approach and generate potential interventions for tackling these. Methods Teenagers aged 1118 years with food allergy completed a questionnaire about their food allergy and underwent a focused, semi‐structured interview with open questions guided by a priori topic areas. Interviews were recorded, transcribed and analysed using a thematic approach. Results The study enrolled 18 teenagers with a median age of 15 years (10 females); the most common food allergens were peanuts and tree nuts. Three key themes emerged: avoidance of allergens, preparation for reactions and the treatment of reactions. The majority of teenagers reported eating foods labelled as ‘may contain’ an allergen as they perceive that they are actually very unlikely to contain an allergen. Many of the teenagers only carried their self‐injectable adrenaline when they thought they are particularly at risk of a reaction. Some do not know how to appropriately treat an allergic reaction. More than half believed that educating other students at school about the seriousness of food allergies would make it easier to live with their food allergy. Conclusions A significant number of teenagers demonstrate risk‐taking behaviour in the management of their food allergies. Teenagers also felt it would be helpful for their peers to be educated about food allergy. This novel strategy might help them to avoid trigger foods and enable teenagers to access help more readily if they suffer a reaction. Cite this as: H. Monks, M. H. Gowland, H. MacKenzie, M. Erlewyn‐Lajeunesse, R. King, J. S. Lucas and G. Roberts, Clinical & Experimental Allergy, 2010 (40) 1533–1540.     

Review of teenage health: time for a new direction.

Teenagers represent a large proportion of the population and have the potential for considerable morbidity because of high smoking rates and unwanted teenage pregnancy. The government intends to reduce the incidence of this important morbidity, but there is no coherent strategy for attaining these improvements. Research in this area is limited in the United Kingdom, but research from elsewhere has clarified teenagers' attitudes. There have also been some intervention studies resulting in improvements in specific aspects of teenage health. A worrying theme which emerges from this research is of a new inverse care law. Teenagers with low self-esteem and less hope for their own future are more likely to lead lifestyles which put them at risk and are less likely to ask for advice in relation to their health or lifestyle. Thus, it may be more difficult to alter behaviour in these patients; overall population based improvements may be difficult to achieve. Teenagers' own concerns appear to be at variance with the goals dictated by government and health professionals. It is suggested that the only method of meeting the needs of teenagers and at the same time aiming to reduce morbidity in this age group is to foster an atmosphere of patient centredness in dealings with adolescent patients and for further ther research in this important health gain area.     

离异家庭青少年不良心理行为综合干预对照研究

随着我国家庭离异率上升 ,离异家庭子女的心理卫生问题日益引起注意。董奇、周敏娟等对离异家庭儿童的再适应状况作了多因素相关研究[1- 3] 。国外对这一群体干预研究已较深入[4 ,5] ,国内干预研究尚缺乏。本课题在影响离异青少年再适应的前期研究[2 ,3] 基础上 ,与学校联合对 30例存在心理卫生问题的离异家庭青少年进行为期 12— 18个月的综合心理干预 ,以考察干预模式的可行性和有效性。1　对象和方法1.1　研究对象1999— 2 0 0 1年 ,在二所中学和心理门诊 12 4例离异子女中 ,选取ＳＣＬ— 90和 /或社交回避苦恼量表多个因子分显著高出常…     

How general practice patients with emotional problems presenting with somatic or psychological symptoms explain their improvement.

BACKGROUND: The emotional problems of patients presenting only somatic symptoms are frequently not detected by general practitioners (GPs), yet clinical outcomes have often been found to be no different from emotional problems directly presented. AIM: To compare clinical outcomes and attributions for improvement of patients with emotional problems presenting only somatic symptoms to GPs, with patients directly presenting emotional problems. DESIGN OF STUDY: Survey of patients with General Health Questionnaire (GHQ) scores in the symptomatic range, with follow-up after three months of a repeat GHQ and a questionnaire of patients' attributions for improvement. SETTING: A sample of 152 adult patients from nine general practices in North and East London. METHOD: Consecutive patients were invited to complete an adapted GHQ prior to their consultation. The consultations were audiotaped and coded to indicate the extent to which psychological discussion took place, as against discussion of other issues. The GPs recorded whether they considered each patient to be emotionally disturbed or psychiatrically ill at the time of the consultation, to assess GP detection of emotional disturbance. To form the initial sample, interviews were conducted one to five days after the consultation with patients who intended to present with either psychological or somatic problems, with a follow-up questionnaire after three months. RESULTS: A total of 106 patients provided follow-up information, of whom 57 presented psychological problems directly at initial consultation and 49 presented only somatic symptoms. There were no differences in clinical outcome at three months between the two groups. Somatic presenters who improved were more likely than psychological presenters to attribute improvement to change in their physical health (68% versus 31%) while psychological presenters were more likely to attribute improvement to the GP's listening and counselling in the consultation (44% versus 18%). Other attributions for improvement, such as passage of time, change in life circumstances, support of family and friends, medication, and 'working through problems myself', were equally common in both groups. CONCLUSIONS: Patients with emotional problems presenting only somatic symptoms have equivalent clinical outcomes to patients presenting psychological problems directly, but are more likely to attribute emotional improvements to change in their physical health. For some such emotionally disturbed patients it may be sufficient for GPs to treat the physical health problems and to reassure the patient, without attempting to treat the underlying emotional disturbance.     

深圳593名新兵心理健康调查与干预

目的：了解新兵的心理水平及干预方式，方法：采用ＳＣＬ－９０症状自评量表对驻深圳边防某部９７年入伍的新兵５９３名进行了心理调查，并尝试用不同方式对其中两个连队进行了心理干预对照研究。结果：新兵有诸多因子分高于国内常模，应属心理问题高发人群。单纯用群体教育的方法对新兵已经发生的心理困扰无明显作用，而采用个别咨询为主的干预方法效果比较理想。部队各级医务人员掌握心理咨询和治疗的技能，对提高我军整体素质十分必要。     

Health-related quality of life in relation to gender and age in couples planning IVF treatment

BACKGROUND: Specific subgroups of people planning IVF might be at risk of having more psychological or health-related problems. Identification of subgroups at risk may better enable allocation of appropriate counselling. METHODS: A group of 425 men and 447 women planning to undergo IVF treatment filled out a questionnaire. Four domains of health-related quality of life were measured, namely perceived emotional, physical, cognitive and social functioning. RESULTS: Young men and women (aged 21-30 years) planning IVF had more short-term social and emotional problems than people of the same age group in the general population. No substantial differences were found in cognitive and physical functioning for all age groups of men nor women planning IVF compared with the general population. A high level of irrational parenthood cognitions substantially accounted for a less optimal score on all the different domains of quality of life. These cognitions ('needing a child in order to live a happy life') were especially prevalent among younger women. CONCLUSIONS: Patients with high levels of irrational parenthood cognitions are at risk of a less optimal quality of life. A short cognitive counselling therapy is advised for patients with high levels of these cognitions.     

Adverse health effects related to mercury exposure from dental amalgam fillings: toxicological or psychological causes?

BACKGROUND: Possible adverse health effects due to mercury released by amalgam fillings have been discussed in several studies of patients who attribute various symptoms to the effects of amalgam fillings. No systematic relation of specific symptoms to increased mercury levels could be established in any of these studies. Thus, a psychosomatic aetiology of the complaints should be considered and psychological factors contributing to their aetiology should be identified. METHODS: A screening questionnaire was used to identify subjects who were convinced that their health had already been affected seriously by their amalgam fillings (N = 40). These amalgam sensitive subjects were compared to amalgam non-sensitive subjects (N = 43). All participants were subjected to dental, general health, toxicological and psychological examinations. RESULTS: The two groups did not differ with respect to the number of amalgam fillings, amalgam surfaces or mercury levels assessed in blood, urine or saliva. However, amalgam sensitive subjects had significantly higher symptom scores both in a screening instrument for medically unexplained somatic symptoms (SOMS) and in the SCL-90-R Somatization scale. Additionally, more subjects from this group (50% versus 4.7%) had severe somatization syndromes. With respect to psychological risk factors, amalgam sensitive subjects had a self-concept of being weak and unable to tolerate stress, more cognitions of environmental threat, and increased habitual anxiety. These psychological factors were significantly correlated with the number and intensity of the reported somatic symptoms. CONCLUSIONS: While our results do not support an organic explanation of the reported symptoms, they are well in accord with the notion of a psychological aetiology of the reported symptoms and complaints. The findings suggest that self-diagnosed 'amalgam illness' is a label for a general tendency toward somatization.     

Psychological and genetic counseling implications for adolescent daughters of mothers with breast cancer

Adolescent daughters of women with breast cancer (BC) are themselves at risk for heritable BC. Although some preliminary evidence suggests this group is at an increased risk for emotional problems, evidence is limited to studies with small samples and no comparison groups. This study examined psychological and family functioning, health attitudes and beliefs about genetic risks in adolescent females. A case-comparison design was used to compare 55 mother-daughter pairs in which the mother had been treated for BC (BC group) to 55 families from the general population (GP). Participants completed an assessment battery measuring perceptions of personal risk for BC and attitudes about gene testing for BC susceptibility, family functioning, and adolescent psychological adjustment. Based on manova, no significant differences were found between the two groups on measures of the psychological functioning. However, BC group adolescents reported significant (p < 0.01) worries about their future health and genetic risk for BC. About 68% of BC adolescents compared with 12% of GP adolescents reported being moderately to greatly concerned about their susceptibility to genetic mutations. Further, 85% of BC group adolescents believed they were susceptible to BC compared with 10% of GP adolescents. The results indicated no evidence of emotional, behavioral, or familial distress in these families. However, BC adolescents have significant worries about their future health. The results of this study demonstrate the need to develop a comprehensive model of care where accurate information about genetics and health risks can be provided. The adolescents also need support to help them cope and communicate with their mothers their worries about BC.     

青少年精神分裂症家庭环境与心理健康相关性分析

目的 探讨青少年精神分裂症的家庭环境模式、心理健康状况及家庭环境对心理健康的影响.方法 以16～19岁首发精神分裂症60例为研究组,同年龄段在校就读学生60例为正常对照组;用家庭环境量表中文版(FES-CV)和心理健康测查表(PHI)进行测评.结果 青少年精神分裂症在亲密度、成功性、知识性、娱乐性、道德性、组织性因子分均低于对照组,且差异非常显著(P＜0.001和P＜0.005);青少年精神分裂症心理健康各量表分均高于正常对照组,除L、SOM、ANX分量表在统计学上无显著性差异外,其它分量表均差异非常显著(P＜0.001);青少年精神分裂症的心理健康状况与家庭环境的亲密度及组织性高度相关(P＜0.001).结论 青少年的心理健康状况受家庭环境诸多因素的严重影响,特别是家庭环境的亲密度、组织性与心理健康的关系最为密切.     

已婚育龄妇女心理卫生状况心理干预研究

目的 通过心理健康干预了解育龄妇士心理卫生状况.方法 随机抽取已婚育龄妇女250人为干预组和对照组成员.对心理干预组进行心理干预3个月,在心理干预前后分别对这些育龄妇女进行了心理卫生状况调查.结果 干预组育龄妇女在心理干预3个月后精神症状自评量表(SCL-90)中押郁、焦虑因子均分明显低于心理干预前数据.前后对比有统计...     

Young teenagers' attitudes towards general practitioners and their provision of sexual health care.

BACKGROUND: Pregnancy rates in under-16-year old teenagers and sexual risk-taking are both increasing. Ensuring that teenagers access health care--particularly sexual health care--appropriately is problematic. AIM: To find out the opinions and attitudes of 13- to 15-year-old teenagers towards general practice-based sexual health care services. METHOD: A quantitative survey, using a questionnaire completed during school hours. RESULTS: One thousand and forty five children aged 13 to 15 years completed questionnaires. The majority (709 [68%]) were aware of the sexual health services offered by general practitioners (GPs), and 786 (75%) were positive about being given helpful advice at a consultation. However, 567 (54%) teenagers believed they had to be over 16 years old to access sexual health services and 604 (58%) were concerned about their confidentiality not being preserved by their GP. They were also concerned about GPs not having the time or skills to deal with their problems (314 [30%]). CONCLUSIONS: This study suggests that work is needed to improve teenagers' access to, and use of, primary care sexual health services. In particular, identifying strategies that improve teenagers' awareness of services and general practitioners' approaches towards teenagers are priorities.     

初中生自杀意念影响因素分析

目的探索初中生自杀意念的相关影响因素,为关注初中生心理健康提供实证依据。方法采用分层整群随机抽样的方法,对上海市松江区15所初中的2265名初中生进行一般情况问卷、自杀意念自评量表(SIOSS)、青少年生活事件量表(ASLEC)、中学生抑郁量表(SDS)、焦虑自评量表(SAS)施测,以SPSS 17.0进行统计分析。结果 1初中生1年内自杀意念检出率为13.47%;2学习成绩差、同伴关系差、有自杀家族史、父亲职业是农民、与父亲关系差、与母亲关系差、家庭经济状况差的初中生自杀意念检出率较高,差异有统计学意义(χ2=51.768,82.119,11.035,13.956,84.731,79.218,7.172;P0.05);3有自杀意念组初中生的抑郁、焦虑、人际关系因子、学习压力因子、受惩罚因子、丧失因子、健康适应因子、其他因子分均高于无自杀意念组,差异有统计学意义(t=-30.853,-25.108,-20.663,-18.947,-14.508,-11.480,-14.474,-19.018;P0.001);4多因素Logistic回归分析表明,初中生自杀意念的影响因素包括性别、年级、家庭状况(是否是单亲家庭)、同伴关系、家庭经济状况、抑郁、焦虑、人际关系因子、受惩罚因子。结论初中生自杀意念与多因素有关,应加强对初中生群体的心理健康教育。     

Psychological crisis intervention for the family members of patients in a vegetative state

OBJECTIVES:

Family members of patients in a vegetative state have relatively high rates of anxiety and distress. It is important to recognize the problems faced by this population and apply psychological interventions to help them. This exploratory study describes the psychological stress experienced by family members of patients in a vegetative state. We discuss the effectiveness of a psychological crisis intervention directed at this population and offer suggestions for future clinical work.

METHODS:

A total of 107 family members of patients in a vegetative state were included in the study. The intervention included four steps: acquisition of facts about each family, sharing their first thoughts concerning the event, assessment of their emotional reactions and developing their coping abilities. The Symptom Check List-90 was used to evaluate the psychological distress of the participants at baseline and one month after the psychological intervention. Differences between the Symptom Check List-90 scores at the baseline and follow-up evaluations were analyzed.

RESULTS:

All participants in the study had significantly higher Symptom Check List-90 factor scores than the national norms at baseline. There were no significant differences between the intervention group and the control group at baseline. Most of the Symptom Check List-90 factor scores at the one-month follow-up evaluation were significantly lower than those at baseline for both groups; however, the intervention group improved significantly more than the control group on most subscales, including somatization, obsessive-compulsive behavior, depression, and anxiety.

CONCLUSION:

The results of this study indicate that the four-step intervention method effectively improves the mental health of the family members who received this treatment and lessens the psychological symptoms of somatization, obsessive-compulsive behavior, depression and anxiety.     

Care of patients with selected health problems in fundholding practices in Scotland in 1990 and 1992: needs, process and outcome.

BACKGROUND. At the time of the introduction of fundholding, a number of potential benefits and concerns about fundholding were debated. AIM. A study was undertaken to compare process and outcome of care in patients with different levels of physical, social and psychological need in 1990 and 1992 in six fundholding groups in Scotland. METHOD. Patients aged 16 years and over consulting with a range of marker conditions in 1990 and 1992 completed a pre-consultation health status questionnaire asking about physical, social and psychological problems, and a postconsultation satisfaction/enablement questionnaire asking about their ability to cope, and understand their illness. Main outcome measures were consultation length and satisfaction/enablement score. RESULTS. Of patients attending in the study period, 39% consulted for one or more marker condition. The proportion of patients reporting social problems rose between 1990 and 1992 for 11 out of 12 conditions. Overall, consultation lengths remained constant. Patients wanting to discuss social problems had significantly longer consultations than those reporting no social problems or problems they did not wish to discuss. The proportion of patients expressing enablement dropped for eight conditions and rose for four between 1990 and 1992. The decrease in the proportion expressing enablement remained after controlling for the rise in the percentage reporting social problems. Patients who had social problems they did not wish to discuss but a general health questionnaire score of five or more were the group reporting lowest enablement. Significantly more patients with pain, skin problems and digestive problems reported social problems and significantly fewer of them reported enablement in 1992 compared with 1990. Patients with diabetes, angina, chronic bronchitis and problems seeing fared relatively well over the study period. Some patients with psychosocial problems fared poorly (they had relatively short consultations and were unlikely to express an ability to cope/understand their illness). CONCLUSION. The issue of whether benefits to some patient groups from recent health service changes may be matched by disadvantage to other groups, for example those with clinical problems with no financial incentive to provide pro-active care or with psychosocial difficulties, is discussed.     

颅脑损伤患者家属心理健康状况及其影响因素分析

目的了解颅脑损伤患者家属的心理健康状况及其影响因素。方法对80名颅脑损伤患者家属采用症状自评量表（SCL-90）、艾森克个性问卷（EPQ）进行调查。结果颅脑损伤患者家属SCL-90总分及各因子分均明显高于国内常模,家属为女性、低龄、低文化程度不利于自身心理健康,而外向—稳定型人格类型有利于自身心理健康。结论颅脑损伤患者家属存在不同程度的心理问题,并受多种因素影响,应予以心理干预。     

高中毕业班学生高考压力与心理健康的关系

目的：了解高中毕业班学生高考压力与焦虑、睡眠质量及心理健康水平的关系。方法：采用《压力自评量尺》《中学生心理健康量表》《状态特质焦虑问卷》和《匹兹堡睡眠质量指数》对长沙市某中学130名高中三年级应考生进行自评问卷调查。结果：23．1％的学生存在不同程度的心理健康问题。56．9％的学生感到处于较高的压力状态，并且压力与学生的心理健康水平、状态一特质焦虑、匹兹堡睡眠指数显著相关，表现为睡眠质量更差，感受到的焦虑也更多。结论：高考压力高的学生心理健康问题更多。不论是为了考生更好地备考，还是为了提高学生的心理健康水平，教育者均应重视学生考试压力相关心理干预。     

童年创伤和虐待与成年精神障碍

目的:探索童年期创伤和虐待经历与成年精神障碍的关系。方法:采用自评童年虐待和创伤量表(CAT)和EPQ问卷,随机选择34位心理科门诊和住院病人为样本组和37位正常人为对照组施测,其中37人在两周后进行CAT重测。结果:EPQ的P维度与CAT总分及各分量表均显著相关(P<0.01),N维度与除性虐待外的其它分量表显著相关(P<0.05),E维度与CAT总分及负面环境、情感虐待呈显著负相关(P<0.05)。病人组在CAT总分和负面环境分上均显著高于正常组(P<0.05)。结论:童年期虐待和创伤经历与成年期罹患精神疾病密切相关,与成年后的人格发展也密切相关。