Kelly, Brendan D.
Kelly, Brendan D.
Kelly, Brendan D.
Now showing 1 - 10 of 17
- PublicationSocial capital and suicide in 11 European countries: an ecological analysisBackground: 'Social capital' refers to the existence of voluntary community networks and relationships based on trust, and the use of these networks and relationships to enable positive social action. Social capital is positively associated with selected indices of mental health. Methods: We performed an ecological investigation of the relationship between social trust (as one component of social capital) and national suicide rates in 11 European countries (n=22,227). Results: There was an inverse relationship between social trust and national suicide rates (i.e. the higher the social trust, the lower was the suicide rate), after controlling for gender, age, marriage rates, standardised income and reported sadness. Conclusions: Social capital may have a protective effect against suicide at the national level. Multi-level analysis, taking into account both group-level and individual-level variables, would help clarify this relationship further and guide appropriate interventions at both the group and individual levels.
813Scopus© Citations 72
- PublicationFactors associated with suicidal ideation in the general population : Five-centre analysis from the ODIN studyBackground: Very few studies have examined the cross-national prevalence of suicidal ideation in the general population or variables associated with it. Aims: To examine the risk factors for suicidal ideas in the general population. Method: As part of a five-country two stage epidemiological study of depressive disorder (the ODIN study) a random sample of over 12 000 people were screened using the Beck Depression Inventory (BDI). There followed detailed analysis of item 9 of the BDI, which measured the severity of suicidal ideation. Results: Age, marriage, concern by others and severity of depressed mood independently increased or decreased the odds of suicidal ideation overall. An interaction between life events and social supports was identified, although this differed between men and women. Only concern by others and severity of depression were independently associated with serious suicidal ideation. The study does not allow for interpretation of the direction of the association. Conclusions: A number of social, clinical and demographic variables were independently associated with all suicidal ideation and with serious suicidal ideation. Longitudinal studies are required to confirm whether these are risk factors for or the result of suicidal ideation or have some other relationship.
438Scopus© Citations 104
- PublicationThe prevalence of suicidal ideation in the general population: results from the Outcome of Depression International Network (ODIN) studyBackground: Suicidal ideation is believed to be part of a constellation of suicidal behaviours that culminates in suicide. There is little information on the cross-national prevalence of all suicidal ideation or of serious suicidal ideation in spite of its likely public health importance. Methods: A two-stage screening approach of over 12,000 adults from the general population were evaluated by face to face interview to identify those meeting ICD-10 criteria for depressive disorders at eight sites in five European countries. This study is a cross-sectional analysis of item 9 (suicidal ideation) of the Beck depression inventory from the total screened sample. Results: The standardised period prevalence for all suicidal ideation varied from 1.1 to 19.8% while for serious suicidal ideation there was much less variation. Examining the inter-relationships between all suicide ideation, serious suicide ideation, depressive disorders and suicide failed to support a seamless transition from suicide ideation through depression and serious ideation to suicide. Conclusions: Strategies to prevent suicide should be tailored to take account of site specific differences in its aetiology and understanding the path from suicidal ideation through depression to suicide is crucial to this.
927Scopus© Citations 77
- PublicationDistinguishing between adjustment disorder and depressive episode in clinical practice: The role of personality disorderBackground: There is significant symptomatic overlap between diagnostic criteria for adjustment disorder and depressive episode, commonly leading to diagnostic difficulty. Our aim was to clarify the role of personality in making this distinction. Methods: We performed detailed assessments of features of personality disorder, depressive symptoms, social function, social support, life-threatening experiences and diagnosis in individuals with clinical diagnoses of adjustment disorder (n=173) or depressive episode (n=175) presenting at consultation-liaison psychiatry services across 3 sites in Dublin, Ireland. Results: Fifty six per cent of participants with adjustment disorder had likely personality disorder compared with 65% of participants with depressive episode. Compared to participants with depressive episode, those with adjustment disorder had fewer depressive symptoms; fewer problems with social contacts or stress with spare time; and more life events. On multi-variable testing, a clinical diagnosis of adjustment disorder (as opposed to depressive episode) was associated with lower scores for personality disorder and depressive symptoms, and higher scores for life-threatening experiences. Limitations: We used clinical diagnosis as the main diagnostic classification and generalisability may be limited to consultation-liaison psychiatry settings. Conclusions: Despite a substantial rate of likely personality disorder in adjustment disorder, the rate was even higher in depressive episode. Moreover, features of likely personality disorder are more strongly associated with depressive episode than adjustment disorder, even when other distinguishing features (severity of depressive symptoms, life-threatening experiences) are taken into account.
Scopus© Citations 17 1333
- PublicationWhat do you think of us? Evaluating patient knowledge of and satisfaction with a psychiatric outpatient serviceAim: This study aimed to measure patient satisfaction with the care they were receiving; examine patients' knowledge of the psychiatric services in general; and identify variables associated with satisfaction. Methods: Patients attending the Mater Misericordiae University Hospital psychiatric outpatient clinics over a 13-week period, and the Mater Misericordiae University Hospital clozapine clinic over a 4-week period and were invited to complete the Barker Scale of Patients' Views Towards Care Received From Psychiatrists. Results: One-hundred and ninety-two patients were invited to participate and there was a response rate of 94%. Eighty-six percent of respondents were satisfied with their care; 92% stated psychiatrists were caring towards them; 85% that psychiatrists know what they are doing; 84% that their illness was explained by their psychiatrist; and 65% that psychiatric care is improving; but 65% stated that psychiatric services are still not good enough. Eighty-six percent were, or had been, in receipt of a psychological treatment. On multi-variable analysis, satisfaction was associated with the view that doctors explained treatment clearly, the view that doctors do not rely excessively on medication, and having been visited by a community mental health nurse. Conclusion: Patients attending psychiatry outpatient services reported a high degree of satisfaction with the treatment they were receiving, although there were discrepancies between satisfaction with their own specific service and with psychiatric services in general.
309Scopus© Citations 10
- PublicationApplications for fees waivers on medical and psychiatric grounds at an Irish third-level collegeBackground: Physical and mental illness present substantial challenges to college students and authorities. Aims: (1) To characterize medical and psychiatric reasons underlying requests for fees waivers at an Irish third-level college; (2) to identify information included in applications; and (3) to develop proposals for standardizing applications. Methods: We examined all applications for exemption from fees for medical or psychiatric reasons over two academic years at an Irish third-level college. Results: Two hundred and twenty-two students applied for exemptions; 91% were successful. Psychiatric problems were more common than physical illness (64.1 vs. 27.9%). There was wide variation in details provided in applications with few providing details on likely ongoing duration of illness (5.0%). Conclusions: We recommend that (a) a structured medical application form be completed by medical practitioners supporting applications; (b) a medical practitioner review applications; and (c) there should be annual re-audit of this process.
- PublicationWhat do you think of us? Evaluating patient knowledge of and satisfaction with a psychiatric outpatient service.Aim: This study aimed to measure patient satisfaction with the care they were receiving; examine patients' knowledge of the psychiatric services in general; and identify variables associated with satisfaction. Methods: Patients attending the Mater Misericordiae University Hospital psychiatric outpatient clinics over a 13-week period, and the Mater Misericordiae University Hospital clozapine clinic over a 4-week period and were invited to complete the Barker Scale of Patients' Views Towards Care Received From Psychiatrists. Results: One-hundred and ninety-two patients were invited to participate and there was a response rate of 94%. Eighty-six percent of respondents were satisfied with their care; 92% stated psychiatrists were caring towards them; 85% that psychiatrists know what they are doing; 84% that their illness was explained by their psychiatrist; and 65% that psychiatric care is improving; but 65% stated that psychiatric services are still not good enough. Eighty-six percent were, or had been, in receipt of a psychological treatment. On multi-variable analysis, satisfaction was associated with the view that doctors explained treatment clearly, the view that doctors do not rely excessively on medication, and having been visited by a community mental health nurse. Conclusion: Patients attending psychiatry outpatient services reported a high degree of satisfaction with the treatment they were receiving, although there were discrepancies between satisfaction with their own specific service and with psychiatric services in general.
Scopus© Citations 10 451
- PublicationCan adjustment disorders and depressive episodes be distinguished? Results from ODINBackground: No large-scale epidemiological study has included adjustment disorders (AD) for consideration yet it is considered to be a common psychiatric diagnosis. Methods:Using a two stage screening method, those above a threshold score for possible caseness on the Beck Depression Inventory (BDI), were interviewed using SCAN to identify those with depressive episode and AD. Variables that might distinguish AD from depressive episode were examined. Results:The prevalence of AD was extremely low with one centre having no cases. Finland, the country with the highest prevalence, only achieved a frequency of 0.8% and 1%, respectively, for urban and rural sites. Logistic regression failed to identify any variables that independently differentiated AD from depressive episode. Findings relating to severity of symptoms using BDI were robust. Limitations: The small sample size might have contributed to a failure to identify distinguishing features between AD and other disorders. Conclusions:Reasons for the failure of even robust results, such as BDI severity, to distinguish AD from depressive episode are considered of which problems in conceptualising AD are the most likely. Further studies are required.
Scopus© Citations 89 714
- PublicationThe Role of a Neuropsychiatry Clinic in a Tertiary Referral Teaching Hospital: A Two-Year StudyObjectives: Mental disorder is common among individuals with neurological illness. We aimed to characterise the patient population referred for psychiatry assessment at a tertiary neurology service in terms of neurological and psychiatric diagnoses and interventions provided. Methods: We studied all individuals referred for psychiatry assessment at a tertiary neurology service over a 2-year period (n= 82). Results: The most common neurological diagnoses among those referred were epilepsy (16%), Parkinson’s disease (15%) and multiple sclerosis (8%). The most common reasons for psychiatric assessment were low mood or anxiety (48%) and medically unexplained symptoms or apparent functional or psychogenic disease (21%). The most common diagnoses among those with mental disorder were mood disorders (62%), and neurotic, stress-related and somatoform disorders, including dissociative (conversion) disorders (28%). Psychiatric diagnosis was not related to gender, neurological diagnosis or psychiatric history. Conclusion: Individuals with neurological illness demonstrate significant symptoms of a range of mental disorders. There is a need for further research into the characteristics and distribution of mental disorder in individuals with neurological illness, and for the enhancement of integrated psychiatric and neurological services to address the comorbidities demonstrated in this population.
- PublicationMental health professionals and information sharing: carer perspectivesBackground: The important role played by carers of those with mental health problems is frequently undervalued among healthcare professionals. Aims: To identify the difficulties encountered by carers in relation to obtaining information from mental health teams. Methods: Participants in the study included carers or family members of persons with mental illness who were affiliated with a support group in Ireland. Information was gathered using an 18-item self-report questionnaire. This is an amended version of the Carer Well-Being and Support Questionnaire for carers of people with a mental health problem or dementia. Results: One-hundred and fifty-nine carers complete the questionnaire. On average respondents stated that they have been in the role of a carer for someone with a mental health problem for 14.4 years, spending a median of 20-h caring each week. Despite most carers maintaining that they are generally satisfied with the support offered to them from medical and/or care staff, the majority (56.3 %) of respondents stated that they have specifically encountered difficulties accessing information from the treating mental health team. The main reasons given to them by the mental health team for withholding information include: lack of patient consent (46.2 %) and unavailability of a team member (46.2 %). From a carer perspective, respondents stated that the main reason they feel there is difficulty in accessing information is a lack of concern for their role as a carer in the patient's management (60.5 %). More than 75 % of all respondents are afraid of negative consequences for them or for the person in their care as a result of information being withheld by the treating team. Conclusions: Carer involvement is essential for the complete and effective management of individuals with mental illness. Confidentiality should not be used as a reason for completely excluding carers.
Scopus© Citations 9 1092