M. Maxwell | University of Stirling (original) (raw)

Papers by M. Maxwell

International Journal of Social Psychiatry, 2010

Background: Community facilitators (CFs), such as pharmacists, policemen, teachers and clergy, ma... more Background: Community facilitators (CFs), such as pharmacists, policemen, teachers and clergy, may be an important community resource for patients with depression in addition to (mental) health professionals. However, they are ill prepared for such a role and little is known about their attitudes toward depression, which may affect practice. Aim: To investigate CFs’ attitudes toward depression and compare them to those of (mental) health professionals and nurses. Method: Attitudes were assessed in participants ( n = 2,670) of training programmes about depression in nine countries of the European Alliance Against Depression (EAAD). The EAAD questionnaire included attitudes toward depression and its treatment, perceived causes, preferred treatment options, and knowledge of depression symptoms. Results: CFs and nurses had a more negative attitude toward patients with depression and toward antidepressants, and more limited knowledge of depression symptoms than (mental) health profession...

Evidence-Based Mental Health, 2013

ED FROM Almeida OP, Pirkis J, Kerse N, Sim M, et al. A randomized trial to reduce the prevalence ... more ED FROM Almeida OP, Pirkis J, Kerse N, Sim M, et al. A randomized trial to reduce the prevalence of depression and self-harm behavior in older primary care patients. Ann Fam Med 2012;10:347–56. Correspondence to: Osvalso P Almeida, WA Centre for Health & Ageing (M573), University of Western Australia, 35 Stirling highway, Crawley, Perth, WA 6009, Australia; osvalso.almeida@uwa.edu.au Sources of funding The National Health and Medical Research Council of Australia (NHMRC) and beyondblue Australia. CO M M EN TA RY Previous attempts to reduce the prevalence of depression have focused on improving its detection and management in primary care. The evidence supports complex interventions that include case management or collaborative care models which are not achievable or sustainable in many countries. This study reports on a trial of an educational intervention for GPs that aimed to reduce the 2-year prevalence of depression and self-harm behaviour among their older patients via a simple and sustainable intervention using educational materials and a practice audit with individualised feedback. Like the majority of educational interventions for depression aimed at professionals, this study showed no impact on medium-term to long-term outcomes for patients, no impact on the management of depression by GPs and no decrease in the prevalence of depression or self-harm behaviour. It did show a modest effect on the prevalence of a composite measure of depression and self-harm behaviour. Older adults in the intervention group were less likely to display self-harm behaviour than controls but this was not associated with better treatment of depression. The authors hypothesise that education about depression may improve the attitudes of physicians toward mental health issues and increase their empathy and willingness to discuss emotional concerns, which may play an important role in reducing self-harm ideation. The association between empathy and therapeutic benefit is well known, therefore improving physician communication and empathy may be a better focus for education than screening and management of depression. It is also time to think beyond educational interventions that focus on improving physician responses once patients have reached the screening threshold. This calls for health promotion interventions at an earlier stage: knowing and identifying the risk factors and trying to do something about them. Increasing opportunities to discuss emotional concerns and increase social interaction might be a better entry point for reducing depression and self-harm in older adults. Such interventions could be delivered within many existing community-based projects and alongside primary care—perhaps a focus on preventative interventions at this level might yield more positive results.

European Journal of General Practice, 2008

Antidepressant prescribing has dramatically increased in Scotland, and the cause is unknown. To i... more Antidepressant prescribing has dramatically increased in Scotland, and the cause is unknown. To investigate if the increase in antidepressant prescribing coincided with a reduction in prescribing of anxiolytics and hypnotics; to investigate this relationship at practice level; and to explore whether general practitioners (GPs) explain the increase by their increased use for anxiety. analysis of routine prescribing data and interviews with GPs. Scottish general practices. 942 practices included in the analysis. Sixty-three GPs in 30 practices completed interviews. Quantity of antidepressants, anxiolytics, and hypnotics prescribed. Relationship at practice level between anxiolytic/hypnotic and antidepressant prescribing. Spontaneous comments by GPs about prescribing antidepressants for anxiety. Antidepressant prescribing increased from 28.9 million defined daily doses (DDDs) in 1992/3 to 128.3 million in 2004/5. Anxiolytic/hypnotic prescribing fell from 64.2 million to 55.1 million DDDs. There was a weak, positive correlation between levels of antidepressant and anxiolytic/hypnotic prescribing (+0.084, p=0.010). GPs treated anxiety with antidepressants, although many described an overlap between anxiety and depression. Some spontaneously identified a relationship with benzodiazepine prescribing when asked to explain the increase in antidepressant prescribing. A small part of the increase in antidepressant prescribing is due to substitution for benzodiazepines to treat anxiety.

BMJ, 1991

Objective-To examine whether the observed excess of childhood leukaemia and non-Hodgkin's lymphom... more Objective-To examine whether the observed excess of childhood leukaemia and non-Hodgkin's lymphoma in the area around the Dounreay nuclear installation is associated with established risk factors, or with factors related to the plant, or with parental occupation in the nuclear industry. Design-Case-control study. Setting-Caithness local government district. Subjects-14 cases of leukaemia and non-Hodgkin's lymphoma occurring in children aged under 15 years diagnosed in the area between 1970 and 1986 and 55 controls matched for sex, date of birth, and area of residence within Caithness at time of birth. Main outcome measures-Antenatal abdominal x ray examination; drugs taken and viral infections during pregnancy; father's occupation; father's employment at Dounreay and radiation dose; distance of usual residence from the path of microwave beams, preconceptional exposure to non-ionising radiation in the father; and other lifestyle factors. Results-No raised relative risks were found for prenatal exposure to x rays, social class of parents, employment at Dounreay before conception or diagnosis, father's dose of ionising radiation before conception, or child's residence within 50 m of the path of microwave transmission beams. Results also proved negative for all lifestyle factors except an apparent association with use of beaches within 25 km of Dounreay. However, this result was based on small numbers, arose in the context of multiple hypothesis testing, and is certainly vulnerable to possible systematic bias. Conclusion-The raised incidence of childhood leukaemia and non-Hodgkin's lymphoma around Dounreay cannot be explained by paternal occupation at Dounreay or by paternal exposure to external ionising radiation before conception. The observation of an apparent association between the use of beaches around Dounreay and the development of childhood leukaemia and non-Hodgkin's lymphoma might be an artefact ofmultiple testing and influenced by recall bias.

BMC Public Health, 2013

Background: Variation in the implementation of complex multilevel interventions can impact on the... more Background: Variation in the implementation of complex multilevel interventions can impact on their delivery and outcomes. Few suicide prevention interventions, especially multilevel interventions, have included evaluation of both the process of implementation as well as outcomes. Such evaluation is essential for the replication of interventions, for interpreting and understanding outcomes, and for improving implementation science. This paper reports on a process evaluation of the early implementation stage of an optimised suicide prevention programme (OSPI-Europe) implemented in four European countries. Methods: The process analysis was conducted within the framework of a realist evaluation methodology, and involved case studies of the process of implementation in four European countries. Datasets include: repeated questionnaires to track progress of implementation including delivery of individual activities and their intensity; serial interviews and focus groups with stakeholder groups; and detailed observations at OSPI implementation team meetings. Results: Analysis of local contexts in each of the four countries revealed that the advisory group was a key mechanism that had a substantial impact on the ease of implementation of OSPI interventions, particularly on their ability to recruit to training interventions. However, simply recruiting representatives of key organisations into an advisory group is not sufficient to achieve impact on the delivery of interventions. In order to maximise the potential of high level 'gatekeepers', it is necessary to first transform them into OSPI stakeholders. Motivations for OSPI participation as a stakeholder included: personal affinity with the shared goals and target groups within OSPI; the complementary and participatory nature of OSPI that adds value to pre-existing suicide prevention initiatives; and reciprocal reward for participants through access to the extended network capacity that organisations could accrue for themselves and their organisations from participation in OSPI. Conclusions: Exploring the role of advisory groups and the meaning of participation for these participants revealed some key areas for best practice in implementation: careful planning of the composition of the advisory group to access target groups; the importance of establishing common goals; the importance of acknowledging and complementing existing experience and activity; and facilitating an equivalence of benefit from network participation.

BMJ, 1994

Objective-To compare quality of care between 1990 and 1992 in patients with self diagnosed joint ... more Objective-To compare quality of care between 1990 and 1992 in patients with self diagnosed joint pain. Design-Questionnaire and record based study. Subjects-Patients identified at consecutive consultations during two weeks in 1990, 1991, and 1992. Setting-Six practice groups in pilot fundholding scheme in Scotland. Main outcome measures-Length of consultation; numbers referred or investigated or prescribed drugs; responses to questions about enablement and satisfaction. Results-About 15% of patients consulted with joint pain each year. 25% (316) of them had social problems in 1990 and 37% (370) in 1992; about a fifth wanted to discuss their social problems. Social problems were associated with a raised general health questionnaire score. The mean length of consultation for patients with pain was 7*6 min in 1990 and 7-7 min in 1992. Patients wishing to discuss social problems received longer consultations (8.5 min 1990; 10-4 min 1992); but other patients with social problems received shorter consultations (7.4 min; 7-2 min). The level of prescribing was stable but the proportion of patients having investigations or attending hospital fell significantly from 1990 to 1992 (31% to 24%/; 31% to 13% respectively). Fewer patients responded "much better" to six questions about enablement in 1992 than in 1990. Enablement was better after longer than shorter consultations for patients with social problems. Conclusions-Quality of care for patients with pain has been broadly maintained in terms of consultation times. The effects of lower rates of investigation and referral need to be investigated firther.

BMC Medical Research Methodology, 2014

Background: Syntheses of qualitative studies can inform health policy, services and our understan... more Background: Syntheses of qualitative studies can inform health policy, services and our understanding of patient experience. Meta-ethnography is a systematic seven-phase interpretive qualitative synthesis approach well-suited to producing new theories and conceptual models. However, there are concerns about the quality of meta-ethnography reporting, particularly the analysis and synthesis processes. Our aim was to investigate the application and reporting of methods in recent meta-ethnography journal papers, focusing on the analysis and synthesis process and output. Methods: Methodological systematic review of health-related meta-ethnography journal papers published from 2012-2013. We searched six electronic databases, Google Scholar and Zetoc for papers using key terms including 'meta-ethnography.' Two authors independently screened papers by title and abstract with 100% agreement. We identified 32 relevant papers. Three authors independently extracted data and all authors analysed the application and reporting of methods using content analysis. Results: Meta-ethnography was applied in diverse ways, sometimes inappropriately. In 13% of papers the approach did not suit the research aim. In 66% of papers reviewers did not follow the principles of meta-ethnography. The analytical and synthesis processes were poorly reported overall. In only 31% of papers reviewers clearly described how they analysed conceptual data from primary studies (phase 5, 'translation' of studies) and in only one paper (3%) reviewers explicitly described how they conducted the analytic synthesis process (phase 6). In 38% of papers we could not ascertain if reviewers had achieved any new interpretation of primary studies. In over 30% of papers seminal methodological texts which could have informed methods were not cited. Conclusions: We believe this is the first in-depth methodological systematic review of meta-ethnography conduct and reporting. Meta-ethnography is an evolving approach. Current reporting of methods, analysis and synthesis lacks clarity and comprehensiveness. This is a major barrier to use of meta-ethnography findings that could contribute significantly to the evidence base because it makes judging their rigour and credibility difficult. To realise the high potential value of meta-ethnography for enhancing health care and understanding patient experience requires reporting that clearly conveys the methodology, analysis and findings. Tailored meta-ethnography reporting guidelines, developed through expert consensus, could improve reporting.

Journal of Occupational and Environmental Medicine, 2012

Contributorship Will Whittaker conducted the analyses and wrote the report on which this paper is... more Contributorship Will Whittaker conducted the analyses and wrote the report on which this paper is based. He was involved in discussions about the design of the study and interpretation of the findings. He revised the article and gave final approval of the version to be published.

The British Journal of Psychiatry, 2014

Background Studies have rarely explored suicides completed following discharge from both general ... more Background Studies have rarely explored suicides completed following discharge from both general and psychiatric hospital settings. Such research might identify additional opportunities for intervention. Aims To identify and summarise Scottish psychiatric and general hospital records for individuals who have died by suicide. Method A linked data study of deaths by suicide, aged ⩾15 years from 1981 to 2010. Results This study reports on a UK data-set of individuals who died by suicide (n = 16 411), of whom 66% (n = 10 907) had linkable previous hospital records. Those who died by suicide were 3.1 times more frequently last discharged from general than from psychiatric hospitals; 24% of deaths occurred within 3 months of hospital discharge (58% of these from a general hospital). Only 14% of those discharged from a general hospital had a recorded psychiatric diagnosis at last visit; an additional 19% were found to have a previous lifetime psychiatric diagnosis. Median time between last...

BMJ, 1999

Objectives To measure quality of care at general practice consultations in diverse geographical a... more Objectives To measure quality of care at general practice consultations in diverse geographical areas, and to determine the principal correlates associated with enablement as an outcome measure. Design Cross sectional multipractice questionnaire based study. Setting Random sample of practices in four participating regions: Lothian, Coventry, Oxfordshire, and west London. Participants 25 994 adults attending 53 practices over two weeks in March and April 1998. Main outcome measures Patient enablement, duration of consultation, how well patients know their doctor, and the size of the practice list. Results A hierarchy of needs or reasons for consultation was created. Similar overall enablement scores were achieved for most casemix presentations (mean 3.1, 95% confidence interval 3.1 to 3.1). Mean duration of consultation for all patients was 8.0 minutes (8.0 to 8.1); however, duration of consultation increased for patients with psychological problems or where psychological and social problems coexisted (mean 9.1, 9.0 to 9.2). The 2195 patients who spoke languages other than English at home were analysed separately as they had generally higher enablement scores (mean 4.5, 4.3 to 4.7) than those patients who spoke English only despite having shorter consultations (mean 7.1 (6.9 to 7.3) minutes. At individual consultations, enablement score was most closely correlated with duration of consultation and knowing the doctor well. Individual doctors had a wide range of mean enablement scores (1.1-5.3) and mean durations of consultation (3.8-14.4 minutes). Doctors' ability to enable was linked to the duration of their consultation and the percentage of their patients who knew them well and was inversely related to the size of their practice. At practice level, mean enablement scores ranged from 2.3 to 4.4, and duration of consultation ranged from 4.9 to 12.2 minutes. Correlations between ranks at practice level were not significant. Conclusions It may be time to reward doctors who have longer consultations, provide greater continuity of care, and both enable more patients and enable patients more.

BMJ, 1993

Objective-To compare prescribing patterns between a group of fundholding practices and a group of... more Objective-To compare prescribing patterns between a group of fundholding practices and a group of non-fundholding practices in north east Scotland using a method which provides more accurate statements about volumes prescribed than standard NHS statistics. Design-The pharmacy practice division of the National Health Service in Scotland provided data for selected British National Formulary sections over two years. Each prescription issued was converted using the World Health Organisation "defined daily dose" mechanism. Setting-Six fundholding groups (nine practices) in Grampian and Tayside regions and six nonfundholding practices in Grampian. Results-During the past two years both fundholding and control practices reduced the volume of their prescribing for the classes of drug analysed. The unit costs of drugs in some classes, however, rose substantially, contributing to higher costs per patient. The unit costs rose more in the control practices (24%) than in the fundholding practices (I11% in Tayside, 16% in Grampian). Conclusion-The use of defined daily doses helped identify cost and volume trends in specific areas of prescribing in fundholding and control practices. The basis on which funds are set needs improving, and defined daily doses may prove useful for setting volume targets within drug classes for all practices, whether fundholding or not.

BMJ, 2010

Objectives To examine whether there was significant variation in levels of claiming incapacity be... more Objectives To examine whether there was significant variation in levels of claiming incapacity benefit across general practices. To establish whether it is possible to identify people with mental health problems who are more at risk of becoming dependent on state benefits for long term health problems based on their general practice consulting behaviour.

BMC Family Practice, 2012

Background: Depression is frequently cited as the reason for sickness absence, and it is estimate... more Background: Depression is frequently cited as the reason for sickness absence, and it is estimated that sickness certificates are issued in one third of consultations for depression. Previous research has considered GP views of sickness certification but not specifically in relation to depression. This study aimed to explore GPs views of sickness certification in relation to depression. Methods: A purposive sample of GP practices across Scotland was selected to reflect variations in levels of incapacity claimants and antidepressant prescribing. Qualitative interviews were carried out between 2008 and 2009. Results: A total of 30 GPs were interviewed. A number of common themes emerged including the perceived importance of GP advocacy on behalf of their patients, the tensions between stakeholders involved in the sickness certification system, the need to respond flexibly to patients who present with depression and the therapeutic nature of time away from work as well as the benefits of work. GPs reported that most patients with depression returned to work after a short period of absence and that it was often difficult to predict which patients would struggle to return to work. Conclusions: GPs reported that dealing with sickness certification and depression presents distinct challenges. Sickness certificates are often viewed as powerful interventions, the effectiveness of time away from work for those with depression should be subject to robust enquiry.

The British Journal of …, 2009

As part of an investigation into the reasons for the rise and variation in the prescribing of ant... more As part of an investigation into the reasons for the rise and variation in the prescribing of antidepressants, this study aimed to describe, and account for, the variation in an agesex standardised rate of antidepressant prescribing between general practices. ... Cross-sectional study ...