Publication Bias, With a Focus on Psychiatry: Causes and Solutions.
Publication Bias, with a Focus on Psychiatry: Causes and Solutions.
CNS Drugs. 2013 May 22;
Turner EH
Publication bias undermines the integrity of the evidence base by inflating apparent drug efficacy and minimizing drug harms, thus skewing the risk-benefit ratio. This paper reviews the topic of publication bias with a focus on drugs prescribed for psychiatric conditions, especially depression, schizophrenia, bipolar disorder, and autism. Publication bias is pervasive; although psychiatry/psychology may be the most seriously afflicted field, it occurs throughout medicine and science. Responsibility lies with various parties (authors as well as journals, academia as well as industry), so the motives appear to extend beyond the financial interests of drug companies. The desire for success, in combination with cognitive biases, can also influence academic authors and journals. Amid the flood of new medical information coming out each day, the attention of the news media and academic community is more likely to be captured by studies whose results are positive or newsworthy. In the peer review system, a fundamental flaw arises from the fact that authors usually write manuscripts after they know the results. This allows hindsight and other biases to come into play, so data can be “tortured until they confess” (a detailed example is given). If a “publishable” result cannot be achieved, non-publication remains an option. To address publication bias, various measures have been undertaken, including registries of clinical trials. Drug regulatory agencies can provide valuable unpublished data. It is suggested that journals borrow from the FDA review model. Because the significance of study results biases reviewers, results should be excluded from review until after a preliminary judgment of study scientific quality has been rendered, based on the original study protocol. Protocol publication can further enhance the credibility of the published literature. HubMed – depression
Sixteen per cent of mothers who present their young infants to the emergency department with non-time-critical conditions screen positive for postnatal depression.
Evid Based Nurs. 2013 May 21;
McMahon C
Adherence and Persistence with Prasugrel Following Acute Coronary Syndrome with Percutaneous Coronary Intervention.
Am J Cardiovasc Drugs. 2013 May 22;
Nordstrom BL, Simeone JC, Zhao Z, Molife C, McCollam PL, Ye X, Effron MB
PURPOSE: To measure the adherence and persistence of patients with acute coronary syndrome (ACS) initiating prasugrel after percutaneous coronary intervention (PCI). METHODS: Using the Thomson Reuters MarketScan Commercial and Medicare Supplemental database, a retrospective cohort study identified patients initiating prasugrel following ACS-PCI hospitalization in 2009-2011. Prasugrel adherence over 12 months was measured using the medication possession ratio (MPR); predictors of adherence were identified using a logistic regression model. Persistence was defined as time on continuous therapy; a Cox model identified predictors of prasugrel discontinuation. RESULTS: Among 1,340 patients, the mean age was 57 years; 79.5 % were male. Median prasugrel MPR was 93.2 %; 69.0 % of patients had an MPR ?80 %. Predictors of adherence <80 % included prior PCI [odds ratio (OR) 0.60; 95 % confidence interval (CI) 0.40-0.90], prior depression (OR 0.37; 95 % CI 0.16-0.84), prior bleeding (OR 0.41; 95 % CI 0.19-0.86), and baseline anticoagulant use (OR 0.13; 95 % CI 0.03-0.55). Baseline statin use predicted higher adherence (OR 1.56; 95 % CI 1.21-2.02). The median duration of prasugrel therapy was 259 days. Predictors of discontinuation included prior anemia [hazard ratio (HR) 1.63; 95 % CI 1.21-2.21], prior cardiomyopathy (HR 2.72; 95 % CI 1.44-5.13), and prior ischemic heart disease (HR 1.15; 95 % CI 1.00-1.32); baseline statin use predicted reduced risk of discontinuation (HR 0.85; 95 % CI 0.75-0.97). CONCLUSIONS: Although adherence to prasugrel was generally high, the duration of therapy was frequently below recommendations. An awareness of risk factors for low adherence or early discontinuation can point to appropriate targets for intervention. HubMed – depression
SELF-ATTRIBUTED SEASONALITY OF MOOD AND BEHAVIOR: A REPORT FROM THE NETHERLANDS STUDY OF DEPRESSION AND ANXIETY.
Depress Anxiety. 2013 May 21;
Winthorst WH, Roest AM, Bos EH, Meesters Y, Penninx BW, Nolen WA, de Jonge P
BACKGROUND: Seasonal changes in mood and behavior are considered to be common in the general population and in patients with psychiatric disorders. However, in several studies this seasonality could not be demonstrated. The present study examined self-attributed seasonality of depressive symptoms among patients with a lifetime diagnosis of a depressive disorder (D), an anxiety disorder (A), a comorbid depressive and anxiety disorder (DA), and healthy controls (HC). METHODS: The CIDI was used to establish diagnoses according to DSM-IV criteria in 2,168 participants of the Netherlands Study of Depression and Anxiety (NESDA). The Seasonal Pattern Assessment Questionnaire (SPAQ) was administered to assess variation in mood and behavior. RESULTS: Of the 2,168 participants 53.5% reported seasonality of mood. Highest percentages of low mood were seen in the winter months. Although all groups showed this pattern of lowered mood during the winter months, D, A, and DA were significantly (P < .001) more likely to experience seasonality is this respect. This was also shown for seasonal changes in energy, social activities, sleeping, eating, weight and for the Global Seasonality Score. A limitation of this study was the cross-sectional design. CONCLUSIONS: Seasonal variation in mood and behavior was demonstrated for both participants with a lifetime diagnosis of depression and/or anxiety disorder and for healthy controls, but patients with anxiety and/or depression were more likely to experience this seasonal variation. Clinicians should take into account that the time of the year could influence the feelings of well- and ill-being of their patients. HubMed – depression
‘Aging well’ in de 21e eeuw: een psychosociaal perspectief.
Tijdschr Gerontol Geriatr. 2013 May 22;
Stevens NL
‘AGING WELL’ IN THE 21TH CENTURY: A PSYCHOSOCIAL PERSPECTIVE: Aging well refers to retaining or restoring well-being in the face of various age-related changes in later life. This process is influenced by the quality of social relationships and active adaptation to loss and change. According to recent studies from the Longitudinal Aging Study Amsterdam, more older adults are maintaining relationships with friends, colleagues and other non-kin longer. Greater diversity in their social networks contributes to happiness and morale, and provides protection against anxiety, depression and loneliness. There is also a slight increase in mastery and in cognitive functioning among new cohorts of older adults. These developments promote adaptation to declines in health and loss of the partner. These improvements are found less frequently among those with lower education, lower incomes, and/or small networks. Several interventions have proven to be effective for these disadvantaged groups: a visiting service for widows and widowers and two self-management interventions for chronically ill or physically vulnerable older adults. HubMed – depression