A brother’s mourning clothes: I wanted a uniform of grief

My sister was the one to care about clothes. After she died, I began to notice how little we do to signal our grief

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Mental health nurse: ‘it’s all about the relationship with our patients’

A nurse consultant at East London NHS foundation trust explains what it’s like to work in a psychiatry team

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Baseline Depression Severity and CBT vs Pharmacotherapy Outcomes – Meta-Analysis

Importance  Current guidelines recommend treating severe depression with pharmacotherapy. Randomized clinical trials as well as traditional meta-analyses have considerable limitations in testing for moderators of treatment outcomes.  Objectives  To conduct a systematic literature search, collect primary data from trials, and analyze baseline depression severity as a moderator of treatment outcomes between cognitive behavioral therapy (CBT) and antidepressant medication (ADM).Data Sources  A total of 14 902 abstracts were examined from a comprehensive literature search in PubMed, PsycINFO, EMBASE, and Cochrane Registry of Controlled Trials from 1966 to January 1, 2014.  Study Selection  Randomized clinical trials in which CBT and ADM were compared in patients with a DSM-defined depressive disorder were included. Data Extraction and Synthesis  Study authors were asked to provide primary data from their trial. Primary data from 16 of 24 identified trials (67%), with 1700 outpatients (794 from the CBT condition and 906 from the ADM condition), were included. Missing data were imputed with multiple imputation methods. Mixed-effects models adjusting for study-level differences were used to examine baseline depression severity as a moderator of treatment outcomes.  Main Outcomes and Measures  Seventeen-item Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI).  Results  There was a main effect of ADM over CBT on the HAM-D (β = −0.88; P = .03) and a nonsignificant trend on the BDI (β = −1.14; P = .08, statistical test for trend), but no significant differences in response (odds ratio [OR], 1.24; P = .12) or remission (OR, 1.18; P = .22). Mixed-effects models using the HAM-D indicated that baseline depression severity does not moderate reductions in depressive symptoms between CBT and ADM at outcome (β = 0.00; P = .96). Similar results were seen using the BDI. Baseline depression severity also did not moderate the likelihood of response (OR, 0.99; P = .77) or remission (OR, 1.00; P = .93) between CBT and ADM.  Conclusions and Relevance  Baseline depression severity did not moderate differences between CBT and ADM on the HAM-D or BDI or in response or remission. This finding cannot be extrapolated to other psychotherapies, to individual ADMs, or to inpatients. However, it offers new and substantial evidence that is of relevance to researchers, physicians and therapists, and patients.

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Stressed and exhausted: spot the signs of burnout before it hits you

Burnout is often described as ‘overachiever syndrome’. It costs businesses and individuals millions of pounds a year. More importantly, it costs lives

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Many military veterans’ PTSD claims ‘fabricated or exaggerated’

Former top military psychiatrist says 42% of cases had no firm link to military service, diverting resources from genuine needs

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Thousands have been abused by Isis and their mental health is shattered

With so many sources of trauma, complex post traumatic stress disorder is on the rise among those living in the refugee camps of northern Iraq

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‘A stranger stopped me killing myself. Now I want to bring hope to others’

Jonny Benjamin, who started the Find Mike campaign, is spreading awareness of mental illness by using videos to reach young people and sharing positive stories

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