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Background: the workload health and social care service users and caregivers take on, and their capacity to do this work is important. It may play a key part in shaping the implementation of innovations in health service delivery and organisation; the utilisation and satisfaction with services; and the outcomes of care. Previous research has often focused on experiences of a narrow range of long-term conditions, and on factors that shape adherence to self-care regimes. Aims: with the aim of deriving policy and practice implications for service redesign, this evidence synthesis will extend our understanding of service user and caregiver workload and capacity by comparing how they are revealed in qualitative studies of lived experience of three kinds of illness trajectories: long-term conditions associated with significant disability (Parkinson’s disease, schizophrenia); serious relapsing remitting disease (Inflammatory Bowel Disease, bipolar disorder); and rapidly progressing acute disease (brain cancer, early onset dementia). Methods: we will review and synthesise qualitative studies of lived experience of participation in health and social care that are shaped by interactions between experienced treatment burdens, social inequalities and illness trajectories. The review will involve: Construction of a theory-informed coding manual; systematic search of bibliographic databases to identify, screen and quality assess full-text papers. Analysis of papers using manual coding techniques, and text mining software; construction of taxonomies of service user and caregiver work and capacity. Designing a model of core components and identifying common factors across conditions, trajectories, and contexts. Work with practitioners, and a Patient and Public Involvement (PPI) group, to explore the validity of the models produced; to develop workload reduction strategies; and to consider person-centred service design. Dissemination: we will promote workload reduction models to support service users and caregivers and produce policy briefs and peer-reviewed publications for practitioners, policy-makers, and researchers.

BackgroundSelf-harm and eating disorders share multiple risk factors, with onset typically occurring during adolescence or early adulthood. We examined incidence rates among young people in the UK in the two years following the onset of the COVID-19 pandemic. MethodsWe conducted a population-based investigation of the primary care electronic health records of patients aged 10-24 years in the UK Clinical Practice Research Datalink (CPRD). Monthly incidence rates of eating disorders and self-harm, January 2010 through March 2022, were calculated. Based on antecedent trends, negative binomial regression models were fitted to predict rates after the pandemic began in March 2020. Percentage differences between observed and predicted rates were calculated to indicate changes following the onset of the pandemic. FindingsSubstantial increases in incidence of both outcomes were observed among young females since the onset of the pandemic. Incidence of eating disorder during the pandemic was 42·3% (95% CI 25·6-61·2%) higher than expected for females aged 13-16, and 32·0% (95% CI 13·3-53·7%) higher for those aged 17-19. Similarly, the increase in self-harm incidence was driven by females aged 13-16, with the number of episodes being 38·3% (95% CI 20·7-58·5%) greater than expected. In contrast, incidence for both outcomes in males remained below or close to expected levels. The increases in incidence for both outcomes were attributable to larger rises in less deprived communities. InterpretationAlthough causes are uncertain, higher frequencies of eating disorder diagnoses and self-harm episodes among teenage females during the first two years of the pandemic highlights an urgent need for intervention. Early identification of mental health difficulties by primary care clinicians is necessary. Timely access to treatments and sufficient support from GPs and mental health services needs to be available to manage presenting problems and to prevent exacerbations of conditions.

The increase in older adult populations globally requires long term plans to meet their needs and for building tailored health management plans. Lack of understanding their social, emotional and physical needs may challenge the health care systems in building efficient intervention plans, resulted in higher costs and burden to the system. In England, for example, health and social care for adults aged 65 years and over accounts for ~70% of the NHS spend annually and is projected to rise [1-3]. Many older adults, especially from lower socioeconomic status [4] live with multimorbidity, also known as multiple long-term conditions (LTCs) [2,3]. These can include both physical and mental health problems [3], that lead to poor quality of life, especially when their health and social care are not supported. Several factors such as socio-economic disadvantage, stigma, and lower education level, have been associated with older adults’ feelings of lower self-confidence, poorer outcomes and less benefit from health service provisions [5,6]. Low self-confidence can result in feelings of shame and guilt. These are both self-conscious emotions that involve some degree of self-evaluation and self-reflection that engender feelings of psychological discomfort. Sometimes when an older adult feels shame and guilt, they may hesitate to ask for help, because they perceive themselves to be a burden. Self- perceived burden is defined as "empathic concern engendered from the impact on others of one’s illness and care needs, resulting in guilt, distress, feelings of responsibility and diminished sense of self" [7]. This scoping review aims to map what past studies reported and map evidence from existing studies on feelings of guilt, shame and burden among older adults with multiple LTCs, and explore gaps that could be covered in future research.

Polypharmacy is increasingly common, and is associated with undesirable consequences. Polypharmacy management necessitates balancing therapeutic benefits and risks, and varying clinical and patient priorities. Current guidance for managing polypharmacy is not supported by high quality evidence. The aim of the Improving Medicines use in People with Polypharmacy in Primary Care (IMPPP) trial is to evaluate the effectiveness of an intervention to optimise medication use for patients with polypharmacy in a general practice setting.

Introduction Depression is a leading mental health problem worldwide. People with long-term conditions are at increased risk of experiencing depression. The COVID-19 pandemic led to strict social restrictions being imposed across the UK population. Social isolation can have negative consequences on the physical and mental wellbeing of older adults. In the Behavioural Activation in Social IsoLation (BASIL+) trial we will test whether a brief psychological intervention (based on Behavioural Activation), delivered remotely, can mitigate depression and loneliness in older adults with long-term conditions during isolation. Methods We will conduct a two-arm, parallel-group, randomised controlled trial across several research sites, to evaluate the clinical and cost-effectiveness of the BASIL+ intervention. Participants will be recruited via participating general practices across England and Wales. Participants must be aged ≥65 with two or more long-term conditions, or a condition that may indicate they are within a ‘clinically extremely vulnerable’ group in relation to COVID-19, and have scored ≥5 on the Patient Health Questionnaire (PHQ9), to be eligible for inclusion. Randomisation will be 1:1, stratified by research site. Intervention participants will receive up to eight intervention sessions delivered remotely by trained BASIL+ Support Workers and supported by a self-help booklet. Control participants will receive usual care, with additional signposting to reputable sources of self-help and information, including advice on keeping mentally and physically well. A qualitative process evaluation will also be undertaken to explore the acceptability of the BASIL+ intervention, as well as barriers and enablers to integrating the intervention into participants’ existing health and care support, and the impact of the intervention on participants’ mood and general wellbeing in the context of the COVID-19 restrictions. Semi-structured interviews will be conducted with intervention participants, participant’s caregivers/supportive others and BASIL+ Support Workers. Outcome data will be collected at one, three, and 12 months post-randomisation. Clinical and cost-effectiveness will be evaluated. The primary outcome is depressive symptoms at the three-month follow up, measured by the PHQ9. Secondary outcomes include loneliness, social isolation, anxiety, quality of life, and a bespoke health services use questionnaire. Discussion This study is the first large-scale trial evaluating a brief Behavioural Activation intervention in this population, and builds upon the results of a successful external pilot trial. Trial registration ClinicalTrials.Gov identifier ISRCTN63034289, registered on 5th February 2021.

Additional file 1: COREQ checklist for ‘Recommendations for improving the working conditions and cultures of distressed junior doctors, based on a qualitative study and stakeholder perspectives’.

Background:\ud The coronavirus disease (COVID‐19) pandemic has had far‐reaching effects upon lives, healthcare systems and society. Some who had an apparently 'mild' COVID‐19 infection continue to suffer from persistent symptoms, including chest pain, breathlessness, fatigue, cognitive impairment, paraesthesia, muscle and joint pains. This has been labelled 'long COVID'. This paper reports the experiences of doctors with long COVID.\ud \ud Methods:\ud A qualitative study; interviews with doctors experiencing persistent symptoms were conducted by telephone or video call. Interviews were transcribed and analysis conducted using an inductive and thematic approach.\ud \ud Results:\ud Thirteen doctors participated. The following themes are reported: making sense of symptoms, feeling let down, using medical knowledge and connections, wanting to help and be helped, combining patient and professional identity. Experiencing long COVID can be transformative: many expressed hope that good would come of their experiences. Distress related to feelings of being ‘let down’ and the hard work of trying to access care. Participants highlighted that they felt better able to care for, and empathize with, patients with chronic conditions, particularly where symptoms are unexplained.\ud \ud Conclusions:\ud The study adds to the literature on the experiences of doctors as patients, in particular where evidence is emerging and the patient has to take the lead in finding solutions to their problems and accessing their own care.\ud \ud Patient and Public contribution:\ud The study was developed with experts by experience (including co‐authors HA and TAB) who contributed to the protocol and ethics application, and commented on analysis and implications. All participants were given the opportunity to comment on findings.

Objective: \ud To investigate the cost‐effectiveness (cost‐utility) of introducing general practitioner screening for anxiety and depression in patients consulting with osteoarthritis (OA).\ud \ud Methods: \ud A cluster‐randomised trial‐based economic evaluation to assess general practitioners screening for anxiety and depression symptoms in patients consulting with OA compared to usual care (screening for pain intensity) was undertaken over a 12‐month period from a UK National Health Service and Societal perspective. Patient‐level mean costs and mean quality‐adjusted life years (QALYs) were estimated and cost‐effectiveness acceptability curves controlling for cluster‐level data were constructed. The base‐case analysis used the net‐benefit regressions approach. The two‐stage non‐parametric sampling technique was explored in a sensitivity analysis.\ud \ud Results: \ud The base‐case analysis demonstrated that the intervention was as costly as, and less effective than, the control (QALY diff, 95% CI: ‐ 0.029 (95% CI ‐0.062 to 0.003)). In the base‐case analyses, GP screening for anxiety and depression was unlikely to be a cost‐effective option (probability < 5% at £20,000/QALY). Similar results were observed in all sensitivity analyses.\ud \ud Conclusions: \ud Prompting GP's to routinely screen and manage comorbid anxiety and depression in patients presenting with OA is unlikely to be cost‐effective. Further research is needed to explore clinically‐effective and cost‐effective models of managing anxiety and depression in patients presenting with clinical OA.

Additional file 6: Table S2. Tests for effect modification by age and gender for incidence rate ratios indicating change in incidence between 2003 and 2018. Table S3. Tests for effect modification by gender for incidence rate ratios measure indicating change in incidence between 2003 and 2018.

Supplemental Material, sj-docx-1-cob-10.1177_26335565211002402 for Acceptability of nurse-led reviews for inflammatory rheumatological conditions: A qualitative study by Daniel Herron, Carolyn A Chew-Graham, Samantha Hider, Annabelle Machin, Zoe Paskins, Kendra Cooke, Erandie Ediriweera Desilva and Clare Jinks in Journal of Comorbidity

Additional file 1: Fig. S1. Flow of cohort members in CPRD Aurum cohort. Fig. S2. Flow of cohort members in CPRD GOLD cohort.

Additional file 4: Fig. S6. Annual incidence rates: inclusive vs. stringent estimate.

Additional file 1. INCLUDE fidelity checklist.

Additional file 3: Fig. S3. Observed annual and predicted incidence rates of anxiety disorders, depression and eating disorders through a linear time trend. Fig. S4. Observed annual and predicted incidence rates of attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) through a linear time trend. Fig. S5. Observed annual and predicted rates of self-harm through a linear time trend.

Supplemental material, sj-pdf-1-chi-10.1177_1742395320983871 for Challenges in the management of people with heart failure with preserved ejection fraction (HFpEF) in primary care: A qualitative study of general practitioner perspectives by Muhammad Z Hossain, Carolyn A Chew-Graham, Emma Sowden, Tom Blakeman, Ian Wellwood, Stephanie Tierney and Christi Deaton in Chronic Illness

Supplemental Material, sj-doc-2-cob-10.1177_26335565211002402 for Acceptability of nurse-led reviews for inflammatory rheumatological conditions: A qualitative study by Daniel Herron, Carolyn A Chew-Graham, Samantha Hider, Annabelle Machin, Zoe Paskins, Kendra Cooke, Erandie Ediriweera Desilva and Clare Jinks in Journal of Comorbidity

Additional file 1:. *Topic guide, *A description of the questions and areas of questioning used within the interviews

Supplemental material, MIR_submission_final_supplementary_information_09_08 for Does anxiety moderate the effectiveness of mirtazapine in patients with treatment-resistant depression? A secondary analysis of the MIR trial by Raphael Rifkin-Zybutz, Stephanie MacNeill, Simon JC Davies, Christopher Dickens, John Campbell, Ian M Anderson, Carolyn A Chew-Graham, Tim J Peters, Glyn Lewis, Nicola Wiles and David Kessler in Journal of Psychopharmacology

Topic guide for patient participants who dropped out of study. (DOCX 14 kb)

Definition of conditions being present; flow chart describing study cohort selection; additional figures S2-S18. (DOCX 4106 kb)

Additional file 6. Profile of the earliest symptom, among all symptom groups, in patients with FEP.

Fidelity checklist patient participants. (DOCX 16 kb)

Topic guide for GP participants. (DOCX 14 kb)

Additional file 7. Statistical assessment of the optimal number of clusters from latent class analysis models based on eight groups of prodrome symptoms.

CHEMIST pilot RCT consort flow chart. (DOCX 40 kb)

Additional file 5. Time interval between first symptom (if any) and FEP diagnosis within each symptom group.

Additional file 1. Comparison of patient characteristics and patterns of symptoms in FEP patients with and without missing data on smoking, alcohol drinking and BMI.

Additional file 3. Comorbid conditions measured at index date in FEP patients and matched participants.

Topic guide for patient participants in intervention arm. (DOCX 14 kb)

Background: Patients with inflammatory rheumatic conditions such as rheumatoid arthritis, polymyalgia rheumatica and ankylosing spondylitis are at increased risk of common comorbidities such as cardiovascular disease, osteoporosis and anxiety and depression which lead to increased morbidity and mortality. These associated morbidities are often un-recognized and under-treated. While patients with other long-term conditions such as diabetes are invited for routine reviews in primary care, which may include identification and management of co-morbidities, at present this does not occur for patients with inflammatory conditions, and thus, opportunities to diagnose and optimally manage these comorbidities are missed. Objective: To evaluate the feasibility and acceptability of a nurse-led integrated care review (the INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community (INCLUDE) review) for people with inflammatory rheumatological conditions in primary care. Design: A pilot cluster randomized controlled trial will be undertaken to test the feasibility and acceptability of a nurse-led integrated primary care review for identification, assessment and initial management of common comorbidities including cardiovascular disease, osteoporosis and anxiety and depression. A process evaluation will be undertaken using a mixed methods approach including participant self-reported questionnaires, a medical record review, an INCLUDE EMIS template, intervention fidelity checking using audio-recordings of the INCLUDE review consultation and qualitative interviews with patient participants, study nurses and study general practitioners (GPs) Discussion: Success of the pilot study will be measured against the engagement, recruitment and study retention rates of both general practices and participants. Acceptability of the INCLUDE review to patients and practitioners and treatment fidelity will be explored using a parallel process evaluation. Trial Registration: ISRCTN12765345.

Introduction: The increasing prevalence of type 2 diabetes (T2DM) presents a significant burden on affected individuals and health-care systems internationally. There is, however, no agreed validated measure to infer diabetes severity from electronic health records (EHRs). We aim to quantify T2DM severity and validate it using clinical adverse outcomes.Methods and Analysis: Primary care data from the Clinical Practice Research Datalink (CPRD), linked hospitalisation and mortality records between April-2007 and March-2017 for T2DM patients in England will be used to develop a clinical algorithm to grade T2DM severity. The EHR-based algorithm will incorporate main risk factors (severity domains) for adverse outcomes to stratify T2DM cohorts by baseline and longitudinal severity scores. Provisionally, T2DM severity domains, identified through a systematic review and expert opinion are: diabetes duration, HbA1c, microvascular complications, comorbidities, and co-prescribed treatments. Severity scores will be developed by two approaches: i) calculating a count score of severity domains; ii) through hierarchical stratification of complications. Regression models estimates will be used to calculate domains weights. Survival analysis for the association between weighted severity scores and future outcomes: cardiovascular events; hospitalisation (diabetes-related, cardiovascular); and mortality (diabetes-related, cardiovascular, all-cause mortality) will be performed as a statistical validation. The proposed EHR-based approach will quantify the T2DM severity for primary care performance management and inform the methodology for measuring severity of other primary care-managed chronic conditions. We anticipate that the developed algorithm will be a practical tool for practitioners, aid clinical management decision-making, inform stratified medicine, support future clinical trials and contribute to more effective service-planning and policy-making.Ethics and Dissemination: The study protocol was approved by the Independent Scientific Advisory Committee (ISAC). Some data were presented at the NIHR SPCR Showcase, September-2017, Oxford,UK; the Diabetes UK Professional Conference March-2018, London,UK. The study findings will be disseminated in relevant academic conferences and peer-reviewed journals.

Aims: Despite the increasing prevalence of Type 2 diabetes, whichpresents a significant burden on healthcare resources, there is noagreed validated UK measure to infer Type 2 diabetes severity fromelectronic health records (EHRs). This study aimed to identifyimportant clinical severity domains, recorded in EHRs, whichcould be used to quantify the severity of Type 2 diabetes.Methods: Data from the Clinical Practice Research Datalink(CPRD) and hospitalisation records for people with Type 2diabetes, registered with linked English general practices, to beused to develop a clinical decision algorithm to grade diabetesseverity between 2006 and 2016. At this stage of the study, wehave identified clinically relevant severity domains (main riskfactors for adverse outcomes) to be incorporated in the severityalgorithm.Results: The main severity domains for Type 2 diabetes identifiedthrough a systematic review and expert opinion include age,diabetes duration, HbA1c, hypoglycaemia, microvascular complications,cardiovascular (CV) disease (heart failure, coronary heartdisease, revascularisation interventions), cerebrovascular disease,renal disease, patterns of prescribed antidiabetic and cardiovasculartreatments, hospital admissions (any-cause, diabetes-relatedand CV disease-related admissions).Summary: All identified severity domains, recorded in routinelycollected real-world EHRs, are clinically relevant in our work todefine the severity of Type 2 diabetes. This first step forms a platformon which to develop the severity tool, which will be informative topractitioners, could stratify clinical management of people withType 2 diabetes, support commissioning and public health programmesand inform the methodology of measuring the severity ofother chronic conditions managed in primary care.

SPIRIT 2013 Checklist. Recommended items to address in a clinical trial protocol and related documents. (DOC 122 kb)

Transcript from online forum. This file shows the transcript from an online forum which was used as a â think aloudâ activity. (DOCX 15 kb)

Storyboard Two. This file shows the second storyboard that was shown to participants and used as a â think aloudâ activity. (DOCX 545 kb)

Storyboard one. This file shows the first storyboard that was shown to participants and used as a â think aloudâ activity. (DOCX 467 kb)

Background This study aimed to evaluate whether prompting general practitioners (GPs) to routinely assess and manage anxiety and depression in patients consulting with osteoarthritis (OA) improves pain outcomes. Methods and findings We conducted a cluster randomised controlled trial involving 45 English general practices. In intervention practices, patients aged ≥45 y consulting with OA received point-of-care anxiety and depression screening by the GP, prompted by an automated electronic template comprising five questions (a two-item Patient Health Questionnaire–2 for depression, a two-item Generalized Anxiety Disorder–2 questionnaire for anxiety, and a question about current pain intensity [0–10 numerical rating scale]). The template signposted GPs to follow National Institute for Health and Care Excellence clinical guidelines for anxiety, depression, and OA and was supported by a brief training package. The template in control practices prompted GPs to ask the pain intensity question only. The primary outcome was patient-reported current pain intensity post-consultation and at 3-, 6-, and 12-mo follow-up. Secondary outcomes included pain-related disability, anxiety, depression, and general health. During the trial period, 7,279 patients aged ≥45 y consulted with a relevant OA-related code, and 4,240 patients were deemed potentially eligible by participating GPs. Templates were completed for 2,042 patients (1,339 [31.6%] in the control arm and 703 [23.1%] in the intervention arm). Of these 2,042 patients, 1,412 returned questionnaires (501 [71.3%] from 20 intervention practices, 911 [68.0%] from 24 control practices). Follow-up rates were similar in both arms, totalling 1,093 (77.4%) at 3 mo, 1,064 (75.4%) at 6 mo, and 1,017 (72.0%) at 12 mo. For the primary endpoint, multilevel modelling yielded significantly higher average pain intensity across follow-up to 12 mo in the intervention group than the control group (adjusted mean difference 0.31; 95% CI 0.04, 0.59). Secondary outcomes were consistent with the primary outcome measure in reflecting better outcomes as a whole for the control group than the intervention group. Anxiety and depression scores did not reduce following the intervention. The main limitations of this study are two potential sources of bias: an imbalance in cluster size (mean practice size 7,397 [intervention] versus 5,850 [control]) and a difference in the proportion of patients for whom the GP deactivated the template (33.6% [intervention] versus 27.8% [control]). Conclusions In this study, we observed no beneficial effect on pain outcomes of prompting GPs to routinely screen for and manage comorbid anxiety and depression in patients presenting with symptoms due to OA, with those in the intervention group reporting statistically significantly higher average pain scores over the four follow-up time points than those in the control group. Trial registration ISRCTN registry ISRCTN40721988, Christian Mallen and colleagues report on a cluster-randomized trial investigating screening for anxiety and depression in patients presenting with osteoarthritis., Author summary Why was this study done? Patients with painful conditions, such as osteoarthritis, are at higher risk of experiencing depression and anxiety. People with pain and coexisting mood problems are more likely to have a poorer long-term outcome. Routine screening for anxiety and depression in higher risk patients is controversial, with conflicting evidence. What did the researchers do and find? We conducted a large cluster randomised trial to investigate the impact on pain of screening and treating people with osteoarthritis for depression and anxiety in the general practice consultation. General practices were randomised either to routinely screen patients consulting with osteoarthritis for depression and anxiety or to not screen. We found that those screened for depression and anxiety had worse pain outcomes over the following 12 months than those not screened. What do these findings mean? Our findings do not support the implementation of routine screening of patients with osteoarthritis for depression and anxiety in primary care. Further work is needed to determine the potential benefit of screening patients with different musculoskeletal disorders.

Managing elderly patients with multimorbidity can be challenging to clinicians, particularly those in primary care. We discuss the complexities and challenges in this editorial. Introducing Alice Alice is 82 years old. She has type 2 diabetes mellitus and is on metformin – she only takes one 500 mg tablet twice a day as she “can’t stand” the abdominal discomfort and loose stools if she takes more, even though the general practitioner (GP) has told her she should take one with each meal. She takes levothyroxine, has asthma (which is managed with a Seretide®inhaler) and hypertension (which is controlled with ramipril). For the pain in her knees and feet, which the GP says is due to “wear and tear”, she takes paracetamol regularly, but does not feel it works – and it might not, given the recent paper in theLancet[1] – so she uses a rubefacient, which makes her feel better. She was recently diagnosed with atrial fibrillation and, after much deliberation, agreed to start rivaroxaban. A year ago, Alice was given simvastatin by one of the practice nurses after having a blood pressure check, but often wonders why she needs to take this; and because the instructions are to take at night, Alice often forgets to take it. Journal of Comorbidity 2016;6(2):53–55 &nbsp

BACKGROUND: Little is known about the clinical management of patients in primary care following self-harm. METHODS: A descriptive cohort study using data from 684 UK general practices that contributed to the Clinical Practice Research Datalink (CPRD) during 2001-2013. We identified 49,970 patients with a self-harm episode, 41,500 of whom had one complete year of follow-up. RESULTS: Among those with complete follow-up, 26,065 (62.8%, 62.3-63.3) were prescribed psychotropic medication and 6318 (15.2%, 14.9-15.6) were referred to mental health services; 4105 (9.9%, CI 9.6-10.2) were medicated without an antecedent psychiatric diagnosis or referral, and 4,506 (10.9%, CI 10.6-11.2) had a diagnosis but were not subsequently medicated or referred. Patients registered at practices in the most deprived localities were 27.1% (CI 21.5-32.2) less likely to be referred than those in the least deprived. Despite a specifically flagged NICE 'Do not do' recommendation in 2011 against prescribing tricyclic antidepressants following self-harm because of their potentially lethal toxicity in overdose, 8.8% (CI 7.8-9.8) of individuals were issued a prescription in the subsequent year. The percentage prescribed Citalopram, an SSRI antidepressant with higher toxicity in overdose, fell sharply during 2012/2013 in the aftermath of a Medicines and Healthcare products Regulatory Agency (MHRA) safety alert issued in 2011. CONCLUSIONS: A relatively small percentage of these vulnerable patients are referred to mental health services, and reduced likelihood of referral in more deprived localities reflects a marked health inequality. National clinical guidelines have not yet been effective in reducing rates of tricyclic antidepressant prescribing for this high-risk group.

ObjectiveMore than 15 million people currently suffer from a chronic physical illness in England. The objective of this study was to determine whether depression is independently associated with prospective emergency hospital admission in patients with chronic physical illness.Method1860 primary care patients in socially deprived areas of Manchester with at least one of four exemplar chronic physical conditions completed a questionnaire about physical and mental health, including a measure of depression. Emergency hospital admissions were recorded using GP records for the year before and the year following completion of the questionnaire.ResultsThe numbers of patients who had at least one emergency admission in the year before and the year after completion of the questionnaire were 221/1411 (15.7%) and 234/1398 (16.7%) respectively. The following factors were independently associated with an increased risk of prospective emergency admission to hospital: having no partner (OR 1.49, 95% CI 1.04 to 2.15); having ischaemic heart disease (OR 1.60, 95% CI 1.04 to 2.46); having a threatening experience (OR 1.16, 95% CI 1.04 to 1.29); depression (OR 1.58, 95% CI 1.04 to 2.40); and emergency hospital admission in the year prior to questionnaire completion (OR 3.41, 95% CI 1.98 to 5.86).ConclusionTo prevent potentially avoidable emergency hospital admissions, greater efforts should be made to detect and treat co-morbid depression in people with chronic physical illness in primary care, with a particular focus on patients who have no partner, have experienced threatening life events, and have had a recent emergency hospital admission.

METRIC topic guide patient evaluation. (DOC 61Â kb)

Recruitment to service evaluation. Further details of recruitment to the service evaluation, including description of roles. (PDF 191 kb)

METRIC topic guide practitioner evaluation. (DOC 71Â kb)