Publications: 2000
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Borrill, C., West, M., Shapiro, D.A., & Rees, A. (2000). Team working and effectiveness in health care. British Journal of Health Service Management, 364-371. With the arrival of the National Plan, this paper presents preliminary findings from a major survey of multidisciplinary team working and effectiveness. The three-year study covered primary, secondary and community health care teams.
Brugha, T.S., Wheatley, S., Taub, N.A., Culverwell, A., Friedman, T., Kirwan, P.H., Jones, D.R., & Shapiro, D.A. (2000). Pragmatic randomised trial of antenatal intervention to prevent postnatal depression by reducing psychosocial risk factors. Psychological Medicine, 30, 1273-1281. BACKGROUND: Social support theory and observational risk factor studies suggest that increased antenatal psychosocial support could prevent post-natal depression. We used empirical knowledge of risk and protective factors for post-natal depression not employed previously in order to develop and evaluate an antenatal preventive intervention. METHODS: We conducted a pragmatic randomized controlled trial in antenatal clinics. We screened 1300 primiparous women and 400 screened positive, 69 screen-positive women were untraceable or not eligible. Of 292 women who completed baseline asessment, 209 consented to randomization, of these 190 provided outcome data 3 months post-natally. 'Preparing for Parenthood', a structured ante-natal risk factor reducing intervention designed to increase social support and problem-solving skills, was compared with routine antenatal care only. We compared the percentage depressed at 3 months after childbirth using the self-completion General Health Questionnaire Depression scale and Edinburgh Post-natal Depression Scale (EPDS), and the Schedules for Clinical Assessment in Neuropsychiatry, a systematic clinical interview. RESULTS: Assignment to the intervention group did not significantly impact on post-natal depression (odds ratio for GHQ-Depression 1.22 (95% CI 0.63-2.39), P = 0.55) or on risk factors for depression. Forty-five per cent of the intervention group women attended sufficient sessions to be likely to benefit from intervention if effective. Attenders benefited no more than non-attenders. CONCLUSIONS: Prevention services targeting post-natal depression should not implement antenatal support programmes on these lines until further research has demonstrated the feasibility and effectiveness of such methods. The development of novel, low cost interventions effective in reducing risk factors should be completed before further trial evaluation.
Paley, G., Shapiro, D.A., & Worrall-Davies, A. (2000). Familial origins of Expressed Emotion in the relatives of people with schizophrenia. Journal of Mental Health, 9, 655-663. Background: Expressed Emotion (EE) is an index of the quality of the relationship between relative and patient. This study approaches EE from an attachment theory perspective and examines whether relatives' internal working models of their own parents influence their subsequent EE status in adult life. Methods: Participants were the 55 key relatives of 32 predominantly long-term, stable, community-based index patients with schizophrenia. Relatives' EE was measured with the Camberwell Family Interview and their recollections of parenting with the Parental Bonding Instrument. Results: Maternal over-protection was positively related to emotional over-involvement but marginally negatively associated with criticism. Conclusion: This study was limited by an unrepresentative sample and the results are not unequivocal, limiting the generalisability of the findings. However, the results offer tentative indications that some aspects of EE may be associated with relatives' childhood experiences, and warrant replication with a more representative sample.
Samoilov, A., Goldfried, M.R., & Shapiro, D.A. (2000). Coding system of therapeutic focus on action and insight. Journal of Consulting and Clinical Psychology, 68, 513-514. This study (a) used an established comprehensive process measure to uncover a latent pattern of therapeutic focus in cognitive-behavioral and psychodynamic-interpersonal sessions; (b) used these results to develop the coding system of Therapeutic Focus on Action and Insight, which makes it possible to evaluate therapists' relative emphasis on the Constructing Meaning and Facilitating Action domains of in-session focus; and (c) evaluated its reliability and validity.
Wheatley, S.L., Culverwell, A., Brugha, T.S., & Shapiro, D.A., (2000). Preparing for Parenthood: Background and development of a risk modifying intervention to prevent postnatal depression. Archives of Womens Mental Health, 3, 81-90. Risk and protective factor modification has been proposed as a rational approach to developing mental health improvement interventions by prevention. The intervention 'Preparation for Parenthood' (PFP) was developed embodying theoretical and evidence based predictors of symptom inception and alleviation as well as a real world set of tasks. A manual describing and directing the operational procedures of PFP is outlined. Course leaders trained in its application endeavoured to implement PFP with women at risk of developing postnatal depression during pregnancy before the birth of their first child. Also described are an initial market research survey, the outcome of three pilot courses and the final design of PFP. The lack of clinical efficacy of PFP, demonstrated in a subsequent randomised evaluation, is discussed in relation to concurrent research in the filed and lessons and implications for more effective preventive intervention development and evaluation.
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