To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Individual placement and support (IPS) is a vocational rehabilitation
programme that was developed in the USA to improve employment outcomes
for people with severe mental illness. Its ability to be generalised to
other countries and its effectiveness in varying economic conditions
remains to be ascertained.
To investigate whether IPS is effective across international settings and
in different economic conditions.
A systematic review and meta-analysis of randomised controlled trials
comparing IPS with traditional vocational services was undertaken; 17
studies, as well as 2 follow-up studies, were included. Meta-regressions
were carried out to examine whether IPS effectiveness varied according to
geographic location, unemployment rates or gross domestic product (GDP)
The overall pooled risk ratio for competitive employment using IPS
compared with traditional vocational rehabilitation was 2.40 (95% CI
1.99–2.90). Meta-regressions indicated that neither geographic area nor
unemployment rates affected the overall effectiveness of IPS. Even when a
country's GDP growth was less than 2% IPS was significantly more
effective than traditional vocational training, and its benefits remained
evident over 2 years.
Individual placement and support is an effective intervention across a
variety of settings and economic conditions and is more than twice as
likely to lead to competitive employment when compared with traditional
Previous studies have suggested that physical activity may have antidepressant and/or anti-anxiety effects.
To examine the bidirectional relationship between physical activity and common mental disorders and establish the importance of context, type and intensity of activity undertaken.
A clinical examination of 40 401 residents of Norway was undertaken. Participants answered questions relating to the frequency and intensity of both leisure-time and workplace activity. Depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Biological and social data were also collected.
There was an inverse relationship between the amount of leisure-time physical activity and case-level symptoms of depression. This cross-sectional association was only present with leisure-time (as opposed to workplace) activity and was not dependent on the intensity of activities undertaken. Higher levels of social support and social engagement were important in explaining the relationship between leisure activity and depression. Biological changes such as alterations to parasympathetic vagal tone (resting pulse) and changes to metabolic markers had a less important role.
Individuals who engage in regular leisure-time activity of any intensity are less likely to have symptoms of depression. The context and social benefits of exercise are important in explaining this relationship.
Depression is reported to be associated with increased mortality,
although underlying mechanisms are uncertain. Associations between
anxiety and mortality are also uncertain.
To investigate associations between individual and combined
anxiety/depression symptom loads (using the Hospital Anxiety and
Depression Scale (HADS)) and mortality over a 3–6 year period.
We utilised a unique link between a large population survey (HUNT–2,
n = 61 349) and a comprehensive mortality
Case-level depression was associated with increased mortality (hazard
ratio (HR) = 1.52, 95% CI 1.35–1.72) comparable with that of smoking (HR
= 1.59, 95% CI 1.44–1.75), and which was only partly explained by somatic
symptoms/conditions. Anxiety comorbid with depression lowered mortality
compared with depression alone (anxiety depression interaction
P = 0.017). The association between anxiety symptom
load and mortality was U-shaped.
Depression as a risk factor for mortality was comparable in strength to
smoking. Comorbid anxiety reduced mortality compared with depression
alone. The relationship between anxiety symptoms and mortality was more
complex with a U-shape and highest mortality in those with the lowest
anxiety symptom loads.
The long-term effect of anxiety and depression on blood pressure is unclear.
To examine the prospective association of anxiety and depression with change in blood pressure in a general population.
Data on 36530 men and women aged 20–78 years participating in the Nord-Tr⊘ndelag Health Study (HUNT) in Norway in 1984–86 were re-examined 11 years later.
A high symptom level of anxiety and depression at baseline predicted low systolic blood pressure (< 10th percentile) at follow-up (OR=1.30, 95% CI 1.08–1.57) when those with low systolic blood pressure at baseline were excluded. Change in symptom level of anxiety and depression between baseline and follow-up was inversely associated with change in systolic blood pressure. For diastolic blood pressure, the findings were weaker or non-significant.
Symptoms of anxiety and depression predicted lower blood pressure 11 years later.
The Hospital Anxiety and Depression (HAD) rating scale is a commonly used questionnaire. Former studies have given inconsistent results as to the psychometric properties of the HAD scale.
To examine the psychometric properties of the HAD scale in a large population.
All inhabitants aged 20–89 years (n=92 100) were invited to take part in The Nord-Tr⊘ndelag Health Study, Norway. A total of 65 648 subjects participated, and only completed HAD scale forms (n=51 930) formed the basis for the psychometric examinations.
Principal component analysis extracted two factors in the HAD scale that accounted for 57% of the variance. The anxiety and depression sub-scales shared 30% of the variance. Both sub-scales were found to be internally consistent, with values of Cronbach's coefficient (a) being 0.80 and 0.76, respectively.
Based on data from a large population, the basic psychometric properties of the HAD scale as a self-rating instrument should be considered as quite good in terms of factor structure, intercorrelation, homogeneity and internal consistency.
Email your librarian or administrator to recommend adding this to your organisation's collection.