Blockade of the angiotensin system improves mental health domain of quality of life: A meta-analysis of randomized clinical trials

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Abstract

It is unclear whether blockade of the angiotensin system has effects on mental health. Our objective was to determine the impact of angiotensin converting enzyme inhibitors and angiotensin II type 1 receptor (AT1R) blockers on mental health domain of quality of life.

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The costs of depression.

Ronald C Kessler (2012)

The data reported herein show clearly that major depression is a commonly occurring and burdensome disorder. The high prevalence, early age of onset, and high persistence of MDD in the many different countries where epidemiologic surveys have been administered confirm the high worldwide importance of depression. Although evidence is not definitive that MDD plays a causal role in its associations with the many adverse outcomes reviewed here, there is clear evidence that depression has causal effects on a number of important mediators, making it difficult to assume anything other than that depression has strong causal effects on many dimensions of burden. These results have been used to argue for the likely cost -effectiveness of expanded depression treatment from a societal perspective. Two separate, large-scale, randomized, workplace depression treatment effectiveness trials have been carried out in the United States to evaluate the cost effectiveness of expanded treatment from an employer perspective. Both trials had positive returns on investment to employers. A substantial expansion of worksite depression care management programs has occurred in the United States subsequent to the publication of these trials. However, the proportion of people with depression who receive treatment remains low in the United States and even lower in other parts of the world. A recent US study found that only about half of workers with MDD received treatment in the year of interview and that fewer than half of treated workers received treatment consistent with published treatment guidelines. Although the treatment rate was higher for more severe cases, even some with severe MDD often failed to receive treatment. The WMH surveys show that treatment rates are even lower in many other developed countries and consistently much lower in developing countries. Less information is available on rates of depression treatment among patients with chronic physical disorders, but available evidence suggests that expanded treatment could be of considerable value. Randomized, controlled trials are needed to expand our understanding of the effects of detection and treatment of depression among people in treatment for chronic physical disorders. In addition, controlled effectiveness trials with long-term follow-ups are needed to increase our understanding of the effects of early MDD treatment interventions on changes in life course role trajectories, role performance, and onset of secondary physical disorders.

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Quantifying, displaying and accounting for heterogeneity in the meta-analysis of RCTs using standard and generalised Q statistics

Jack Bowden, Jayne F. Tierney, Andrew J. Copas … (2011)

Background Clinical researchers have often preferred to use a fixed effects model for the primary interpretation of a meta-analysis. Heterogeneity is usually assessed via the well known Q and I 2 statistics, along with the random effects estimate they imply. In recent years, alternative methods for quantifying heterogeneity have been proposed, that are based on a 'generalised' Q statistic. Methods We review 18 IPD meta-analyses of RCTs into treatments for cancer, in order to quantify the amount of heterogeneity present and also to discuss practical methods for explaining heterogeneity. Results Differing results were obtained when the standard Q and I 2 statistics were used to test for the presence of heterogeneity. The two meta-analyses with the largest amount of heterogeneity were investigated further, and on inspection the straightforward application of a random effects model was not deemed appropriate. Compared to the standard Q statistic, the generalised Q statistic provided a more accurate platform for estimating the amount of heterogeneity in the 18 meta-analyses. Conclusions Explaining heterogeneity via the pre-specification of trial subgroups, graphical diagnostic tools and sensitivity analyses produced a more desirable outcome than an automatic application of the random effects model. Generalised Q statistic methods for quantifying and adjusting for heterogeneity should be incorporated as standard into statistical software. Software is provided to help achieve this aim.

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The new field of ‘precision psychiatry’

Brisa S. Fernandes, Leanne M. Williams, Johann Steiner … (2017)

Background Precision medicine is a new and important topic in psychiatry. Psychiatry has not yet benefited from the advanced diagnostic and therapeutic technologies that form an integral part of other clinical specialties. Thus, the vision of precision medicine as applied to psychiatry – ‘precision psychiatry’ – promises to be even more transformative than in other fields of medicine, which have already lessened the translational gap. Discussion Herein, we describe ‘precision psychiatry’ and how its several implications promise to transform the psychiatric landscape. We pay particular attention to biomarkers and to how the development of new technologies now makes their discovery possible and timely. The adoption of the term ‘precision psychiatry’ will help propel the field, since the current term ‘precision medicine’, as applied to psychiatry, is impractical and does not appropriately distinguish the field. Naming the field ‘precision psychiatry’ will help establish a stronger, unique identity to what promises to be the most important area in psychiatry in years to come. Conclusion In summary, we provide a wide-angle lens overview of what this new field is, suggest how to propel the field forward, and provide a vision of the near future, with ‘precision psychiatry’ representing a paradigm shift that promises to change the landscape of how psychiatry is currently conceived.

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Author and article information

Journal

Title: Australian & New Zealand Journal of Psychiatry

Abbreviated Title: Aust N Z J Psychiatry

Publisher: SAGE Publications

ISSN (Print): 0004-8674

ISSN (Electronic): 1440-1614

Publication date Created: November 06 2017

Publication date Created: January 2018

Publication date (Electronic): July 28 2017

Publication date (Print): January 2018

Volume: 52

Issue: 1

Pages: 24-38

Affiliations

[1 ]Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia

[2 ]Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain

[3 ]Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil

[4 ]Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK

[5 ]Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, UK

[6 ]Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK

[7 ]Psychiatry and Mental Health Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal

[8 ]Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal

[9 ]Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar (PSM), Barcelona, Spain

[10 ]Center for Pattern Recognition and Data Analytics, School of Information Technology, Deakin University, Geelong, VIC, Australia

[11 ]IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia

[12 ]Barwon Health, Geelong, VIC, Australia

[13 ]Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA

[14 ]Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA

[15 ]Neuroscience Graduate Program, Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center UTHealth, Houston, TX, USA

[16 ]Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina (UNESC), Criciúma, Brazil

[17 ]Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia

[18 ]Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia

[19 ]The Florey Institute for Neuroscience Mental Health, Parkville, VIC, Australia

[20 ]Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

Article

DOI: 10.1177/0004867417721654

PubMed ID: 28754072

SO-VID: f4491d0e-9693-4645-ba03-c65f5c8910fb

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Blockade of the angiotensin system improves mental health domain of quality of life: A meta-analysis of randomized clinical trials

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Most cited references 71

The costs of depression.

Quantifying, displaying and accounting for heterogeneity in the meta-analysis of RCTs using standard and generalised Q statistics

The new field of ‘precision psychiatry’

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