This programme unites work that we have done in psychosocial aspects of chronic physical disease.

Psychological factors associated with long term conditions and poor health outcomes

In a number of studies over the last years, the principal investigator has assessed psychological factors associated with a wide range of chronic physical illnesses and their impact on several health outcomes. He has focused on rheumatologic disorders, cancer, inflammatory bowel disease and irritable bowel syndrome, COPD and diabetes, and he has performed the standardization study of the screening for depression Patient Health Questionnaire 9 (PHQ-9) for use within Greek rheumatologic patients. He has confirmed the high incidence of psychiatric comorbidity in Greek patients with long-term medical conditions and its relationship with impairment of health-related quality of life, poor compliance with and adherence to treatment, treatment decision making preferences or other ill-prone behaviours. He has also highlightened the role of the underlying psychological defensive and coping profile in the formation of a number of disease’s outcomes, and he has established the usually underestimated but crucial role of the somatization process in the formation of health outcomes in cancer, inflammatory bowel disease, glaucoma, COPD and rheumatologic disorders.

Predictors of health care utilisation

In 7 studies over recent years, Else Guthrie and Francis Creed have measured consultation rates in primary and/or secondary care including the A&E and identified predictors of healthcare use. In nearly all these studies psychological status was an important predictor of health care use. In one study, which most closely corresponds to our proposed study, Else Guthrie and Francis Creed found that not being married, not living with a partner, panic disorder (present in 22% of frequent users) and perception of illness were powerful predictors of frequent use of unscheduled care even after severity of physical condition was adjusted for.

Reducing costs and health care utilisation

Francis Creed and Else Guthrie have carried out two randomised controlled trials of the cost effectiveness of psychological interventions in patients who are high utilisers of health care; both showed that treatment resulted in improved health status and a reduction in health care costs.

Improving outcome in long term conditions

Principal investigator, Else Guthrie and Francis Creed have evaluate in an RCT study psychological treatment (Interpersonal Psychodynamic Psychotherapy - IPT) in patients with severe irritable bowel syndrome; the methodology of this intervention is translatable to the current programme. Else Guthrie and Francis Creed have also evaluated in RCTs psychological treatment in patients seen in A&E after self harm and in adults with poorly controlled diabetes. All interventions led to improved outcomes.

Feasibility

Else Guthrie and Francis Creed’s recent study of psychological and social factors associated with the onset and persistence of medically unexplained symptoms has demonstrated the feasibility of using a detailed psychological questionnaire in the medical environment in Manchester, UK, and we have no reasons to doubt that the same applies in Greece as well.

The Hellenic Society of Rheumatology has provided financial support for initial research in the field of psychosocial factors associated with long term conditions and poor health-outcomes (“Psychological Distress and Personality Traits in Patients with Rheumatoid Arthritis”).