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Families express a need for information to support people with severe anorexia nervosa.
To examine the impact of the addition of a skills training intervention for caregivers (Experienced Caregivers Helping Others, ECHO) to standard care.
Patients over the age of 12 (mean age 26 years, duration 72 months illness) with a primary diagnosis of anorexia nervosa and their caregivers were recruited from 15 in-patient services in the UK. Families were randomised to ECHO (a book, DVDs and five coaching sessions per caregiver) or treatment as usual. Patient (n=178) and caregiver (n=268) outcomes were measured at discharge and 6 and 12 months after discharge.
Patients with caregivers in the ECHO group had reduced eating disorder psychopathology (EDE-Q) and improved quality of life (WHO-Quol; both effects small) and reduced in-patient bed days (7–12 months post-discharge). Caregivers in the ECHO group had reduced burden (Eating Disorder Symptom Impact Scale, EDSIS), expressed emotion (Family Questionnaire, FQ) and time spent caregiving at 6 months but these effects were diminished at 12 months.
Small but sustained improvements in symptoms and bed use are seen in the intervention group. Moreover, caregivers were less burdened and spent less time providing care. Caregivers had most benefit at 6 months suggesting that booster sessions, perhaps jointly with the patients, may be needed to maintain the effect. Sharing skills and information with caregivers may be an effective way to improve outcomes. This randomised controlled trial (RCT) was registered with Current Controlled Trials ISRCTN06149665.
The Patient Health Questionnaire (PHQ) is the most commonly used measure to screen for depression in primary care but there is still lack of clarity about its accuracy and optimal scoring method.
To determine via meta-analysis the diagnostic accuracy of the PHQ-9-linear, PHQ-9-algorithm and PHQ-2 questions to detect major depressive disorder (MDD) among adults.
We systematically searched major electronic databases from inception until June 2015. Articles were included that reported the accuracy of PHQ-9 or PHQ-2 questions for diagnosing MDD in primary care defined according to standard classification systems. We carried out a meta-analysis, meta-regression, moderator and sensitivity analysis.
Overall, 26 publications reporting on 40 individual studies were included representing 26 902 people (median 502, s.d.=693.7) including 14 760 unique adults of whom 14.3% had MDD. The methodological quality of the included articles was acceptable. The meta-analytic area under the receiver operating characteristic curve of the PHQ-9-linear and the PHQ-2 was significantly higher than the PHQ-9-algorithm, a difference that was maintained in head-to-head meta-analysis of studies. Our best estimates of sensitivity and specificity were 81.3% (95% CI 71.6–89.3) and 85.3% (95% CI 81.0–89.1), 56.8% (95% CI 41.2–71.8) and 93.3% (95% CI 87.5–97.3) and 89.3% (95% CI 81.5–95.1) and 75.9% (95% CI 70.1–81.3) for the PHQ-9-linear, PHQ-9-algorithm and PHQ-2 respectively. For case finding (ruling in a diagnosis), none of the methods were suitable but for screening (ruling out non-cases), all methods were encouraging with good clinical utility, although the cut-off threshold must be carefully chosen.
The PHQ can be used as an initial first step assessment in primary care and the PHQ-2 is adequate for this purpose with good acceptability. However, neither the PHQ-2 nor the PHQ-9 can be used to confirm a clinical diagnosis (case finding).
Depression and obesity are highly prevalent, and major impacts on public health frequently co-occur. Recently, we reported that having depression moderates the effect of the FTO gene, suggesting its implication in the association between depression and obesity.
To confirm these findings by investigating the FTO polymorphism rs9939609 in new cohorts, and subsequently in a meta-analysis.
The sample consists of 6902 individuals with depression and 6799 controls from three replication cohorts and two original discovery cohorts. Linear regression models were performed to test for association between rs9939609 and body mass index (BMI), and for the interaction between rs9939609 and depression status for an effect on BMI. Fixed and random effects meta-analyses were performed using METASOFT.
In the replication cohorts, we observed a significant interaction between FTO, BMI and depression with fixed effects meta-analysis (β=0.12, P = 2.7 × 10−4) and with the Han/Eskin random effects method (P = 1.4 × 10−7) but not with traditional random effects (β = 0.1, P = 0.35). When combined with the discovery cohorts, random effects meta-analysis also supports the interaction (β = 0.12, P = 0.027) being highly significant based on the Han/Eskin model (P = 6.9 × 10−8). On average, carriers of the risk allele who have depression have a 2.2% higher BMI for each risk allele, over and above the main effect of FTO.
This meta-analysis provides additional support for a significant interaction between FTO, depression and BMI, indicating that depression increases the effect of FTO on BMI. The findings provide a useful starting point in understanding the biological mechanism involved in the association between obesity and depression.
To quantify the association of dietary quality with prospective changes in adiposity.
Children participating in the QUALITY (QUebec Adipose and Lifestyle InvesTigation in Youth) study underwent examination at baseline and at 2-year follow-up. Dietary quality was assessed by the Diet Quality Index–International (DQII) using three non-consecutive 24 h diet recalls at baseline. The DQII has four main categories: dietary adequacy, variety, moderation and overall balance. Fat mass index (FMI; [fat mass (kg)]/[height (m)]2), central FMI (CFMI; [trunk fat mass (kg)]/[height (m)]2), percentage body fat (%BF; [total fat mass (kg)]/[total mass (kg)]) and percentage central BF (%CBF; [trunk fat mass (kg)]/[total mass (kg)]) were assessed through dual-energy X-ray absorptiometry.
Children were selected from schools in the greater Montreal, Sherbrooke and Quebec City metropolitan areas between 2005 and 2008, Quebec, Canada.
A total of 546 children aged 8–10 years, including 244 girls and 302 boys.
Regression analysis adjusting for age, sex, energy intake, physical activity and Tanner stage revealed that every 10-unit improvement in overall DQII score was associated with lower gain in CFMI (β=−0·08; 95 % CI −0·17, −0·003) and %BF (β=−0·55; 95 % CI −1·08, −0·02). Each unit improvement in dietary adequacy score was associated with lower gain in FMI (β=−0·05; 95 % CI −0·08, −0·008), CFMI (β=−0·03; 95 % CI −0·05, −0·007), %BF (β=−0·15; 95 % CI −0·28, −0·03) and %CBF (β=−0·09; 95 % CI −0·15, −0·02).
Promotion of dietary quality and adequacy may reduce weight gain in childhood and prevent chronic diseases later in life.
The fact that crime and disorder are concentrated at a few places is interesting and deserves an explanation. It is also interesting that places show up in other criminological theories and in other disciplines. And it is useful to understand the methods for studying places. However, a primary reason we are interested in high-crime places is that it might be possible to do something about crime by addressing these places. We are convinced that focusing on places can substantially reduce crime and disorder. Our conviction is not a matter of faith, but is based on over twenty-five years of accumulating evidence.
This chapter summarizes the research evidence examining whether focusing on crime places reduces crime. We first discuss a broad range of place-based prevention strategies examined by Eck and Guerrette (2012). This review provides strong evidence for a place-based approach to crime prevention. We then turn to a specific form of place-based crime prevention – hot spots policing (Sherman and Weisburd 1995). Again, we have a strong body of evidence supporting a place-based approach. Having reviewed hot spots policing, we turn to the importance of place managers and third parties in controlling problem places. We then examine an extension of the third-party approach to argue that a place-based approach to crime may free crime control policy from the police monopoly. Then we describe how a place-based approach to crime could be incorporated in community corrections to improve probation and parole outcomes. Finally, we review the larger body of research on the potential threat of crime displacement, and its opposite, the diffusion of crime control benefits. Consistently, the evidence described in this chapter clearly shows the substantial utility of a place-based approach for reducing crime.
SITUATIONAL CRIME PREVENTION AT PLACES
In Chapter 3 we argued for the importance of social disorganization theories for understanding crime places. This is an area where basic research suggests promise (e.g., see Weisburd et al. 2012; Weisburd et al. 2014), but where there is little evidence of effectiveness of specific practices. Such evidence is beginning to be developed, but we can say little at this juncture. In contrast, the evidence regarding opportunity reduction and crime has grown systematically over the last few decades.
Take a moment to imagine a crime occurring – perhaps a street robbery or a bag snatch. When you do this, it is difficult not to visualize the crime occurring in a particular setting or place. So, you might imagine a dark street corner with dim street lighting or seating in the outside area of a public bar. It seems intuitively sensible to analyze and understand crime at this unit of analysis – in other words, to investigate how criminals behave and crime concentrates at small microplaces. However, engaging in such microlevel analysis has tended to be a more recent criminological undertaking, and there are still many fruitful avenues to explore in terms of advancing both our knowledge and the sophistication of the methods that we use in this research area.
In this chapter, we raise and endeavor to answer a number of questions concerning the appropriate scale of analysis of criminological enquiry. To do this, we will start by defining what we mean by place and how this differs from other geographic concepts. Next, we highlight what has become the key catalyst for the criminology of place – the tremendous concentration of crime at microgeographic units of analysis. The strong and consistent concentration of crime at addresses, street segments, and other microgeographic units across cities is key to understanding why it is important to study the criminology of place and why it has such strong policy implications. We then turn to some additional statistical benefits of studying crime at microgeographic units that have to do with what is often termed “spatial interaction effects.” Finally, we examine problems that crime and place researchers will need to consider, and recommend some future directions for research exploring crime concentration at places.
PLACE AND SPACE
Geographic concepts are sometimes used in criminological research without a clear understanding of their meaning. Place and space are two such concepts. The subtle difference between them is important to keep in mind, as they can be a guide to establishing a carefully constructed study and influence the interpretation of findings. Furthermore, as will become apparent later in this chapter, a confusion of these concepts can mislead the reader in the interpretation of an argument. For example, it is important to keep in mind that place does not necessarily mean small units of analysis, nor does space necessarily refer to large areas.
Over the last two decades, there has been increased interest in the distribution of crime and other antisocial behavior at lower levels of geography. The focus on micro geography and its contribution to the understanding and prevention of crime has been called the 'criminology of place'. It pushes scholars to examine small geographic areas within cities, often as small as addresses or street segments, for their contribution to crime. Here, the authors describe what is known about crime and place, providing the most up-to-date and comprehensive review available. Place Matters shows that the study of criminology of place should be a central focus of criminology in the twenty-first century. It creates a tremendous opportunity for advancing our understanding of crime, and for addressing it. The book brings together eighteen top scholars in criminology and place to provide comprehensive research expanding across different themes.
This chapter explores the importance of place in theory and research in both mainstream criminology and other disciplines. As we noted in earlier chapters, traditional criminology has focused primarily on understanding why people commit crime. This focus on criminality has generally inhibited study of microgeographies and their role in producing crime. However, more recently there has been a trend toward integrating microgeographic places into traditional theorizing about criminality. In the first part of the chapter we discuss this trend, focusing on some recent innovations in understanding criminality that have incorporated place-based perspectives. In the second part of the chapter we focus on how other disciplines have influenced thinking in this area, focusing in particular on contributions in psychology, economics, and public health. Finally, we explore how trends in other disciplines might influence future directions of study in the criminology of place.
THE GROWING ROLE OF MICROGEOGRAPHIC PLACES IN TRADITIONAL THEORIZING OF CRIMINALITY
As we noted in Chapter 1, places, at least at a macro level, played a key part in the development of criminology in the nineteenth and early twentieth centuries. But despite the role of place in crime in empirical study in Europe and theoretical development in the Chicago School through social disorganization theory, microgeographic places were mostly ignored. This was not because early criminologists failed to recognize the role of place in crime. Crime occurs in specific environments, and this was apparent to observers of the crime problem. Nonetheless, as we noted in Chapter 1, early criminologists did not see “crime places” – small discrete areas within communities – as a relevant focus of criminological study. This was the case, in part, because crime opportunities provided by places were assumed to be so numerous as to make concentration on specific places of little utility for theory or policy. What is the point of focusing theory or research on the opportunities offered by specific places if such opportunities can be found throughout the urban context?
Moreover, criminologists did not see the utility in focusing in on situational opportunities when criminal motivation was the key to understanding crime rates. Criminologists traditionally assumed that situational factors played a relatively minor role in explaining crime as compared with the “driving force of criminal dispositions” (Clarke and Felson 1993, 4; Trasler 1993).
In the previous chapter, we showed that crime is concentrated at very small geographic units, substantially smaller than neighborhoods, and that these concentrations, on average, are relatively stable. This is true whether examining high- or low-crime neighborhoods. Although high-crime places do cluster, they seldom form a homogeneous block of high-crime places. Rather, interspersed within concentrations of high-crime places are many low- and modest-crime places.
Why is crime concentrated in a relatively small number of places? Standard criminology has not asked this question, largely because standard criminology focuses on criminality and implicitly assumes that the density of offenders explains crime density. Recognition that place characteristics matter is the starting point for this chapter. We look at two perspectives on crime place characteristics. We use the term “perspective” because each type of explanation is comprised of multiple theories linked by a common orientation. The first perspective arises from opportunity theories of crime. The second perspective arises from social disorganization theories of crime.
We begin by contrasting two ways of thinking about how a place becomes a crime hot spot and suggest that the process by which high-crime places evolve must involve place characteristics. In the next sections, we examine opportunity and social disorganization explanations. In the final section of the chapter, we examine possible ways researchers might link these two perspectives.
PROCESSES THAT CREATE CRIME PLACES
Before we look for explanations of why places become hot spots of crime it is important to consider two processes that might lead to such an outcome. Criminologists have generally proposed two generic models to account for the processes that lead to variation in place susceptibility to crime. One model suggests that places may start with reasonably similar risks of an initial criminal attack, but once attacked the risk of a subsequent attack on the place rises. Over time, places diverge in their crime risk, and consequently in their crime counts. This temporal contagion model is also known as a boost model (see Chapter 2) or a state-dependence model. It puts the emphasis on offenders’ willingness to return to a previously successful crime site (Johnson et al. 2007; Townsley et al. 2000). It suggests that irrespective of initial crime risk the occurrence of a crime will lead to changes in risk of crime at a place.
We began this book by noting that criminologists have largely ignored the involvement of microgeographic places in crime. Mainstream criminologists have focused on “who done it?” and not “where done it?” (Sherman 1995). At least for the last century the key inquiries of crime and the key prevention approaches have looked to doing something about criminal motivation (Sutherland 1947; Reiss 1981). Why people commit crime has been the main focus of criminology (Brantingham and Brantingham 1990; Weisburd 2002), and catching and processing offenders has been the main focus of crime prevention (Weisburd 2008). In contrast, the criminology of place (Sherman et al. 1989; Weisburd et al. 2012), which began to develop in the 1980s and 1990s (Brantingham and Brantingham 1981; 1984; Eck 1994; Eck and Weisburd 1995; Roncek and Bell 1981; Weisburd and Green 1995a), provides an alternative vision of how we can understand crime and the crime problem. Like the emergence of community criminology during the same period (Bursik 1988; Morenoff et al. 2001; Sampson 2008; Sampson et al. 1997) the criminology of place has offered a new set of mechanisms for crime study and a new set of methods for doing something about the crime problem.
Theory has been a driving force in criminological study, and as we note below, we think that more not less attention to theory is important for advancing the criminology of place. However, theories are about something and try to explain something. When we change the unit of analysis, we are changing the target for theory. The criminology of place proposes a new target. It focuses on places, rather than people. Its goal is to explain the criminal involvement of microgeographic units rather than trying to explain the criminal involvement of people. This does not mean we ignore the role of individuals in the crime problem. But it does mean that we begin our inquiries with the place and see the individuals as only one part of the crime equation at places.
We have illustrated in the preceding chapters the extent to which theory, method, and empirical evidence about crime places have been developing over the last three decades. In this concluding chapter, we want to draw from our review of what is known some key themes that we think our work has identified, and key questions that still need to be answered.