ORCID Profile
0000-0002-0476-9146
Current Organisation
University of Sydney
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Industrial and Organisational Psychology | Health Economics | Demography | Psychology | Family and Household Studies | Applied Economics | Social Policy | Neurology And Neuromuscular Diseases | Public Health And Health Services Not Elsewhere Classified | Social Change | Environmental and Occupational Health and Safety |
ANZSRC Socio-Economic Objective (SEO)
Work not elsewhere classified | Expanding Knowledge through Studies of Human Society | Health and support services not elsewhere classified | Families and Family Services | Nervous system and disorders | Mental Health | Health Status (e.g. Indicators of Well-Being) | Social Class and Inequalities | Occupational Health
Related Links
Publications
Letter to the Editor: Author reply to Letter to the Editor regarding ‘What happened to the predicted COVID-19-induced suicide epidemic, and why?’
Publisher: SAGE Publications
Date: 18-08-2023
Health Anxiety and Disability Pension Award: The HUSK Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2009
Is sleep duration related to obesity? A critical review of the epidemiological evidence
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1016/J.SMRV.2008.03.001
Abstract: 1. Observational studies have implicated habitual sleep duration as a risk factor for mortality and morbidity. Part of this association might be mediated by obesity, which has also been associated with habitual sleep duration. These studies generate wide media attention because of the public's health concerns surrounding increasing obesity and the temporal association with the other modern "epidemic" of sleep loss. Some commentators have recommended public health interventions to control obesity via habitual sleep duration modification. We conducted a critical review of the available literature describing the relationship between habitual sleep duration and obesity in community-based studies in both adults and children, with particular emphasis on longitudinal studies and on studies with objective measures of habitual sleep duration. 2. Existing data have variable consistency. Only one study objectively measured sleep duration for more than one 24-h period. Cross-sectional and longitudinal studies in adults often demonstrated an association of short sleep duration with BMI. However, some of these studies also showed that long sleep duration was also associated with obesity. In contrast, other studies showed that neither long nor short sleep was associated with obesity. In paediatric populations there appeared to be a clear pattern where shorter sleep durations were associated with obesity. We did not locate any interventional studies where sleep duration had been manipulated in order to prevent or treat obesity. 3. We contend that the evidence base is not yet strong enough to give public health advice to the general population or specific groups about sleep duration being a modifiable risk factor for obesity. We need to experimentally clarify whether sleep duration variability is a risk factor for obesity, in what manner, and in which populations. If a reliable aetiological model could be found, we would ideally then need community-based randomised controlled trials that show that sleep duration can be changed and that sleep duration manipulation produces actual weight loss and/or prevents the development of obesity without undue side-effects.
Workplace effects of the stigmatization of depression
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-1998
DOI: 10.1097/00043764-199809000-00008
Abstract: Employers have previously been shown to hold negative attitudes toward mental illness. The purpose of this survey of human resource officers in UK companies was to ascertain whether these attitudes prejudice employment opportunities for subjects with mental illness--specifically, depression--and, if so, some of the beliefs upon which these attitudes are based. When employers were given vignettes of job applicants identical except for diagnosis, a label of depression significantly reduced the chances of employment, compared with one of diabetes, despite both being seen as equally credible illnesses. This stigmatization is based upon perceptions of potential poor work performance, rather than expectations of future absenteeism, but is not concordant with previous research. It is suggested that greater dissemination of information may alleviate some of this stigma.
A New Online Mental Health Training Program for Workplace Managers: Pre-Post Pilot Study Assessing Feasibility, Usability, and Possible Effectiveness
Publisher: JMIR Publications Inc.
Date: 03-07-2018
DOI: 10.2196/10517
Abstract: Mental health has become the leading cause of sickness absence in high-income countries. Managers can play an important role in establishing mentally healthy workplaces and coordinating their organization’s response to a mentally ill worker. This pilot study aims to evaluate the feasibility, usability, and likely effectiveness of a newly developed online training program for managers called HeadCoach. HeadCoach aims to build managers’ confidence in supporting the mental health needs of staff and promote managerial behavior most likely to result in a more mentally healthy workplace. In total, 66 managers from two organizations were invited to participate in this pre-post pilot study of HeadCoach, which was made available to managers to complete at their own pace over a 4-week period. Data were collected at baseline and post intervention via an online research platform. The difference in mean scores for each outcome between these two time points was calculated using paired s les t tests. Of all the invited managers, 59.1% (39/66) participated in the trial, with complete pre–post data available for 56.4% (22/39) of the participants. The majority of respondents reported positive engagement with the program. During the study period, managers’ knowledge regarding their role in managing mental health issues (P=.01) and their confidence in communicating with employees regarding mental illness (P .001) significantly increased. In addition, a significant increase was observed from the baseline in managers’ self-reported actions to use strategies to prevent and decrease stress among their team members (P=.02). Although caution is needed due to the absence of a control group, preliminary results of this study suggest that HeadCoach could be a feasible, acceptable, and efficient method of training managers in best workplace practices to help support the mental health needs of their staff.
Framework for the Design Engineering and Clinical Implementation and Evaluation of mHealth Apps for Sleep Disturbance: Systematic Review (Preprint)
Publisher: JMIR Publications Inc.
Date: 27-09-2020
Abstract: obile health (mHealth) apps offer a scalable option for treating sleep disturbances at a population level. However, there is a lack of clarity about the development and evaluation of evidence-based mHealth apps. he aim of this systematic review was to provide evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. systematic search of studies published from the inception of databases through February 2020 was conducted using 5 databases (MEDLINE, Embase, Cochrane Library, PsycINFO, and CINAHL). total of 6015 papers were identified using the search strategy. After screening, 15 papers were identified that examined the design engineering and clinical implementation and evaluation of 8 different mHealth apps for sleep disturbance. Most of these apps delivered cognitive behavioral therapy for insomnia (CBT-I, n=4) or modified CBT-I (n=2). Half of the apps (n=4) identified adopting user-centered design or multidisciplinary teams in their design approach. Only 3 papers described user and data privacy. End-user acceptability and engagement were the most frequently assessed implementation metrics. Only 1 app had available evidence assessing all 4 implementation metrics (ie, acceptability, engagement, usability, and adherence). Most apps were prototype versions (n=5), with few matured apps. A total of 6 apps had supporting papers that provided a quantitative evaluation of clinical outcomes, but only 1 app had a supporting, adequately powered randomized controlled trial. his is the first systematic review to synthesize and examine evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. The minimal number of apps with published evidence for design engineering and clinical implementation and evaluation contrasts starkly with the number of commercial sleep apps available. Moreover, there appears to be no standardization and consistency in the use of best practice design approaches and implementation assessments, along with very few rigorous efficacy evaluations. To facilitate the development of successful and evidence-based apps for sleep disturbance, we developed a high-level framework to guide researchers and app developers in the end-to-end process of app development and evaluation. >
Internet-Delivered Cognitive Behavioural Therapy for Adults with Mild to Moderate Depression and High Cardiovascular Disease Risks: A Randomised Attention-Controlled Trial
Publisher: Public Library of Science (PLoS)
Date: 26-03-2013
Letter to the Editor: Well controls in case-control studies
Publisher: Cambridge University Press (CUP)
Date: 26-10-2011
Mental illness and surgery: do we care?
Publisher: Wiley
Date: 06-2019
DOI: 10.1111/ANS.15248
Worker Preferences for a Mental Health App Within Male-Dominated Industries: Participatory Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 20-09-2017
Abstract: en are less likely to seek help for mental health problems, possibly because of stigma imposed by cultural masculine norms. These tendencies may be lified within male-dominated workplaces such as the emergency services or transport industries. Mobile apps present a promising way to provide access to mental health support. However, little is known about the kinds of mental health technologies men would be willing to engage with, and no app can be effective if the intended users do not engage with it. he goal of this participatory user research study was to explore the perceptions, preferences, and ideas of workers in male-dominated workplaces to define requirements for a mental health app that would be engaging and effective at improving psychological well-being. orkers from male-dominated workplaces in rural, suburban, and urban locations took part in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for mental health support and the design of an app for mental health. Participants generated a number of artifacts (including draft screen designs and promotional material) designed to reify their perceptions, tacit knowledge, and ideas. total of 60 workers aged between 26 and 65 years, 92% (55/60) male, from male-dominated workplaces in rural (16/60, 27%), suburban (14/60, 23%), and urban (30/60, 50%) locations participated in one of the 6 workshops, resulting in 49 unique feature ideas and 81 participant-generated artifacts. Thematic analysis resulted in a set of feature, language, and style preferences, as well as characteristics considered important by participants for a mental health app. The term “mental health” was highly stigmatized and disliked by participants. Tools including a mood tracker, self-assessment, and mood-fix tool were highly valued, and app characteristics such as brevity of interactions, minimal on-screen text, and a solutions-oriented approach were considered essential by participants. Some implementation strategies based on these findings are included in the discussion. uture mental health mobile phone apps targeting workers in male-dominated workplaces need to consider language use and preferred features, as well as balance the preferences of users with the demands of evidence-based intervention. In addition to informing the development of mental health apps for workers in male-dominated industries, these findings may also provide insights for mental health technologies, for men in general, and for others in high-stigma environments.
Perceptions of social and work functioning are related to social anxiety and executive function in autistic adults
Publisher: SAGE Publications
Date: 16-07-2021
DOI: 10.1177/13623613211013664
Abstract: Autistic adults report concerns with social skills and unemployment. Despite anxiety and difficulty with executive cognitive skills being associated with autism, no studies to date have investigated relationships between anxiety or executive cognition with social and work functioning. This study aimed to investigate the associations between perceived social anxiety, perceived and objective executive function, and perceived social and work functioning in a s le of autistic people. A total of 62 participants completed self-report questionnaires of social anxiety (via the Liebowitz Social Anxiety Scale), mental health (via the Depression Anxiety Stress Scale), executive cognition (via the Behaviour Rating Inventory of Executive Function) and perceived social and work functioning (the Work and Social Adjustment Scale), and a smaller subset ( n = 36–40) completed performance-based executive function tasks (Trail Making Task and Rapid Visual Processing Task). Participants who reported having more social anxiety and more difficulty with executive cognition also perceived themselves as having poorer social and work functioning. Performance-based executive function was not related to social or work functioning. Our results suggest that perceived social anxiety and executive cognition are both areas that have potential to be targeted to investigate whether they improve social and vocational outcomes for autistic people. Many autistic adults have trouble in social situations and at work. Researchers do not know exactly why autistic people might find it difficult in these environments, and no studies to date have looked the way anxiety or other cognitive processes might affect autistic peoples’ ability to socialise and succeed in getting and keeping jobs. Anxiety (how much you worry) and difficulty with getting stuff done or switching attention (known as executive function) can be concerns for autistic people and may contribute to social and work difficulties. This study looked at the relationships between the way autistic people perceived their anxiety and executive functioning and their ability to socialise and work. Sixty-two autistic participants completed questionnaires related to their ability to socialise and work, their social anxiety and their executive function. We found that participants who thought that they had poorer ability to work also found themselves to have more difficulties with executive function and they were more socially anxious. Our results showed that how autistic participants perceived their social anxiety and executive function were important in their perception of their social skills and work ability. This study supports the idea that anxiety and executive function could be targeted in interventions to support autistic people and their social and work outcomes.
The relationship between depression and cognitive function in adults with cardiovascular risk: Evidence from a randomised attention-controlled trial
Publisher: Public Library of Science (PLoS)
Date: 05-09-2018
Promoting positive attitudes of tobacco-dependent mental health patients towards NRT-supported harm reduction and smoking cessation
Publisher: SAGE Publications
Date: 06-06-2014
‘Having a thick skin is essential’: mental health challenges for young apprentices in Australia
Publisher: Informa UK Limited
Date: 27-02-2021
Pitfalls of big data
Publisher: SAGE Publications
Date: 16-02-2018
Facilitating Secure Sharing of Personal Health Data in the Cloud
Publisher: JMIR Publications Inc.
Date: 27-05-2016
Patient Psychological Characteristics Have Minimal Influence on Surgical Prioritization
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2004
DOI: 10.1097/01.PSY.0000116251.31787.B2
Abstract: Rationing of health care is universal in systems free at the point of delivery. United Kingdom National Health Service (NHS) policy is for treatment on the basis of "clinical need." Surgeons routinely prioritize elective cases, and structured assessments of symptom severity have been suggested as a rational method of prioritization. We hypothesized that patient psychological factors would play an important role in prioritization as currently practiced. Two hundred thirty participants were recruited from a potential pool of 259 eligible referrals to an orthopaedic department for assessment of lower limb arthroplasty. Participants were assessed at time of referral and followed for 2.5 years. Associations were estimated between participant's psychological distress, illness perceptions, and the outcome of surgical prioritization. One hundred forty-one participants were listed for arthroplasty 62 (44%) of these were considered urgent cases. Pain was the only univariate predictor of this outcome. Patient's psychological distress and illness perceptions were not associated with being classified as urgent even after adjusting for clinical and demographic status. In a multivariate model, only older age showed an independent effect (OR 2.75, 95% CI 1.14, 6.66) of increasing the chances of being considered urgent. Urgent cases had a 3-month-shorter inpatient wait among the 108 participants operated on during the study. The psychological status of arthroplasty candidates had no significant effect on the surgical prioritization process. Allocation to the urgent list appears to be based primarily on the patient's age, but is partially influenced by patient's better physical health and viewing treatment as being effective.
RE: Headspace - Australia's innovation in youth mental health: Who are the clients and why are they presenting?
Publisher: AMPCo
Date: 05-2014
DOI: 10.5694/MJA14.00145
Worker Preferences for a Mental Health App Within Male-Dominated Industries: Participatory Study
Publisher: JMIR Publications Inc.
Date: 25-04-2018
DOI: 10.2196/MENTAL.8999
Abstract: Men are less likely to seek help for mental health problems, possibly because of stigma imposed by cultural masculine norms. These tendencies may be lified within male-dominated workplaces such as the emergency services or transport industries. Mobile apps present a promising way to provide access to mental health support. However, little is known about the kinds of mental health technologies men would be willing to engage with, and no app can be effective if the intended users do not engage with it. The goal of this participatory user research study was to explore the perceptions, preferences, and ideas of workers in male-dominated workplaces to define requirements for a mental health app that would be engaging and effective at improving psychological well-being. Workers from male-dominated workplaces in rural, suburban, and urban locations took part in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for mental health support and the design of an app for mental health. Participants generated a number of artifacts (including draft screen designs and promotional material) designed to reify their perceptions, tacit knowledge, and ideas. A total of 60 workers aged between 26 and 65 years, 92% (55/60) male, from male-dominated workplaces in rural (16/60, 27%), suburban (14/60, 23%), and urban (30/60, 50%) locations participated in one of the 6 workshops, resulting in 49 unique feature ideas and 81 participant-generated artifacts. Thematic analysis resulted in a set of feature, language, and style preferences, as well as characteristics considered important by participants for a mental health app. The term “mental health” was highly stigmatized and disliked by participants. Tools including a mood tracker, self-assessment, and mood-fix tool were highly valued, and app characteristics such as brevity of interactions, minimal on-screen text, and a solutions-oriented approach were considered essential by participants. Some implementation strategies based on these findings are included in the discussion. Future mental health mobile phone apps targeting workers in male-dominated workplaces need to consider language use and preferred features, as well as balance the preferences of users with the demands of evidence-based intervention. In addition to informing the development of mental health apps for workers in male-dominated industries, these findings may also provide insights for mental health technologies, for men in general, and for others in high-stigma environments.
The Sri Lankan twin registry biobank: South Asia's first twin biobank
Publisher: Hindawi Limited
Date: 2020
DOI: 10.1017/GHEG.2020.4
Abstract: Biobanks are a valuable resource for creating advancements in science through cutting-edge omics research. Twin research methods allow us to understand the degree to which genetics and environmental factors contribute to health outcomes. The Sri Lankan Twin Registry biobank (SLTR-b) was established in 2015 as part of Colombo Twin and Singleton Follow-up Study. Venous blood and urine were collected from twins and comparative s le of singletons for clinical investigations and biobanking. The SLTR-b currently houses 3369 DNA and serum s les. Biobank specimens are linked to longitudinal questionnaire data, clinical investigations, anthropometric measurements, and other data. The SLTR-b aims to address gaps in health and genetics research. It will provide opportunities for academic collaborations, local and international, and capacity building of future research leaders in twin and omics research. This paper provides a cohort profile of the SLTR-b and its linked data, and an overview of the strategies used for biobanking.
Demographic and clinical characteristics of young people seeking help at youth mental health services: baseline findings of the Transitions Study
Publisher: Wiley
Date: 28-03-2015
DOI: 10.1111/EIP.12133
Abstract: The Transitions Study was designed to establish a cohort of young people (12-25 years) seeking help for mental health problems, in order to longitudinally explore and refine a clinical staging model of the development and progression of mental disorders. This paper presents the baseline demographic and clinical characteristics of the cohort, particularly the nature and severity of psychopathology. All eligible young people attending one of four headspace clinical services were invited to participate, and completed a battery of self-report and interviewer-administered measures of psychopathology and functional impairment at baseline, which will be repeated at the annual follow up. Of 1615 eligible clients, 802 young people (66% women mean age = 18.3 years) consented to participate and completed baseline assessments (participation rate = 50%). The severity of mental health problems varied, with 51% meeting the criteria for probable caseness related to generalized anxiety, 45% presenting with moderate to severe depressive symptoms and over a third experiencing subthreshold psychotic symptomatology. Disordered eating (32%) and problematic tobacco (56%), cannabis (30%) and alcohol (38%) use also affected a significant proportion. Overall, 39% of the cohort were classed as being functionally impaired at baseline. The Transitions Study recruited a heterogeneous cohort at baseline in relation to the nature and severity of mental health problems and levels of functional impairment. The variation in clinical presentations within the cohort, from mild, through moderate to severe levels of psychopathology and impairment, increases the likelihood of the Transitions Study ultimately being able to achieve its aims of empirically testing a clinical staging model for mental disorders.
Apprentices’ healthy coping strategies and attitudes to using a smartphone app to support their mental health (Preprint)
Publisher: JMIR Publications Inc.
Date: 10-12-2021
Abstract: pprenticeships are a common pathway for young people transitioning into the workforce. Apprentices often face many employment-related challenges and have high levels of psychological distress and are at risk of mental health problems. However, they tend to have low engagement in digital mental health interventions, which are often not catered to their interests and needs. his study explored healthy coping strategies used by apprentices and their preferences for an app to support their mental wellbeing. mixed methods study was conducted with 54 apprentices (92.6% male) with a mean age 22.7 years (SD=5.7). Across eight focus groups, participants were asked to describe healthy strategies they used to cope with occupational stressors. They also completed a survey on preferred ways of using an app to support mental health. our major types of coping behaviours were identified: 1) social connection for disclosure and advice, and socialising 2) pleasurable activities such as engaging in hobbies, time-out, and developing work-life separation 3) cognitive approaches including de-fusing from thoughts and cognitive reframing and 4) self-care approaches including exercise, healthy diet and getting adequate sleep. Only 10% of participants currently used a mental health app, but there was high interest in using an app to support friends (88%) and develop self-help strategies to manage or prevent mental health issues (78%). pprentices utilised a range of healthy behaviours to cope with workplace stressors and were willing to use a smartphone app to support their mental health. However, many of the preferred coping strategies identified are not those focussed on by current mental health interventions, including currently available apps, indicating the need for more targeted digital interventions for this group.
Absence from work and return to work in people with back pain: a systematic review and meta-analysis
Publisher: BMJ
Date: 11-2013
Adolescents and young adults who are not in employment, education, or training
Publisher: BMJ
Date: 18-09-2013
DOI: 10.1136/BMJ.F5270
A systematic review of the print media representation of ketamine treatments for psychiatric disorders
Publisher: Royal College of Psychiatrists
Date: 07-06-2023
DOI: 10.1192/BJO.2023.75
Abstract: Public and patient expectations of treatment influence health behaviours and decision-making. We aimed to understand how the media has portrayed the therapeutic use of ketamine in psychiatry. We systematically searched electronic databases for print and online news articles about ketamine for psychiatric disorders. The top ten UK, USA, Canadian and Australian newspapers by circulation and any trade and consumer magazines indexed in the databases were searched from 2015 to 2020. Article content was quantitatively coded with a framework encompassing treatment indication, descriptions of prior use, references to research, benefits and harms, treatment access and process, patient and professional testimony, tone and factual basis. We found 119 articles, peaking in March 2019 when the United States Food and Drug Administration approved esketamine. Ketamine treatment was portrayed in an extremely positive light ( n = 82, 68.9%), with significant contributions of positive testimony from key opinion leaders (e.g. clinicians). Positive research results and ketamine's rapid antidepressant effect ( n = 87, 73.1%) were frequently emphasised, with little reference to longer-term safety and efficacy. Side-effects were frequently reported ( n = 96, 80.7%), predominantly ketamine's acute psychotomimetic effects and the potential for addiction and misuse, and rarely cardiovascular and bladder effects. Not infrequently, key opinion leaders were quoted as being overly optimistic compared with the existing evidence base. Information pertinent to patient help-seeking and treatment expectations is being communicated through the media and supported by key opinion leaders, although some quotes go well beyond the evidence base. Clinicians should be aware of this and may need to address their patients’ beliefs directly.
Health status before, during and after disability pension award: the Hordaland Health Study (HUSK)
Publisher: BMJ
Date: 11-2008
Abstract: Up to one in eight of the working age population receives permanent disability benefits. As little is known about the consequences of this major event, analysis aimed to compare health status before and after disability pension award. Data from the population based Hordaland Health Study (HUSK) in Norway 1997-99 (n = 18 581) were linked to official disability benefits registries. The study identified 1087 participants who were awarded a disability pension before, during and after the health survey. These were grouped into different strata defined by temporal proximity between disability pension award and health survey participation. The study then compared health status across these strata covering the 7 years before to the 7 years after the award. The study found an inverse U-shaped trend with an increase in reported symptoms (anxiety, depression, pain distribution, sleep problems and somatic symptoms) approaching the award, and a reversing of this trajectory afterwards (p<0.05 for the non-linear trend for all symptoms). We found no similar trend for the more objective health measures blood pressure, physical diagnoses and prescribed medication. For most measures, similar levels of health problems were found 3-7 years before compared to 3-7 years after the award. When comparing the strata defined by time to the event of disability pension award, there was an increase in symptoms around the time of the disability pension award, with a subsequent return towards pre-award levels. The design precludes any firm conclusions as to what causes the observed results, but possible explanations include temporary adverse health effects from the process itself, the beneficial effects of being removed from harmful work conditions, and recovery after increasing health problems leading up to disability pension award.
Increasing rates of psychiatric publication from low- and middle-income countries
Publisher: SAGE Publications
Date: 03-08-2010
Abstract: Objective: The low level of psychiatric research in low- and middle-income (LAMI) countries has been identified as a cause for concern, particularly because the extent of the unmet need for psychiatric treatment in many LAMI countries is not known. The aim of this study was to establish if the worldwide increase in research publication during the last decade included an increase in publication about mental disorders from LAMI countries. Method: We searched PubMed for articles about mental disorder, depression and schizophrenia using the names of LAMI and high-income (HI) countries in the institutional affi liation address (AD) field published during two five-year periods: 1998—2002 and 2003—2007. We then examined the relationship between per capita publications about mental disorder and the independent variables of per capita gross domestic product purchasing power parity (GDP ppp), per capita psychiatric beds, per capita psychiatrists, total population and whether the country had a designated mental health budget. Results: The number of medical research publications per capita, and the number of publications about mental disorder from LAMI countries is low when compared to the rate from HI countries. However, the absolute number of publications from LAMI regions and the proportion of research publications about mental disorder, schizophrenia and depression increased significantly during the decade of the study. There were independent associations between GDP ppp and population size and the rate of publications about mental disorder in LAMI countries. Conclusions: The overall increase in the number of publications about mental disorder in the last decade probably reflects an increase in psychiatric research in LAMI countries. The increase in rates of publication was greatest in middle-income countries with the largest populations.
How Are Household Economic Circumstances Affected After a Stroke? The Psychosocial Outcomes In StrokE (POISE) Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2012
DOI: 10.1161/STROKEAHA.112.666453
Abstract: Stroke is associated with severe economic consequences. This is the first study to investigate in younger survivors the household economic burden of stroke. A multicenter, 3-year prospective cohort study was conducted of younger (18–65 years) survivors in Australia. Pre- and poststroke patterns of income and hardship were evaluated and multivariable logistic regression identified the predictors of economic hardship after stroke. Four hundred fourteen participants were followed up over 12 months after stroke. The variables that independently predicted economic hardship after stroke were: female (OR, 2.94 95% CI, 1.52–5.70), hazardous alcohol consumption (OR, 2.28 95% CI, 1.00–5.20), manual occupation (OR, 1.88 95% CI, 1.07–3.30), lack of health insurance (OR, 2.01 95% CI, 1.12–3.60), and prior hardship (OR, 3.93 95% CI, 2.12–7.29), whereas concessional status (OR, 0.50 95% CI, 0.26–0.95) and more social contacts per week (OR, 0.99 95% CI, 0.98–1.00) reduced hardship likelihood. Higher prestroke income did not buffer hardship after stroke nor did clinical, health service, or disability factors. Policies to reduce inequalities after stroke would be best aimed at socioeconomic targets.
The differential impact of major life events on cognitive and affective wellbeing.
Publisher: Elsevier BV
Date: 04-2020
A feasibility study of a mobile app to treat insomnia.
Publisher: Oxford University Press (OUP)
Date: 30-03-2021
DOI: 10.1093/TBM/IBAA019
Abstract: Insomnia is a major public health concern. Sleep restriction therapy (SRT) is an effective behavioral treatment but its delivery is impeded by a shortage of trained clinicians. We developed a mobile app delivering SRT to in iduals with insomnia. This feasibility study employed a mixed-methods design to examine the engagement, acceptability, and potential efficacy of the mobile app. Fifteen participants diagnosed with insomnia disorder used the mobile app synchronized with a wearable device for 3 weeks. Those who persisted with the study (n = 12) found the mobile app to be highly acceptable and engaging, logging on average 19 nightly sleep diary entries across the 21 day period. Significant improvements were observed for sleep measures (insomnia severity and sleep efficiency) and daytime symptoms (fatigue and sleepiness). The results suggest that a mobile app delivering SRT to in iduals with insomnia is engaging, acceptable, and potentially efficacious. Further, a full-scale effectiveness study is warranted.
Evaluating differential developmental trajectories to adolescent-onset mood and psychotic disorders
Publisher: Springer Science and Business Media LLC
Date: 12-11-2013
Prevalence of Driving and Traffic Accidents among People with Seizures: A Systematic Review
Publisher: S. Karger AG
Date: 2019
DOI: 10.1159/000500599
Abstract: b i Background and Objectives: /i /b Epilepsy influences the ability to drive. We undertook a systematic review to determine the prevalence of driving or holding a driver’s license among people with seizures, the prevalence of traffic accidents among those who drive, and factors that may explain heterogeneity in these point estimates. b i Method: /i /b We followed MOOSE and PRISMA guidelines in searching 8 databases from inception to June 27, 2018. All published observational studies were included, with the exception of case-control studies where prevalence could not be determined, case reports, and studies with fewer than 50 participants. We assessed external and internal validity and quality of studies, produced forest plots, and conducted meta-regression in “Stata 13.” b i Results: /i /b Data were available from 67 studies published between 1967 and 2018. Across the studies there was a wide range in the prevalence of driving (3–90%) and holding a driver’s license (8–98%). Up to 39% of people with epilepsy drove in violation of restrictions. Prevalence of traffic accidents ranged from 0 to 61% following seizure onset, or in the past 1–5 years. The percentage of people with seizures who drove decreased as time since diagnosis increased ( i /i = 0.01, adjusted i R /i sup /sup = 31%). The number of people with seizures who drove or held a driver’s license appears to have increased over time ( i /i = 0.02, adjusted i R /i sup /sup = 7%) but without a corresponding increase in the number of traffic accidents. There was considerable heterogeneity between studies related to definitions, design, and population differences. b i Conclusions: /i /b There is considerable variation in the prevalence of driving after a diagnosis of epilepsy and in reported motor vehicle accidents. Further efforts are required to better understand the impact of epilepsy, and epilepsy surgery, on driving and road safety, especially where driving continues in violation of restrictions. Policy changes are needed to encourage the introduction of available and affordable alternatives for driving, for ex le, developing public transport networks, and promoting subsidy schemes to encourage use of public transport, taxis, Uber, and Lyft, among people experiencing seizures.
Environmental exposures and their genetic or environmental contribution to depression and fatigue: a twin study in Sri Lanka
Publisher: Springer Science and Business Media LLC
Date: 02-02-2010
eHealth interventions for the prevention of depression and anxiety in the general population: A systematic review and meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 29-08-2017
Mental Health Support for Chinese Healthcare Professionals: Challenges and Opportunities (Preprint)
Publisher: JMIR Publications Inc.
Date: 27-07-2023
Abstract: ental health issues like burnout is prevalent among healthcare professionals (HCPs) in China, necessitating specially targeted interventions. However, most evidence-based interventions are developed and validated in the Global North. Whether these approaches are feasible in the Chinese healthcare context remains unclear. More contextual research is needed to inform the design and implementation of mental health support tools for Chinese HCPs. his study aimed to explore multiple aspects among Chinese HCPs, including their work engagement level, along with their knowledge and perceptions concerning mental health and support techniques. By doing so, the research sought to identify challenges and potential opportunities for developing effective and engaging mental health support specifically tailored to Chinese HCPs' needs. his study aimed to explore multiple aspects among Chinese HCPs, including their work engagement level, along with their knowledge and perceptions concerning mental health and support techniques. By doing so, the research sought to identify challenges and potential opportunities for developing effective and engaging mental health support specifically tailored to Chinese HCPs' needs. 20 valid survey responses were collected, and 10 interviews were conducted. In this s le, Chinese HCPs had a work engagement score of 3.64 (SD=1.19). Participants demonstrated a concerning lack of knowledge on mental health, with 52% unaware of "burnout" and over 70% unfamiliar with its interventions. Strong stigma was identified from their perspectives on mental health issues and seeking support. Participants demonstrated a strong inclination towards self-reliant coping when facing stress and burnout. They also reported a significantly higher preference score for personal space for relaxation as a means of mental health support at work. On the other hand, they expressed a strong aversion towards less private means like group-based support and counselling. Digital interventions for HCPs are currently not common in China but HCPs are open to adopting them, suggesting the potential for larger impact. n this study, work engagement among Chinese HCPs was found to be significantly lower than that of their counterparts in the Global North. Low mental health literacy and stigma are identified as key challenges when implementing mental health support for Chinese HCPs. Implementation of interventions that inform them about mental health, emphasize privacy, and provide personal space are strongly recommended, as it presents an opportunity to promote mental well-being within this particular cohort. This study offers new perspectives on the cross-cultural dimensions of mental health support and calls for contextually adapted interventions for HCPs in erse cultural contexts.
A systematic review and meta-analysis of placebo versus no treatment for insomnia symptoms.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.SMRV.2017.03.006
Abstract: This systematic review and meta-analysis aimed to determine the size of the placebo effect for insomnia symptoms when comparing placebo treatment with no treatment. PsycINFO, MEDLINE, and CINAHL databases were systematically searched for studies allocating participants with insomnia symptoms (diagnosed or self-reported) to receive a placebo that they were led to believe was an active treatment or to a no treatment control group. Thirteen independent studies (n = 566) met inclusion criteria. Meta-analysis indicated a reliable placebo effect whereby placebo treatment led to improved perceived sleep onset latency (SOL Hedges g = 0.272), total sleep time (TST Hedges g = 0.322), and global sleep quality (GSQ Hedges' g = 0.581), when compared with no treatment. There was no effect on objective assessment of SOL, however only a few studies reported this outcome and there were insufficient s le sizes to meta-analyse other objective outcomes. Moderator analysis indicated that the placebo effect for perceived insomnia symptoms was quite consistent across different variables. The present findings provide strong evidence for placebo effects for perceived insomnia symptoms, but not on the only objective measurement with sufficient s le size to meta-analyse, namely objective SOL. This has important implications for the treatment of insomnia symptoms and the design and interpretation of clinical trials for insomnia symptoms.
Who is driving and who is prone to have traffic accidents? A systematic review and meta-analysis among people with seizures
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.YEBEH.2019.03.032
Abstract: Epilepsy influences the ability to drive. We aimed to systematically summarize factors associated with driving, holding a driver's license, and traffic accidents among people with seizures. Eight databases were searched (from their inception to 27 June 2018). We included all published observational studies, except for case reports and studies with fewer than 50 participants. Pooled mean differences and pooled risk ratios (pRRs) with corresponding confidence intervals (CIs) were calculated using random effects. Data were available from 18 studies, reporting a wide range of factors. There were frequent biases associated with cross-sectional study designs, selection bias, poor statistical quality, small s les, and lack of validation of models. The following six variables were consistently associated with driving: male gender (pRR: 1.42 95% CI: 1.23 to 1.64), being in paid work (pRR: 1.72 95% CI: 1.46 to 2.03), married (pRR: 1.26 95% CI: 1.01 to 1.57), older age at seizure onset or diagnosis (pooled mean difference: 4.83 95% CI: 0.48 to 9.18 years), less frequent seizures (fewer than monthly, pRR: 1.32 95% CI: 1.12 to 1.56), and taking one or no antiepileptic drug (pRR: 1.34 95% CI: 1.09 to 1.63). Lower seizure frequency was also protective for avoiding traffic accidents (pRR: 0.26 95% CI: 0.10 to 0.66). Stable multivariate models to predict driving or traffic accidents among people with seizures have not yet been developed. Current evidence shows that the likelihood of driving is associated with demographic and epilepsy-related factors, while the risk of traffic accidents is associated with seizure frequency.
Distress, quality of life and disability in treatment-seeking young adults with social anxiety disorder
Publisher: Wiley
Date: 16-01-2021
DOI: 10.1111/EIP.12910
Abstract: This study aimed to: (a) examine whether treatment-seeking young adults with social anxiety disorder (SAD) demonstrate similar degrees of distress, quality of life (QoL) and disability to those with other mental disorders and (b) investigate the impact of comorbidity, specific comorbid conditions and antidepressants use on distress, QoL and disability in treatment-seeking young adults with SAD. A cohort of treatment-seeking young adults (aged 16-45) diagnosed with SAD (N = 298) or other mental health disorders (N = 842 including depression, N = 349 bipolar, N = 141 psychosis, N = 173) completed self-report assessments of distress, QoL and disability. Young adults with SAD showed distress and disability of similar degree to those with most other mental disorders. Specifically, young adults with SAD reported significantly lower QoL than those with major depressive disorder or obsessive-compulsive disorder. Furthermore, young adults with SAD had the most difficulties in getting along with others and the second highest level of distress in comparison to other psychiatric groups. In comparison to antidepressants use, the presence of comorbidity showed a substantial negative influence on these health outcomes, particularly when presenting with comorbid depression or obsessive-compulsive disorder. Findings highlight significant impairments in young adults seeking treatment for SAD and the important moderating influence of comorbidity. This emphasizes the urgent need for effective management and treatment for its presentation and comorbidities in mental health services targeting young adults.
Mindfulness and yoga for psychological trauma: systematic review and meta-analysis
Publisher: Informa UK Limited
Date: 26-05-2020
Development of the Shift Smartphone App to Support the Emotional Well-Being of Junior Physicians: Design of a Prototype and Results of Usability and Acceptability Testing (Preprint)
Publisher: JMIR Publications Inc.
Date: 09-12-2020
Abstract: unior physicians report higher levels of psychological distress than senior doctors and report several barriers to seeking professional mental health support, including concerns about confidentiality and career progression. Mobile health (mHealth) apps may be utilized to help overcome these barriers to assist the emotional well-being of this population and encourage help-seeking. his study describes the development and pilot trial of the i Shift /i mHealth app to provide an unobtrusive avenue for junior physicians to seek information about, and help for, well-being and mental health concerns, which is sensitive to workplace settings. 4-phase iterative development process was undertaken to create the content and features of i Shift /i involving junior physicians using the principles of user-centered design. These 4 phases were—needs assessment, on the basis of interviews with 12 junior physicians prototype development with user experience feedback from 2 junior physicians evaluation, consisting of a pilot trial with 22 junior physicians to assess the usability and acceptability of the initial prototype and redesign, including user experience workshops with 51 junior physicians. ualitative results informed the content and design of i Shift /i to ensure that the app was tailored to junior physicians’ needs. The i Shift /i app prototype contained cognitive behavioral, mindfulness, value-based actions, and psychoeducational modules, as well as a tracking function that visualized patterns of daily variations in mood and health behaviors. Pilot-testing revealed possible issues with the organization of the app content, which were addressed through a thorough restructuring and redesign of i Shift /i with the help of junior physicians across 3 user experience workshops. his study demonstrates the importance of ongoing end user involvement in the creation of a specialized mHealth app for a unique working population experiencing profession-specific stressors and barriers to help-seeking. The development and pilot trial of this novel i Shift /i mHealth app are the first steps in addressing the mental health and support-seeking needs of junior physicians, although further research is required to validate its effectiveness and appropriateness on a larger scale.
Examining the efficacy of a multicomponent m-Health physical activity, diet and sleep intervention for weight loss in overweight and obese adults: randomised controlled trial protocol
Publisher: BMJ
Date: 10-2018
DOI: 10.1136/BMJOPEN-2018-026179
Abstract: Traditional behavioural weight loss trials targeting improvements in physical activity and diet are modestly effective. It has been suggested that sleep may have a role in weight loss and maintenance. Improving sleep health in combination with physical activity and dietary behaviours may be one strategy to enhance traditional behavioural weight loss trials. Yet the efficacy of a weight loss intervention concurrently targeting improvements in physical activity, dietary and sleep behaviours remains to be tested. The primary aim of this three-arm randomised controlled trial is to examine the efficacy of a multicomponent m-Health behaviour change weight loss intervention relative to a waitlist control group. The secondary aims are to compare the relative efficacy of a physical activity, dietary behaviour and sleep intervention (enhanced intervention), compared with a physical activity and dietary behaviour only intervention (traditional intervention), on the primary outcome of weight loss and secondary outcomes of waist circumference, glycated haemoglobin, physical activity, diet quality and intake, sleep health, eating behaviours, depression, anxiety and stress and quality of life. Assessments will be conducted at baseline, 6 months (primary endpoint) and 12 months (follow-up). The multicomponent m-Health intervention will be delivered using a smartphone/tablet ‘app’, supplemented with email and SMS and in idualised in-person dietary counselling. Participants will receive a Fitbit, body weight scales to facilitate self-monitoring, and use the app to access educational material, set goals, self-monitor and receive feedback about behaviours. Generalised linear models using an analysis of covariance (baseline adjusted) approach will be used to identify between-group differences in primary and secondary outcomes, following an intention-to-treat principle. The Human Research Ethics Committee of The University of Newcastle Australia provided approval: H-2017–0039. Findings will be disseminated via publication in peer-reviewed journals, conference presentations, community presentations and student theses. ACTRN12617000735358 UTN1111-1219-2050.
The Effectiveness of Digital Insomnia Treatment with Adjunctive Wearable Technology: A Pilot Randomized Controlled Trial
Publisher: Informa UK Limited
Date: 20-08-2021
DOI: 10.1080/15402002.2021.1967157
Abstract: This pilot trial aimed to provide evidence for whether the integration of a wearable device with digital behavioral therapy for insomnia (dBTi) improves treatment outcomes and engagement. One hundred and twenty-eight participants with insomnia symptoms were randomized to a 3-week dBTi program (SleepFix®) with a wearable device enabling sleep data synchronization (dBTi+wearable group n = 62) or dBTi alone (n = 66). Participants completed the Insomnia Severity Index (ISI) and modified Pittsburgh Sleep Quality Index (PSQI) parameters: wake-after-sleep-onset (WASO), sleep-onset-latency (SOL), and total sleep time (TST) at baseline and weeks 1, 2, 3, and primary endpoint of week 6 and follow-up at 12 weeks. Engagement was measured by the number of daily sleep diaries logged in the app. There was no difference in ISI change scores between the groups from pre- to post-treatment (Cohen's This pilot trial found that integration of wearable device with a digital insomnia therapy enhanced user engagement and led to improvements in sleep parameters compared to dBTi alone. These findings suggest that adjunctive wearable technologies may improve digital insomnia therapy effectiveness.
The importance of manager support for the mental health and well-being of ambulance personnel
Publisher: Public Library of Science (PLoS)
Date: 23-05-2018
Communicating Personal Risk Profiles of Alzheimer’s Disease to Older Adults: A Pilot Trial
Publisher: SERDI
Date: 2021
Abstract: Communicating personal Alzheimer’s disease risk profiles based on validated risk algorithms may improve public knowledge about risk reduction, and initiate action. This proof of concept pilot trial aimed to test whether this is feasible and potentially effective and/or harmful. Older at-risk adults (N=24) were provided with their personal Alzheimer’s disease risk profile online, which contained information on their personal risk level, scores and tailored recommendations to manage modifiable risk factors. After receiving the risk profile, participants were significantly more accurate in identifying risk and protective factors, and revised their perceived risk to be lower than their initial estimate. There was no apparent harm seen in psychological distress or dementia-related worry. This shows preliminary support for the feasibility of delivering personal dementia risk profiles to low risk, help-seeking older adults in an online format. A definitive trial examining behavioural outcomes and testing in groups with higher risk profiles is now warranted.
Selective Prevention of Depression in Workers Using a Smartphone App: Randomized Controlled Trial
Publisher: JMIR Publications Inc.
Date: 24-08-2023
DOI: 10.2196/45963
Abstract: There is increasing evidence that depression can be prevented however, universal approaches have had limited success. Appropriate targeting of interventions to at-risk populations has been shown to have potential, but how to selectively determine at-risk in iduals remains unclear. Workplace stress is a risk factor for depression and a target for intervention, but few interventions exist to prevent depression among workers at risk due to heightened stress. This trial aimed to evaluate the efficacy of a smartphone-based intervention in reducing the onset of depression and improving related outcomes in workers experiencing at least moderate levels of stress. A randomized controlled trial was conducted with participants who were currently employed and reported no clinically significant depression and at least moderate stress. The intervention group (n=1053) were assigned Anchored, a 30-day self-directed smartphone app-based cognitive behavioral- and mindfulness-based intervention. The attention-control group (n=1031) were assigned a psychoeducation website. Assessment was performed via web-based self-report questionnaires at baseline and at 1-, 3-, and 6-month postbaseline time points. The primary outcome was new depression caseness aggregated over the follow-up period. The secondary outcomes included depressive and anxiety symptoms, stress, well-being, resilience, work performance, work-related burnout, and quality of life. Analyses were conducted within an intention-to-treat framework using mixed modeling. There was no significant between-group difference in new depression caseness (z score=0.69 P=.49) however, those in the Anchored arm had significantly greater depressive symptom reduction at 1 month (Cohen d=0.02 P=.049) and 6 months (Cohen d=0.08 P=.03). Anchored participants also showed significantly greater reduction in anxiety symptoms at 1 month (Cohen d=0.07 P=.04) and increased work performance at 1 month (Cohen d=0.07 P=.008) and 6 months (Cohen d=0.13 P=.01), compared with controls. Notably, for Anchored participants completing at least two-thirds of the intervention, there was a significantly lower rate of depression onset (1.1%, 95% CI 0.0%-3.7%) compared with controls (9.0%, 95% CI 6.8%-12.3%) at 1 month (z score=4.50 P .001). Significant small to medium effect sizes for most secondary outcomes were seen in the highly engaged Anchored users compared with controls, with effects maintained at the 6-month follow-up for depressive symptoms, well-being, stress, and quality of life. Anchored was associated with a small comparative reduction in depressive symptoms compared with controls, although selective prevention of case-level depression was not observed in the intention-to-treat analysis. When users adequately engaged with the app, significant findings pertaining to depression prevention, overall symptom reduction, and functional improvement were found, compared with controls. There is a need for a greater focus on engagement techniques in future research. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000178943 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378592
Physical health, depression and cognitive function as correlates of disability in an older Korean population
Publisher: Wiley
Date: 2005
DOI: 10.1002/GPS.1266
Abstract: The World Health Organisation Disability Assessment Schedule II (WHODAS II) measures functioning and disability in concordance with the bio-psycho-social model of the WHO's International Classification of Functioning, Disability, and Health. Our objectives were to investigate the independent associations of physical health, depression and cognitive function with WHODAS II disability in an older Korean population. The WHODAS II was administered to a community s le of 1204 residents age 65 or over. Data on demographic characteristics (age, gender, living area, marital state, and religion), socio-economic state (education, type of accommodation, number of rooms, previous occupation, current employment, monthly income), social support, number of physical illness, depression (GMS), and cognitive function (MMSE) was gathered. A subs le (n = 746) received a clinical examination for dementia. Scores on the WHODAS II were significantly and independently associated with worse physical health, depression, and lower cognitive function. Associations with other factors were no longer apparent after adjustment for these. These associations persisted in the absence of dementia. In participants with dementia (n = 110), WHODAS II scores were principally associated with physical health and accommodation type. Level of disability, as measured by the WHODAS II, was principally associated with physical health, depression and cognitive function, rather than socio-demographic factors.
Sampling bias in an internet treatment trial for depression
Publisher: Springer Science and Business Media LLC
Date: 23-10-2012
DOI: 10.1038/TP.2012.100
Personalised yoga for burnout and traumatic stress in junior doctors.
Publisher: Oxford University Press (OUP)
Date: 16-04-2020
DOI: 10.1136/POSTGRADMEDJ-2019-137413
Abstract: Junior doctors are frequently exposed to occupational and traumatic stress, sometimes with tragic consequences. Mindfulness-based and fitness interventions are increasingly used to mitigate this, but have not been compared. We conducted a randomised, controlled pilot trial to assess the feasibility, acceptability and effectiveness of these interventions in junior doctors. We randomised participants (n=21) to weekly 1-hour sessions of personalised, trauma-informed yoga (n=10), with a 4-hour workshop, and eHealth homework or group-format fitness (n=8) in an existing wellness programme, MDOK. Burnout, traumatic stress and suicidality were measured at baseline and 8 weeks. Both interventions reduced burnout, and yoga increased compassion satisfaction within group on the Professional Quality of Life scale, without difference between groups on this measure. Personalised yoga significantly reduced depersonalisation (z=−1.99, p=0.05) compared with group fitness on the Maslach Burnout Inventory (MBI-HSS (MP)) and showed greater flexibility changes. Both interventions increased MBI Personal Accomplishment, with no changes in other self-report psychological or physiological metrics, including breath-counting. Participants doing one-to-one yoga rated it more highly overall (p=0.02) than group fitness, and reported it comparatively more beneficial for mental (p=0.01) and physical health (p=0.05). Face-to-face weekly sessions were 100% attended in yoga, but only 45% in fitness. In this pilot trial, both yoga and fitness improved burnout, but trauma-informed yoga reduced depersonalisation in junior doctors more than group-format fitness. One-to-one yoga was better adhered than fitness, but was more resource intensive. Junior doctors need larger-scale comparative research of the effectiveness and implementation of in idual, organisational and systemic mental health interventions. ANZCTR 12618001467224.
Disability in older adults across the continuum of cognitive decline: unique contributions of depression, sleep disturbance, cognitive deficits and medical burden
Publisher: Cambridge University Press (CUP)
Date: 04-02-2019
DOI: 10.1017/S1041610218002144
Abstract: Disability in older adults is associated with a need for support in work, education, and community activities, reduced independence, and poorer quality of life. This study examines potential determinants of disability in a clinical s le of older adults across the continuum of cognitive decline, including sociodemographic, medical, psychiatric, and cognitive factors. This is a cross-sectional study. Participants were recruited from a specialty clinic for adults “at risk” of or with early dementia (including subjective cognitive complaints, mild cognitive impairment, and early dementia). Four hundred forty-two older adults (mean age = 67.11, SD = 9.33) underwent comprehensive medical, neuropsychological, and mood assessments. Disability was assessed via the self-report World Health Organization Disability Assessment Schedule 2.0. A stepwise (forward) linear regression model was computed to determine factors that contribute to disability within this group. Depressive symptoms were the largest predictor, uniquely explaining 31.8% of the variance. Other contributing factors in the model included younger age, medical burden, and sleep quality, with all factors together accounting for a total of 50.4% of the variance in disability. Cognitive variables did not contribute to the model. Depressive symptoms account for a significant portion of the variance in disability, but other factors such as age, medical burden and sleep quality are also important contributors in older adults across the continuum of cognitive decline. The relative association of these variables with disability appears to differ for older (≥65 years) relative to younger ( years) participants. Given the relationship between disability and these risk factors, an integrative and multidisciplinary approach to risk reduction will likely be most effective, with potential carry over effects for physical and mental health.
Frequency and predictors of psychological distress after a diagnosis of epilepsy: A community-based study
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.YEBEH.2017.07.044
Abstract: The objective of the study was to determine the frequency and predictors of psychological distress after a diagnosis of epilepsy. The Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC) was a prospective, multicenter, community-based study of people of all ages with newly diagnosed epilepsy in Sydney, Australia. Analyses involved multivariate logistic regression and multinomial logit regression to identify predictors of psychological distress, assessed using the Hospital Anxiety and Depression Scale (HADS) and the Strengths and Difficulties Questionnaire (SDQ), as part of structured interviews. Psychological distress occurred in 33% (95% confidence interval [CI] 26 to 40%) and 24% (95% CI 18 to 31%) of 180 adults at baseline and 12months, respectively, and 23% (95% CI 14 to 33%) of 77 children at both time points. Thirty adults and 7 children had distress at baseline who recovered at 12months, while 15 adults and 7 children had new onset of distress during this period. History of psychiatric or behavioral disorder (for adults, odds ratio [OR] 6.82, 95% CI 3.08 to 15.10 for children, OR 28.85, 95% CI 2.88 to 288.60) and higher psychosocial disability (adults, OR 1.17, 95% CI 1.07 to 1.27) or lower family functioning (children, OR 1.80, 95% CI 1.08 to 3.02) were associated with psychological distress (C statistics 0.80 and 0.78). Psychological distress is common and fluctuates in frequency after a diagnosis of epilepsy. Those with premorbid psychological, psychosocial, and family problems are at high risk of this adverse outcome.
Preliminary Effectiveness of a Smartphone App to Reduce Depressive Symptoms in the Workplace: Feasibility and Acceptability Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 25-07-2018
Abstract: he workplace represents a unique setting for mental health interventions. Due to range of job-related factors, employees in male-dominated industries are at an elevated risk. However, these at-risk groups are often overlooked. HeadGear is a smartphone app–based intervention designed to reduce depressive symptoms and increase well-being in these populations. his paper presents the development and pilot testing of the app’s usability, acceptability, feasibility, and preliminary effectiveness. he development process took place from January 2016 to August 2017. Participants for prototype testing (n=21 stage 1) were recruited from industry partner organizations to assess acceptability and utility. A 5-week effectiveness and feasibility pilot study (n=84 stage 2) was then undertaken, utilizing social media recruitment. Demographic data, acceptability and utility questionnaires, depression (Patient Health Questionnaire-9), and other mental health measures were collected. he majority of respondents felt HeadGear was easy to use (92%), easily understood (92%), were satisfied with the app (67%), and would recommend it to a friend (75% stage 1). Stage 2 found that compared with baseline, depression and anxiety symptoms were significantly lower at follow-up (t30=2.53 P=.02 and t30=2.18 P=.04, respectively), days of sick leave in past month (t28=2.38 P=.02), and higher self-reported job performance (t28=−2.09 P=.046 stage 2). Over 90% of respondents claimed it helped improve their mental fitness, and user feedback was again positive. Attrition was high across the stages. verall, HeadGear was well received, and preliminary findings indicate it may provide an innovative new platform for improving mental health outcomes. Unfortunately, attrition was a significant issue, and findings should be interpreted with caution. The next stage of evaluation will be a randomized controlled trial. If found to be efficacious, the app has the potential to reduce disease burden and improve health in this at-risk group.
Academic performance in adolescents with delayed sleep phase
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.SLEEP.2015.04.011
Abstract: Delayed sleep phase (DSP) in adolescence has been linked to reduced academic performance, but there are few population-based studies examining this association using validated sleep measures and objective outcomes. The youth@hordaland-survey, a large population-based study from Norway conducted in 2012, surveyed 8347 high-school students aged 16-19 years (54% girls). DSP was assessed by self-report sleep measures, and it was operationalized according to the International Classification of Sleep Disorders - Second Edition. School performance (grade point average, GPA) was obtained from official administrative registries, and it was linked in idually to health data. DSP was associated with increased odds for poor school performance. After adjusting for age and gender, DSP was associated with a threefold increased odds of poor GPA (lowest quartile) [odds ratio (OR) = 2.95 95% confidence interval (CI): 2.03-4.30], and adjustment for sociodemographics and lifestyle factors did not, or only slightly, attenuate this association. Adjustment for nonattendance at school reduced the association substantially, and in the fully adjusted model, the effect of DSP on poor academic performance was reduced to a non-significant level. Mediation analyses confirmed both direct and significant indirect effects of DSP on school performance based on school absence, daytime sleepiness, and sleep duration. Poor academic performance may reflect an independent effect of underlying circadian disruption, which in part could be mediated by school attendance, as well as daytime sleepiness and short sleep duration. This suggests that careful assessment of sleep is warranted in addressing educational difficulties.
Occupational egg allergy in an embryological research facility
Publisher: Oxford University Press (OUP)
Date: 07-06-2013
Abstract: Hen and quail eggs are commonly used in embryological research. While immunoglobin E (IgE)-associated allergy to hens' egg proteins is recognized in employees in the food industry, there are no previous reports from workers in embryological research. Two newly identified cases prompted us to examine the extent of this problem in a university laboratory. To determine the prevalence and determinants of sensitization to egg among a group of workers in an embryological research laboratory. Following the identification of egg sensitization in two research workers, we surveyed 116 employees from a single embryology research laboratory in 2005. Sensitization to egg was assessed by skin prick tests and/or specific IgE measurement and examined in relation to a number of potential determinants, including the extent of appropriate control measures. Four employees were sensitized to egg, each with digestive symptoms of egg allergy. All had worked directly with eggs, giving a prevalence of specific sensitization in that group of 6.1% (95% confidence interval (CI) [1.7%, 14.8%]). There was a statistically significant trend for those sensitized to report a shorter duration of exposure to eggs and less frequent use of hygiene control measures to reduce exposure. Sensitization to eggs among those occupationally exposed to egg protein in research work occurs more commonly than in the general population. The presence of digestive symptoms after eating eggs may be indicative of sensitization to egg and should be incorporated into health evaluation of exposed workers.
Early intervention for cognitive decline: Is there a role for multiple medical or behavioural interventions?
Publisher: Wiley
Date: 02-2009
DOI: 10.1111/J.1751-7893.2008.00102.X
Abstract: Early medical or behavioural intervention to slow cognitive decline might be a viable strategy for reducing disability and rates of institutional care in older persons. This paper details the published work supporting cross-sectional and longitudinal associations between vascular risk factors, depressive symptoms and progressive cognitive decline. Evidence for the beneficial effects of providing relevant interventions is assessed. Relevant published work from the areas of dementia research, 'vascular depression' and the cognitive benefits that might result from treating vascular risk factors, managing depression or promoting nutrition, cognitive or physical exercise was ascertained from electronic database searches and recent reviews of key areas. The existing published work does not provide many ex les of early intervention strategies that target vascular strategies or active treatment of depression to reduce the rate of cognitive decline. Most studies have major limitations including the evaluation of only single-risk-factor interventions, the observational designs and the inadequate measurement of cognition. An optimal early intervention strategy might be to target multiple risk factors within relevant experimental or health service frameworks. Early identification and multifaceted reduction of vascular risk factors, active management of depression, engagement in cognitive activity and physical exercise and promotion of better nutrition might together help to slow some forms of cognitive decline or progression to dementia. This health services approach now requires systematic evaluation.
Recognition and treatment of depression
Publisher: Springer Science and Business Media LLC
Date: 20-11-2009
DOI: 10.1007/S00127-008-0471-5
Abstract: Depression is a major public health problem in both China and Australia. To improve services, we need to ensure health professionals have an appropriate understanding of depression and its treatments. This study compares the level of awareness of depression between Chinese and Australian medical students. The International Depression Literacy Survey assessing the public health impact, recognition and treatment of depression was completed by pre-psychiatric training medical students in China (n = 220) and Australia (n = 177). Chinese students were far less likely to consider mental health conditions and depression as major public health problems (P < 0.001). Depression symptom recognition was similar with four of the top five symptoms of depression the same in both groups of students. Chinese students were more likely to consider some psychological symptoms such as "thinking life is not worth living", but less likely to consider somatic features such as "sleep disturbance" as typical for people with depression. Chinese students were more likely to claim that they would seek help from mental health professionals if experiencing depression whilst Australian students were more likely to seek help from a general or family doctor. Chinese medical students recognise depression similarly to Australian students but do not consider it a major public health problem. These results challenge the stereotype that depression is characterised by somatic symptoms in China. Increasing awareness of the public health impact of depression should be incorporated into the medical curriculum in China.
Commencing and Persisting With a Web-Based Cognitive Behavioral Intervention for Insomnia: A Qualitative Study of Treatment Completers
Publisher: JMIR Publications Inc.
Date: 10-02-2017
DOI: 10.2196/JMIR.5639
How junior doctors perceive personalised yoga and group exercise in the management of occupational and traumatic stressors.
Publisher: Oxford University Press (OUP)
Date: 09-03-2021
DOI: 10.1136/POSTGRADMEDJ-2020-139191
Abstract: Junior doctors are exposed to occupational and traumatic stressors, some of which are inherent to medicine. This can result in burnout, mental ill-health and suicide. Within a crossover pilot study comparing personalised, trauma-informed yoga to group-format exercise, qualitative interviews were conducted to understand the experience of junior doctors and whether such interventions were perceived to help manage these stressors. Twenty-one doctors, 76% female, were order-randomised to consecutive 8-week yoga and exercise programmes. Fifty-two interviews were recorded before and after each programme. Many participants reported being time poor, sleep-affected, frequently stressed and occasionally in physical pain/distress. Major stressor themes were workplace incivility, death/human suffering and shift work with minimal support. Both interventions were acceptable for different reasons. Personalised yoga offered a therapeutic alliance, time to check-in and reduced anxiety/rumination. Group exercise provided energy and social connection. One participant found yoga beneficial following an acute workplace trauma: ‘It was really eye opening how much I felt my body just needed to detox … I wouldn't have gone to a group fitness the next day … I just wanted to relax and breathe …We still had a big debrief which was great … (but) I almost felt like … I dealt with it physically and emotionally before going into it (P20).’ Junior doctors found both interventions useful for stress management adjunctive to other organisational programmes though for different and complementary reasons, possibly related to delivery mode. Personalised, trauma-informed yoga provided a confidential therapeutic alliance whereas group exercise offered social connection.
Does the metabolic syndrome exist? The identification of cardio-metabolic profiles in a South Asian population study
Publisher: Cold Spring Harbor Laboratory
Date: 29-11-2019
DOI: 10.1101/19012195
Abstract: Research testing the validity of the metabolic syndrome (MetS) as a clinical construct associated with cardiovascular disease risk has produced inconsistent results. This study tested the existence of the MetS, explored alternative cardiometabolic risk characterisations, and examined the relative influence of genetic and environmental factors in a South Asian s le. Data came from the Colombo Twin and Singleton follow-up Study, CoTaSS-2 (N=3969). Latent class analysis tested the clustering of MetS indicators (waist circumference, high-density-lipoprotein cholesterol (HDL-C), triglycerides (TG), blood pressure, fasting plasma glucose (FPG), medications and diabetes). Regression analyses tested cross-sectional associations between identified latent classes and covariates. Structural equation modelling estimated genetic and environmental influences on these classes. Analyses were stratified by gender (n=1681 men, n=2288 women). Three classes were identified in men: 1) “Healthy” (52.3%), 2) “Central obesity, high TG, high FPG” (40.2%), and 3) “Central obesity, high TG, diabetes” (7.6%). Four classes were identified in women: 1) “Healthy” (53.2%), 2) “Very high central obesity, low HDL-C, raised FPG” (32.8%), 3) “Very high central obesity, diabetes” (7.2%) and 4) “Central obesity, hypertension, raised FPG” (6.8%). Older age in men and women, and high socioeconomic status in men, was associated with cardiometabolic risk categories, compared to the “Healthy” classes. In men, in idual differences in cardiometabolic class membership were due to environmental effects. In females, genetic differences significantly predicted class membership. The findings did not support the MetS construct. Instead, distinct clinical profiles were identified in men and women, suggesting different aetiological pathways.
Applying clinical staging to young people who present for mental health care
Publisher: Wiley
Date: 05-06-2013
DOI: 10.1111/J.1751-7893.2012.00366.X
Abstract: The study aims to apply clinical staging to young people who present for mental health care to describe the demographic features, patterns of psychological symptoms, disability correlates and clinical stages of those young people and to report longitudinal estimates of progression from less to more severe stages. The study uses cross-sectional and longitudinal assessments of young people managed in specialized youth clinics. On the basis of clinical records, subjects were assigned to a specific clinical 'stage' (i.e. 'help-seeking', 'attenuated syndrome', 'discrete disorder' or 'persistent or recurrent illness'). Young people (n = 209, mean age = 19.9 years (range = 12-30 years), 48% female) were selected from a broader cohort of n = 1483 subjects. Ten percent were assigned to the earliest 'help-seeking' stage, 54% to the 'attenuated syndrome' stage, 25% to the 'discrete disorder' stage and 11% to the later 'persistent or recurrent illness' stage. The interrater reliability of independent ratings at baseline was acceptable (κ = 0.71). Subjects assigned to the 'attenuated syndrome' stage reported symptom and disability scores that were similar to those assigned to later stages. Longitudinally (median = 48 weeks), transition to later clinical stages were 11% of the 'help-seeking', 19% of the 'attenuated syndrome' and 33% of the 'discrete disorder' groups. Among young people presenting for mental health care, most are clinically staged as having 'attenuated syndromes'. Despite access to specialized treatment, a significant number progress to more severe or persistent disorders.
EPA-1092 – Insomnia predicts mortality in a middle-age population
Publisher: Cambridge University Press (CUP)
Date: 2014
Correction: Preliminary Investigation of Shift, a Novel Smartphone App to Support Junior Doctors’ Mental Health and Well-being: Examination of Symptom Progression, Usability, and Acceptability After 1 Month of Use (Preprint)
Publisher: JMIR Publications Inc.
Date: 14-03-2023
Abstract: hift is a novel smartphone app for providing a digital-first mental health resource to junior doctors. It contains psychoeducational material, cognitive behavioral modules, guided mediations, information on common work stressors, and a section on help-seeking options for psychological problems through workplace and private avenues. his study aimed to conduct a preliminary investigation of the use and potential effectiveness of i Shift /i on depressive and anxiety symptoms (primary outcomes) and work and social functioning, COVID-19 safety concerns, and help seeking (secondary outcomes). This study also sought feedback on whether i Shift /i was seen as an acceptable tool. unior doctors in New South Wales, Australia, were approached through promotional activities from the Ministry of Health, specialist medical colleges, and social media advertisements between June and August 2020. Consenting participants provided web-based baseline data, used the i Shift /i app for 30 days, and were asked to complete a poststudy web-based questionnaire. Outcomes were analyzed under the intention-to-treat principle. total of 222 (n=156 female, 70.3% mean age 29.2, SD 4.61 years) junior doctors provided full baseline data. Of these, 89.2% (198/222) downloaded the app, logged into the app approximately 6 times (mean 5.68, SD 7.51), completed 4 in-app activities (mean 3.77, SD 4.36), and spent a total of 1 hour on in-app activities (mean 52:23, SD 6:00:18) over 30 days. Postintervention and app use data were provided by 24.3% (54/222) of participants. Depressive and anxiety symptoms significantly decreased between the pre- and postassessment points as expected however, physicians’ COVID-19 safety concerns significantly increased. Work and social functioning, COVID-19 concerns for family and friends, and help seeking did not change significantly. There was no significant relationship between symptom changes and app use (number of log-ins, days between first and last log-in, and total activity time). Most poststudy completers (31/54, 57%) rated i Shift /i highly or very highly. espite high levels of nonresponse to the poststudy assessment and increases in COVID-19 safety concerns, junior doctors who used the app reported some improvements in depression and anxiety, which warrant further exploration in a robust manner.
Delayed sleep onset in depressed young people
Publisher: Springer Science and Business Media LLC
Date: 08-02-2014
Validation of the social functioning scale: Comparison and evaluation in early psychosis, autism spectrum disorder and social anxiety disorder
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.PSYCHRES.2019.03.037
Abstract: Social functioning is an important component of mental disorders for assessment and treatment. There is no recognised self-report instrument to measure social functioning across disorders where social impairment is significant. The Social Functioning Scale (SFS) has, however, been used to assess social functioning in psychotic disorders, including Schizophrenia and Early Psychosis. The current study investigated the reliability, validity and sensitivity of the SFS in Early Psychosis, Autism Spectrum Disorder (ASD), Social Anxiety Disorder (SAD) and neurotypical control populations. As expected, all clinical groups showed significant impairment on the total and sub-scale scores of the SFS. The SFS showed good internal consistency and concurrent validity for people diagnosed with SAD and Early Psychosis and a similar factors structure was found for these groups. Participants with ASD reported a relatively low internal consistency and poor concurrent validity, as well as a three-component solution. The SFS has also showed a good sensitivity to separate clinical populations and neurotypical controls. This study supports the use of the SFS for those with SAD and Early Psychosis. Lower internal consistency in ASD populations suggests further research in larger s les is required and that the relationship between its scales are likely different to other populations. Alternative scales or significant other reports may be required for adults with ASD.
Sleep disturbance in cancer patients and caregivers who contact telephone-based help services
Publisher: Springer Science and Business Media LLC
Date: 10-10-2014
DOI: 10.1007/S00520-014-2458-Y
Abstract: Insomnia is highly prevalent in people who are affected by cancer. However, options available to receive support for insomnia are limited. Telephone-based help services, such as cancer helplines, may be ideally placed to meet unmet needs regarding insomnia after cancer. The present study describes the prevalence and predictors of insomnia in patients and caregivers who call cancer helplines seeking support. Participants (N = 500 patients, N = 234 caregivers) were recruited through an Australian state-based telephone-delivered cancer helpline. In addition to routine screening with the Distress Thermometer, participants were administered the Insomnia Severity Index. Most participants were female, older than 50 years of age, and were three (caregivers) to four (patients) months post-diagnosis. Insomnia symptoms were reported by 59.4 % of patients and 62.9 % of caregivers, with moderate to severe levels of insomnia reported by 27 % of patients and 30 % of caregivers. Insomnia was predicted by distress level for both patients (β = .31, p < .001) and caregivers (β = .32, p < .001) and age for patients only (β = -.13, p < .01). Insomnia symptoms are common in patients and caregivers who call cancer helplines and appear to be related to distress. Telephone-based helplines have the potential to act as the first line of support in a stepped care approach addressing insomnia.
The impact of gender on early ill-health retirement in people with heart disease and depression
Publisher: SAGE Publications
Date: 05-01-2012
Abstract: Objective: Depression and heart disease are major causes of early ill-health retirement. The effect of comorbid depression on the award of ill-health retirement in those with heart disease is unclear, however, and may differ by gender. Given the deleterious effects of ill-health retirement, identifying at-risk groups is important for guiding targeted interventions. Method: We retrospectively analysed baseline data of 20,655 participants from the 45 and Up Study (New South Wales, Australia), who had fully retired between the ages of 45 and 64. We examined the associations of depression and heart disease with ill-health retirement and then adjusted for the presence of common confounders. We then restricted the s le to the 1165 in iduals with heart disease prior to retirement, to determine the impact of comorbid depression on IHR and analysed whether there was a differential impact by gender. Results: In the complete s le, 3836 out of 20,655 (18.6%) of the participants retired early due to ill health. Prior heart disease and depression were both independently and strongly associated with ill-health retirement. Those who retired due to ill health were also more likely to be men, less educated, report greater physical disability and were younger at retirement. Among the 1165 for whom heart disease predated any form of retirement, 40% retired due to ill health. Comorbid depression prior to ill-health retirement was strongly associated with an increased risk of this IHR in women (odds ratio = 2.85 95% confidence interval = 1.20–6.77, p = 0.01), but not in men (interaction term, p = 0.045). Conclusions: Ill-health retirement is common in those with heart disease. Women appear to be particularly susceptible to the effects of comorbid depression. Given the policy emphasis on reducing the number of people leaving the workforce early, women with early heart disease may represent a particular group in whom interventions designed to detect and treat comorbid depression should be targeted.
Genetic and Environmental Etiology of Nicotine Use in Sri Lankan Male Twins
Publisher: Springer Science and Business Media LLC
Date: 19-05-2012
Accuracy of self-reported sleep parameters compared with actigraphy in young people with mental ill-health
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.SLEH.2015.07.006
Abstract: Validation of self-report assessment of habitual sleep duration and onset time in young people with mental ill-health. Validation s le. Specialized early intervention centers for young people in Sydney, Australia. One hundred and forty-six young people with mental ill-health. N/A. Self-reported habitual sleep duration and onset time were compared against at least 7 days of actigraphy monitoring. Average bias in and calibration of subjective measures were assessed, along with correlation of subjective and objective measures. Differences by age, sex, mental-disorder type, and reported insomnia were also explored. On average, subjective estimates of sleep were unbiased. Overall, each additional hour of objective habitual sleep duration predicted 41 minutes more subjective habitual sleep duration, and each hour later objective habitual sleep onset occurred predicted a 43-minute later subjective habitual sleep onset. There were subgroup differences: subjective habitual sleep duration in self-reported insomnia was shorter than objective duration by 30 minutes (SD = 119), on average. Calibration of habitual sleep duration was worse for those with mood disorders than with other primary diagnoses (t = -2.39, P = .018). Correlation between subjective and objective measures was strong for sleep onset time (Á = .667, P < .001) and moderate for sleep duration (r = .332, P < .001). For the mood disorder group, subjective and objective sleep durations were uncorrelated. Self-reports seem valid for large-scale studies of habitual sleep duration and onset in help-seeking young people, but assessment of habitual sleep duration requires objective measures where in idual accuracy is important.
Disentangling what works best for whom in comorbidity
Publisher: Oxford University Press (OUP)
Date: 15-10-2023
Reply to Taheri and Thomas: Is sleep duration associated with obesity-U cannot be serious
Publisher: Elsevier BV
Date: 08-2008
A comprehensive systematic review and meta-analysis of pharmacological and dietary supplement interventions in paediatric autism: Moderators of treatment response and recommendations for future research
Publisher: Cambridge University Press (CUP)
Date: 16-01-2017
DOI: 10.1017/S0033291716003457
Abstract: Autism spectrum disorders (ASDs) are pervasive and multifactorial neurodevelopmental conditions, characterized by impairments in social communication and interaction, and restricted, repetitive patterns of behaviour, interests or activities. Treatment options to ameliorate symptoms of ASDs are limited. Heterogeneity complicates the quest for personalized medicine in this population. Our aim was to investigate if there are baseline characteristics of patients that moderate response or trial design features that impede the identification of efficacious interventions for ASDs. Literature searches of EMBASE, MEDLINE and PsycINFO identified 43 studies for qualitative assessment of baseline characterization of participants and 37 studies for quantitative analysis of moderators of treatment response. Criteria included blinded randomized controlled trials (RCTs) in paediatric ASD, with at least 10 participants per arm or 20 overall, of oral treatments, including pharmacological interventions and dietary supplements. Random-effects meta-analysis of 1997 participants (81% male) identified three moderators associated with an increase in treatment response: trials located in Europe and the Middle-East outcome measures designated primary status and the type of outcome measure. Inconsistent reporting of baseline symptom severity and intellectual functioning prevented analysis of these variables. Qualitative synthesis of baseline characteristics identified at least 31 variables, with only age and gender reported in all trials. Biological markers were included in six RCTs. Few trials reported adequate baseline characteristics to permit detailed analysis of response to treatment. Consideration of geographical location, baseline severity and intellectual function is required to ensure generalizability of results. The use of biological markers and correlates in ASD trials remains in its infancy. There is great need to improve the application of baseline characterization and incorporation of biological markers and correlates to permit selection of participants into homogeneous subgroups and to inform response to treatment in ASD.
Sleep patterns and insomnia in young adults: A national survey of Norwegian university students
Publisher: Wiley
Date: 04-12-2018
DOI: 10.1111/JSR.12790
Abstract: The aim of this study was to describe sleep patterns and rate of insomnia according to diagnostic criteria in college and university students, as well as to examine potential changes in sleep problems from 2010 to 2018. Data stemmed from a national student health survey from 2018 for higher education in Norway (the SHoT study), which invited all 162,512 fulltime students in Norway. A total of 50,054 students (69.1% women) aged 18-35 years were included, yielding a response rate of 30.8%. Sleep parameters, reported separately for weekdays and weekends, included calculations of bedtime, rise time, sleep duration, sleep-onset latency, wake after sleep onset, sleep need and sleep deficit. Insomnia was defined according to the Diagnostic and Statistical Manual of Mental Disorders (5th edn) criteria. For the trend analysis, we used one item measuring difficulties initiating and/or maintaining sleep, over three time points (2010, 2014 and 2018). The results from 2018 showed large weekday-weekend differences across most sleep parameters. Both male and female students obtained a mean sleep duration in the lower end of the normal range on weekdays (7:24 hr), but met their own sleep need and sleep recommendations at weekends (8:25 hr). The overall prevalence of insomnia was 34.2% in women and 22.2% in men. There was a substantial increase in sleep problems from 2010 (22.6%) to 2018 (30.5%), which was especially pronounced in women. We conclude that sleep problems are both prevalent and increasing among students. This warrants attention as a public health problem in this population.
Getting it Right: validating a culturally specific screening tool for depression (aPHQ-9) in Aboriginal and Torres Strait Islander Australians
Publisher: AMPCo
Date: 30-06-2019
DOI: 10.5694/MJA2.50212
Abstract: To determine the validity, sensitivity, specificity and acceptability of the culturally adapted nine-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander people. Prospective observational validation study, 25 March 2015 - 2 November 2016. 500 adults (18 years or older) who identified as Aboriginal or Torres Strait Islander people and attended one of ten primary health care services or service events in urban, rural and remote Australia that predominantly serve Indigenous Australians, and were able to communicate sufficiently to respond to questionnaire and interview questions. Criterion validity of the aPHQ-9, with the depression module of the Mini-International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standard. 108 of 500 participants (22% 95% CI, 18-25%) had a current episode of major depression according to the MINI criterion. The sensitivity of the aPHQ-9 algorithm for diagnosing a current major depressive episode was 54% (95% CI, 40-68%), its specificity was 91% (95% CI, 88-94%), with a positive predictive value of 64%. For screening for a current major depressive episode, the area under the receiver operator characteristic curve was 0.88 (95% CI, 0.85-0.92) with a cut-point of 10 points its sensitivity was 84% (95% CI, 74-91%) and its specificity 77% (95% CI, 71-83%). The aPHQ-9 was deemed acceptable by more than 80% of participants. Indigenous Australians found the aPHQ-9 acceptable as a screening tool for depression. Applying a cut-point of 10 points, the performance characteristics of the aPHQ were good.
Open-label placebo for insomnia (OPIN): study protocol for a cohort multiple randomised controlled trial
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJOPEN-2020-044045
Abstract: Insomnia is a prevalent sleep disorder that causes substantial personal and societal harm. There is evidence that placebo interventions can reduce insomnia symptoms, but this research has involved deceptively administering the placebo under the guise of a real medication (conventional placebo, CP), which has obvious ethical constraints. Open-label placebo (OLP) treatment, in which a placebo is administered with full disclosure that there are no active ingredients, has been proposed as a method of using the placebo effect ethically, but the efficacy and acceptability of OLP for insomnia is currently unknown. This study uses a cohort multiple randomised controlled trial design to compare OLP, CP and no treatment for insomnia. Two-hundred and sixty-seven participants with self-reported insomnia symptoms (Insomnia Severity Index, ISI ≥10) will be recruited into an observational study and have their sleep monitored over a 2-week period. Participants will then be randomised to one of three groups: invite to OLP, invite to CP described deceptively as a new pharmacological agent, or no invite/observational control. Those in OLP and CP accepting the invite receive identical placebos for a 2-week treatment period while sleep is monitored in all participants. The primary outcome is ISI at the end of the treatment period. Secondary outcomes include treatment uptake and clinically significant response rates, objective and subjective sleep parameters, fatigue, mood, expectancy, treatment satisfaction and side effects. Predictors of uptake and responses to OLP and CP will be explored. The trial has been approved by The University of Sydney Human Research Ethics Committee. Written informed consent is obtained from every participant. OLP and CP participants accepting the invite undergo an additional consent process. Results will be disseminated via peer-reviewed conference proceedings and publications. ACTRN12620001080910.
Outcome of major depression in Ethiopia: Population-based study
Publisher: Royal College of Psychiatrists
Date: 09-2006
DOI: 10.1192/BJP.BP.105.013417
Abstract: The outcome and impact of major depression in developing countries are not clear. To describe the outcome of major depression and compare the disability and patterns of service use among different outcome groups. In a case cohort study, nested within a population-based survey of 68 000 participants using the Composite International Diagnostic Interview (CIDI), 300 participants were randomly selected from those with current major depression and 300 from those with no lifetime history. Participants were re-interviewed after 18–62 months to ascertain current diagnosis, psychological symptoms, disability and use of health services. Of participants with major depression at baseline 26% also met criteria for major depression at follow up. Mortality ratio standardised for age and gender was 3.55 (95% CI 1.97 to 6.39). All indices of measure of disability were significantly higher in the persistently depressed group compared with the completely recovered group. Participants who had recovered partially resembled participants with persistent depression. Two-thirds of those with persistent depression had not sought any help. Major depression was associated with mortality and disability Those with residual symptoms remained disabled. Help-seeking was unusual.
The effect of OSAS on sick leave and work disability
Publisher: European Respiratory Society (ERS)
Date: 12-2008
DOI: 10.1183/09031936.00044908
Abstract: The objective of the present study was to examine the independent contribution of symptoms of obstructive sleep apnoea syndrome (OSAS) to long-term sick leave and permanent work disability. Using a historical cohort design with 4 yrs of follow-up, information on sick leave and disability benefit recipiency were merged with health information from the Hordaland Health Study, carried out in western Norway during 1997-1999. Persons aged 40-45 yrs (n = 7,028) were assessed for self-reported symptoms of OSAS (snoring, breathing cessations and daytime sleepiness), body mass index, somatic conditions and other potential confounders. The outcomes, cumulative sick leave of > or =8 weeks and permanent work disability, were identified in records from the National Insurance Administration. After excluding participants with work disability at baseline, symptoms of OSAS were found to be a significant predictor of both subsequent long-term sick leave and permanent work disability. These effects remained significant after adjustment for a range of possible confounding factors. Daytime sleepiness showed the greatest explanatory power, followed by breathing cessations and snoring. It is concluded that self-reported symptoms of obstructive sleep apnoea syndrome are an independent risk factor for subsequent long-term sick leave and permanent work disability. These findings need to be replicated using objective measures of obstructive sleep apnoea syndrome.
Interpretation of medical information acts by UK occupational physicians
Publisher: Oxford University Press (OUP)
Date: 20-03-2009
Abstract: Difficulties arise in applying the Data Protection Act 1998 and the Access to Medical Reports Act 1988 in occupational health practice. There is no guidance on detailed aspects of applying these Acts in practice and consistent advice has proved difficult to obtain. To audit the understanding and practice of UK occupational physicians to see if a consensus view existed. A postal questionnaire sent to all UK-based Society of Occupational Medicine (SOM) members between December 2005 and June 2006. Responses were analysed using the SPSS 13.0 software. Responses were received from 726 SOM members, a response rate of 48%. The study revealed wide variation and a limited consensus in practice. Significant differences existed between doctors with a Diploma in Occupational Medicine and those with higher Faculty qualifications, between part-time and full-time practitioners and between doctors who qualified pre- and post-1974. The audit revealed wide variation in responding to clinical scenarios in relation to both the Access to Medical Reports and the Data Protection Acts. The findings have implications for clinical practice, policy and research. The majority of respondents reported that national guidance is needed.
Internet-based treatment for older adults with depression and co-morbid cardiovascular disease: protocol for a randomised, double-blind, placebo controlled trial
Publisher: Springer Science and Business Media LLC
Date: 14-01-2011
Abstract: Depression, cardiovascular disease (CVD) risk factors and cognitive impairment are important causes of disability and poor health outcomes. In combination they lead to an even worse prognosis. Internet or web-based interventions have been shown to deliver efficacious psychological intervention programs for depression on a large scale, yet no published studies have evaluated their impact among patients with co-existing physical conditions. The aims of this randomised controlled trial are to determine the effects of an evidence-based internet intervention program for depression on depressive mood symptoms, cognitive function and treatment adherence in patients at risk of CVD. This study is an internet-based, double-blind, parallel group randomised controlled trial. The trial will compare the effectiveness of online cognitive behavioural therapy with an online attention control placebo. The trial will consist of a 12-week intervention phase with a 40-week follow-up. It will be conducted in urban and rural New South Wales, Australia and will recruit a community-based s le of adults aged 45 to 75 years. Recruitment, intervention, cognitive testing and follow-up data collection will all be internet-based and automated. The primary outcome is a change in severity of depressive symptoms from baseline to three-months. Secondary outcomes are changes in cognitive function and adherence to treatment for CVD from baseline to three, six and 12-months. Prior studies of depression amongst patients with CVD have targeted those with previous vascular events and major depression. The potential for intervening earlier in these disease states appears to have significant potential and has yet to be tested. Scalable psychological programs using web-based interventions could deliver care to large numbers in a cost effective way if efficacy were proved. This study will determine the effects of a web-based intervention on depressive symptoms and adherence to treatment among patients at risk of CVD. In addition it will also precisely and reliably define the effects of the intervention upon aspects of cognitive function that are likely to be affected early in at risk in iduals, using sensitive and responsive measures. Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12610000085077
Preferences for a Mental Health Support Technology Among Chinese Employees: Mixed Methods Approach
Publisher: JMIR Publications Inc.
Date: 22-12-2022
DOI: 10.2196/40933
Abstract: Workplace mental health is under-studied in China, making it difficult to design effective interventions. To encourage the engagement with interventions, it is crucial to understand employees’ motivation toward seeking help through technologies. This study aimed to understanding how Chinese employees view digital mental health support technology and how mental health support technology could be designed to boost the motivation of Chinese employees to use it. A mixed methods approach was used. In total, 458 Chinese employees (248/458, 54% female) in 5 industries (manufacturing, software, medical, government, and education) responded to a survey, and 14 employees and 5 managers were interviewed. Government data and employee responses showed that mental health support in China is limited. In the workplace, Chinese employees experience a lower sense of autonomy satisfaction compared with competence and relatedness. Although managers and employees try to empathize with those who have mental health issues, discrimination and the stigma of mental illness are rife in Chinese workplaces. Digital technologies are perceived as a potential medium for mental health interventions however, privacy is a major concern. The results of this study demonstrated the potential of self-help digital mental health support for Chinese employees. Interdisciplinary cooperation between design engineers and mental health researchers can contribute toward understanding the issues that engage or disengage users with digital mental health interventions.
Eligibility, the ICF and the UN Convention: Australian perspectives
Publisher: Springer Science and Business Media LLC
Date: 2011
A qualitative exploration of young people’s mental health needs in rural and regional Australia: engagement, empowerment and integration
Publisher: Springer Science and Business Media LLC
Date: 13-10-2023
Nurse Motivation, Engagement and Well-Being before an Electronic Medical Record System Implementation: A Mixed Methods Study.
Publisher: MDPI AG
Date: 08-03-2021
Abstract: Implementation of an electronic medical record (EMR) is a significant workplace event for nurses in hospitals. Understanding nurses’ key concerns can inform EMR implementation and ongoing optimisation strategies to increase the likelihood of nurses remaining in the nursing workforce. This concurrent mixed-methods study included surveys from 540 nurses (response rate 15.5%), and interviews with 63 nurses to examine their perceptions of using a new EMR prior to implementation at a single healthcare organisation. Survey findings revealed 32.2% (n = 174) of nurses reported low well-being scores and 28.7% (n = 155) were experiencing burnout symptoms. In contrast, 40.3% (n = 216) of nurses reported high work satisfaction, 62.3% (n = 334) had high intentions of staying in their role, and 34.3% (n = 185) were engaged in their work. Nearly half (n = 250, 46.3%) reported intrinsic motivation towards EMR use. Thematic analysis of focus group interviews revealed two themes, each with three subthemes: (1) Us and Them, detailed the juxtaposition between nurses’ professional role and anticipated changes imposed on them and their work with the EMR implementation and (2) Stuck in the middle, revealed nurses’ expectations and anticipations about how the EMR may affect the quality of nurse-patient relationships. In conclusion, anticipation of the EMR implementation emerged as a stressor for nursing staff, with some groups of nurses particularly vulnerable to negative consequences to their well-being.
Impact of Mental Health Screening on Promoting Immediate Online Help-Seeking: Randomized Trial Comparing Normative Versus Humor-Driven Feedback
Publisher: JMIR Publications Inc.
Date: 05-04-2018
DOI: 10.2196/MENTAL.9480
Abstract: Given the widespread availability of mental health screening apps, providing personalized feedback may encourage people at high risk to seek help to manage their symptoms. While apps typically provide personal score feedback only, feedback types that are user-friendly and increase personal relevance may encourage further help-seeking. The aim of this study was to compare the effects of providing normative and humor-driven feedback on immediate online help-seeking, defined as clicking on a link to an external resource, and to explore demographic predictors that encourage help-seeking. An online s le of 549 adults were recruited using social media advertisements. Participants downloaded a smartphone app known as “Mindgauge” which allowed them to screen their mental wellbeing by completing standardized measures on Symptoms (Kessler 6-item Scale), Wellbeing (World Health Organization [Five] Wellbeing Index), and Resilience (Brief Resilience Scale). Participants were randomized to receive normative feedback that compared their scores to a reference group or humor-driven feedback that presented their scores in a relaxed manner. Those who scored in the moderate or poor ranges in any measure were encouraged to seek help by clicking on a link to an external online resource. A total of 318 participants scored poorly on one or more measures and were provided with an external link after being randomized to receive normative or humor-driven feedback. There was no significant difference of feedback type on clicking on the external link across all measures. A larger proportion of participants from the Wellbeing measure (170/274, 62.0%) clicked on the links than the Resilience (47/179, 26.3%) or Symptoms (26/75, 34.7%) measures (χ2=60.35, P .001). There were no significant demographic factors associated with help-seeking for the Resilience or Wellbeing measures. Participants with a previous episode of poor mental health were less likely than those without such history to click on the external link in the Symptoms measure (P=.003, odds ratio [OR] 0.83, 95% CI 0.02-0.44), and younger adults were less likely to click on the link compared to older adults across all measures (P=.005, OR 0.44, 95% CI 0.25-0.78). This pilot study found that there was no difference between normative and humor-driven feedback on promoting immediate clicks to an external resource, suggesting no impact on online help-seeking. Limitations included: lack of personal score control group, limited measures of predictors and potential confounders, and the fact that other forms of professional help-seeking were not assessed. Further investigation into other predictors and factors that impact on help-seeking is needed. Australian New Zealand Clinical Trials Registry ACTRN12616000707460 www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370187 (Archived by WebCite at y8m8sVxr)
Maybe it's quality not length that matters
Publisher: Oxford University Press (OUP)
Date: 03-2012
DOI: 10.5665/SLEEP.1684
A cross-sectional exploration of the clinical characteristics of disengaged (NEET) young people in primary mental healthcare
Publisher: BMJ
Date: 12-2014
Insomnia symptoms and short sleep duration predict trajectory of mental health symptoms.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.SLEEP.2018.10.008
Abstract: We evaluated whether insomnia symptoms and short or long sleep duration, alone or in combination, are robustly associated with subsequent trajectory of mental health symptoms. Participants were 2598 in iduals (15 to 94 years of age) with elevated mental health symptoms at baseline (2013-14). Associations of baseline insomnia symptoms and sleep duration with two-year trajectory of mental health were estimated and adjusted for multiple potential confounders. Outcomes included recovery (well at both follow-up timepoints), intermittent symptoms (unwell at one follow-up timepoint), and chronic symptoms (unwell at each follow-up timepoint). Adjusted for age and sex, baseline insomnia symptoms predicted intermittent (OR 1.43, 95% CI 1.15-1.80) and chronic (OR 2.16, 95% CI 1.77-2.68) trajectories of mental health symptoms. Short sleep duration (<6 h and ≥6 to <7 h) only predicted a chronic trajectory (ORs 1.70-2.06). Associations were attenuated but significant after confounder adjustment. Those who experienced both insomnia and short (<7 h) sleep duration had the greatest risk of chronic mental health symptoms (OR 2.35, 95% CI 1.60-3.45). A focus on just sleep duration or insomnia symptoms in those with elevated mental health symptoms will not be adequate to address chronicity. Both components of sleep disturbance, and in particular their co-occurrence, should be addressed.
Sleep health epidemiology in low and middle-income countries: a systematic review and meta-analysis of the prevalence of poor sleep quality and sleep duration.
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.SLEH.2018.03.001
Abstract: Sleep research has been dominated by high income countries (HIC). Sleep may be different in low and middle income countries (LMIC) due to cultural, demographic, geographical and health factors. We systematically reviewed the epidemiological literature reporting sleep parameters in the adult population in LMIC and meta-analyzed the prevalence of subjective poor sleep quality and sleep duration. We identified 45 publications over 50% of which came from China and Brazil. Of the 45 identified studies, 32 contained data on sleep quality and 17 on self-reported sleep duration. Only one study utilized polysomnography and only one study utilized actigraphy. This review provides evidence that sleep parameters in LMIC appear to be similar to those in HIC but the variability and bias found suggests any attempt to extract a universal prevalence estimate or average sleep duration from the current data is very likely flawed and should be taken with caution. In our meta-analysis we found an enormous variability that was not explicable by regional, rurality, gender, age group or sleep assessment method. Further, there was a suggestion of significant small study effect, with smaller studies reporting worse sleep. There is surprisingly little consistent high-quality data that could be used for policy, planning, or scientific purposes at a global level in low and middle-income countries about what humans spend a third of their lives doing. High-quality epidemiological research about basic sleep health parameters is needed that focuses on the whole-population in LMIC, and that uses standardized, well-validated and culturally applicable measures.
Predictors of placebo response in pharmacological and dietary supplement treatment trials in pediatric autism spectru disorder: A meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 22-09-2015
DOI: 10.1038/TP.2015.143
Abstract: Large placebo responses in many clinical trials limit our capacity to identify effective therapeutics. Although it is often assumed that core behaviors in children with autism spectrum disorders (ASDs) rarely remit spontaneously, there has been limited investigation of the size of the placebo response in relevant clinical trials. These trials also rely on caregiver and clinical observer reports as outcome measures. The objectives of this meta-analysis are to identify the pooled placebo response and the predictors of placebo response in pharmacological and dietary supplement treatment trials for participants with a diagnosis of ASD. Randomized controlled trials (RCTs) in pediatric ASD, conducted between 1980 and August 2014, were identified through a search of Medline, EMBASE, Web of Science, Cochrane Database of Systematic Reviews and clinicaltrials.gov. RCTs of at least 14 days duration, comparing the treatment response for an oral active agent and placebo using at least one of the common outcome measures, were included. Analysis of 25 data sets (1315 participants) revealed a moderate effect size for overall placebo response (Hedges’ g =0.45, 95% confidence interval (0.34–0.56), P .001). Five factors were associated with an increase in response to placebo, namely: an increased response to the active intervention outcome ratings by clinicians (as compared with caregivers) trials of pharmacological and adjunctive interventions and trials located in Iran. There is a clear need for the identification of objective measures of change in clinical trials for ASD, such as evaluation of biological activity or markers, and for consideration of how best to deal with placebo response effects in trial design and analyses.
Clinical classification in mental health at the cross-roads: Which direction next?
Publisher: Springer Science and Business Media LLC
Date: 14-05-2013
Sleep-Disordered Breathing and Psychiatric Disorders
Publisher: Springer Science and Business Media LLC
Date: 12-10-2014
DOI: 10.1007/S11920-014-0519-Z
Abstract: Sleep-disordered breathing, the commonest form of which is obstructive sleep apnoea (OSA) is increasingly recognised as a treatable cause of morbidity. It shares many risk factors with psychiatric disorders including behaviours such as smoking and physical comorbidity. Many symptoms of the two overlap, leaving OSA often undetected and undertreated. In the few studies that assess the two, OSA is commonly comorbid with depression (17-45%) and schizophrenia (up to 55%) and possibly bipolar. There is some limited evidence that treating OSA can ameliorate psychiatric symptoms. Some psychotropics, such as narcotics, cause sleep-disordered breathing (SDB), whilst weight-inducing neuroleptics may exacerbate it. An extreme form of SDB, sudden infant death syndrome (SIDS), is a risk in mothers with substance abuse. Being aware of these common comorbidities may help improve psychiatric patient's treatment and quality of life.
Getting it Right: Study protocol to determine the diagnostic accuracy of a culturally-specific measure to screen for depression in Aboriginal and/or Torres Strait Islander people
Publisher: BMJ
Date: 12-2016
A New Online Mental Health Training Program for Workplace Managers: Pre-Post Pilot Study Assessing Feasibility, Usability, and Possible Effectiveness (Preprint)
Publisher: JMIR Publications Inc.
Date: 28-03-2018
Abstract: ental health has become the leading cause of sickness absence in high-income countries. Managers can play an important role in establishing mentally healthy workplaces and coordinating their organization’s response to a mentally ill worker. his pilot study aims to evaluate the feasibility, usability, and likely effectiveness of a newly developed online training program for managers called HeadCoach. HeadCoach aims to build managers’ confidence in supporting the mental health needs of staff and promote managerial behavior most likely to result in a more mentally healthy workplace. n total, 66 managers from two organizations were invited to participate in this pre-post pilot study of HeadCoach, which was made available to managers to complete at their own pace over a 4-week period. Data were collected at baseline and post intervention via an online research platform. The difference in mean scores for each outcome between these two time points was calculated using paired s les t tests. f all the invited managers, 59.1% (39/66) participated in the trial, with complete pre–post data available for 56.4% (22/39) of the participants. The majority of respondents reported positive engagement with the program. During the study period, managers’ knowledge regarding their role in managing mental health issues (P=.01) and their confidence in communicating with employees regarding mental illness (P .001) significantly increased. In addition, a significant increase was observed from the baseline in managers’ self-reported actions to use strategies to prevent and decrease stress among their team members (P=.02). lthough caution is needed due to the absence of a control group, preliminary results of this study suggest that HeadCoach could be a feasible, acceptable, and efficient method of training managers in best workplace practices to help support the mental health needs of their staff.
Diet quality and depressive symptoms. Assessing the direction of the association in a population-based cohort study.
Publisher: Elsevier BV
Date: 09-2020
Midlife insomnia and subsequent mortality: the Hordaland health study
Publisher: Springer Science and Business Media LLC
Date: 15-07-2014
Psychosocial risk factors for coronary heart disease a consensus statement from the national heart foundation of Australia
Publisher: AMPCo
Date: 08-2013
DOI: 10.5694/MJA13.10440
Abstract: In 2003, the National Heart Foundation of Australia published a position statement on psychosocial risk factors and coronary heart disease (CHD). This consensus statement provides an updated review of the literature on psychosocial stressors, including chronic stressors (in particular, work stress), acute in idual stressors and acute population stressors, to guide health professionals based on current evidence. It complements a separate updated statement on depression and CHD. Perceived chronic job strain and shift work are associated with a small absolute increased risk of developing CHD, but there is limited evidence regarding their effect on the prognosis of CHD. Evidence regarding a relationship between CHD and job (in)security, job satisfaction, working hours, effort-reward imbalance and job loss is inconclusive. Expert consensus is that workplace programs aimed at weight loss, exercise and other standard cardiovascular risk factors may have positive outcomes for these risk factors, but no evidence is available regarding the effect of such programs on the development of CHD. Social isolation after myocardial infarction (MI) is associated with an adverse prognosis. Expert consensus is that although measures to reduce social isolation are likely to produce positive psychosocial effects, it is unclear whether this would also improve CHD outcomes. Acute emotional stress may trigger MI or takotsubo ("stress") cardiomyopathy, but the absolute increase in transient risk from an in idual stressor is low. Psychosocial stressors have an impact on CHD, but clinical significance and prevention require further study. Awareness of the potential for increased cardiovascular risk among populations exposed to natural disasters and other conditions of extreme stress may be useful for emergency services response planning. Wider public access to defibrillators should be available where large populations gather, such as sporting venues and airports, and as part of the response to natural and other disasters.
Direct and indirect psychological impacts of shark-bite events
Publisher: SAGE Publications
Date: 30-10-2019
Abstract: Shark bites are rare, with intense media exposure. There are no known studies of the psychological impacts of this specific type of traumatic event. This is the first study that describes those directly and indirectly affected, and evaluates the prevalence of post-traumatic stress disorder (PTSD) and related risk factors. In total, 124 members of an Australian shark-bite peer-support group were invited to complete an online survey assessing demographic, event, media and psychological factors. Response rate was 48% ( n = 60, 63% male, 44 ± 14 years). Retrospective and current measures of PTSD (PTSD Checklist for DSM-5 [PCL-5]) and suicidality (Suicidal Ideation Attributes Scale [SIDAS-5]) were used. Post-event PTSD was prevalent in this s le ( n = 16/59, 27.1%, 95% confidence interval [CI] = [15.4, 38.8]), but less so currently ( n = 2/55, 3.6%, 95% CI = [0.0, 8.7]). In addition, nine ( n = 9/59, 15.3%, 95% CI = [5.8, 24.7]) had subthreshold, but highly symptomatic, syndromes post event. There was no association of PTSD with direct/indirect bite involvement, gender, or prior trauma. Two respondents were at risk of suicidal behaviour. PTSD was commonly reported by those without a partner (odds ratio [OR] = 5.91, 95% CI = [1.52, 22.99], p = 0.01) or with two friends or fewer to rely on (OR = 5.83, 95% CI = [1.62, 21.01], p = 0.01). PTSD was more likely in those with a negative media experience ( n = 34/52, 65.4%, OR = 11.90, 95% CI = [1.42, 100.04], p = 0.02) and 61.5% ( n = 32/52) of respondents reported media coverage lasting months or years. In multivariate modelling, negative media impact, relationship status and friendships were independently associated with PTSD and explained much of the variance in PTSD ( F 4,41 = 10.94, p 0.0001, r 2 = 0.52). Nearly one-third of members of an Australian shark-bite peer-support group report post-event PTSD, and one-quarter of these were not present at the time of the event. Findings support interventions targeting negative media impact, similar to media reporting guidelines for suicide, and enhancing social support.
Quantifying the human impact of Melbourne’s 111-day hard lockdown experiment on the adult population
Publisher: Springer Science and Business Media LLC
Date: 31-08-2023
Measurement of social capital in relation to health in low and middle income countries (LMIC): A systematic review
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.SOCSCIMED.2015.01.005
Abstract: Social capital is a neglected determinant of health in low and middle income countries. To date, majority of evidence syntheses on social capital and health are based upon high income countries. We conducted this systematic review to identify the methods used to measure social capital in low and middle-income countries and to evaluate their relative strengths and weaknesses. An electronic search was conducted using Pubmed, Science citation index expanded, Social science citation index expanded, Web of knowledge, Cochrane, Trip, Google scholar and selected grey literature sources. We aimed to include all studies conducted in low and middle-income countries, published in English that have measured any aspect of social capital in relation to health in the study, from 1980 to January 2013. We extracted data using a data extraction form and performed narrative synthesis as the measures were heterogeneous. Of the 472 articles retrieved, 46 articles were selected for the review. The review included 32 studies from middle income countries and seven studies from low income countries. Seven were cross national studies. Most studies were descriptive cross sectional in design (n = 39). Only two randomized controlled trials were included. Among the studies conducted using primary data (n = 32), we identified18 purposely built tools that measured various dimensions of social capital. Validity (n = 11) and reliability (n = 8) of the tools were assessed only in very few studies. Cognitive constructs of social capital, namely trust, social cohesion and sense of belonging had a positive association towards measured health outcome in majority of the studies. While most studies measured social capital at in idual/micro level (n = 32), group level measurements were obtained by aggregation of in idual measures. As many tools originate in high income contexts, cultural adaptation, validation and reliability assessment is mandatory in adapting the tool to the study setting. Evidence on causality and assessing predictive validity is a problem due to the scarcity of prospective study designs. We recommend Harpham et al. s' Adapted Social Capital Assessment Tool (A-SCAT), Hurtado et al. s' six item tool and Elgar et al. s' World Value Survey Social Capital Scale for assessment of social capital in low and middle income countries.
Social capital; A link towards health and wellbeing among minority pregnant women?
Publisher: Sri Lanka Journals Online (JOL)
Date: 28-10-2015
In search of an integrative measure of functioning
Publisher: MDPI AG
Date: 26-05-2015
Work and psychiatric disorder
Publisher: CRC Press
Date: 29-10-2010
DOI: 10.1201/B13467-92
Returning to Unpaid Work after Stroke: The Psychosocial Outcomes in Stroke Cohort Study.
Publisher: S. Karger AG
Date: 2019
DOI: 10.1159/000496399
Abstract: b i Background: /i /b While returning to paid work is a crucial marker of stroke recovery, little is known about the differences in unpaid work by sex following stroke. We aimed to determine the sex differences in participation in unpaid work 12 months after stroke. b i Methods: /i /b Psychosocial outcomes in stroke were a prospective, multicentre observational study that recruited in iduals, 18–64 years, within 28 days of stroke from New South Wales, Australia. Unpaid work was defined as ≥5 h per week of one or more of: unpaid domestic work for the household unpaid care of others looking after own children without pay or looking after someone else’s children without pay. Data was collected before stroke, 28 days (baseline), 6 and 12 months follow-up. b i Results: /i /b Eighty per cent of women and 52% of men engaged in ≥5 h per week of unpaid work before stroke. At 12 months after, 69% of women and 53% of men completed ≥5 h of unpaid work per week. For women, there was a significant association between participation in unpaid work at 12 months and having financially dependent children (OR 2.67 95% CI 1.08–6.59). A return to unpaid work in men was associated with participation in unpaid work before stroke (OR 3.74 95% CI 2.14–6.53). b i Conclusions: /i /b More women are engaged in unpaid work before and at 12 months after stroke, but there is a reduction in the proportion of women returning to unpaid work at 12 months not seen in men. Consideration may need to be given to the development of rehabilitation strategies targeted at the specific needs of stroke survivors.
Evaluation of psychometric properties of patient-reported outcome measures frequently used in narcolepsy randomized controlled trials: a systematic review
Publisher: Oxford University Press (OUP)
Date: 07-07-2022
Abstract: To systematically determine subjective and objective outcome measures used to measure the efficacy of narcolepsy interventions in randomized controlled trials (RCTs) in adults and children and assess psychometric properties of patient-reported outcome measures (PROMs) used. We searched bibliographical databases and clinical trial registries for narcolepsy RCTs and extracted objective and subjective outcome measures. If PROMs were used, we searched for psychometric studies conducted in a narcolepsy population using bibliographical databases and appraised using Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. In total, 80 different outcome measures were used across 100 RCTs. Epworth Sleepiness Scale (ESS) (n = 49) and Maintenance of Wakefulness Test (n = 47) were the most frequently used outcome measures. We found 19 validation studies of 10 PROMs in narcolepsy populations. There was limited evidence for validity or responsiveness of the ESS yet sufficient reliability (pooled ICC: 0.81–0.87). Narcolepsy Severity Scale (NSS) had sufficient reliability (pooled ICC: 0.71–0.92) and both adult and pediatric versions had sufficient discriminant validity (treated/untreated). Content validity was only evaluated in pediatric populations for ESS-CHAD and NSS-P and rated inconclusive. Quality of evidence of the psychometric studies for all scales ranged from very low to low. Although recognized by regulatory bodies and widely used as primary outcome measures in trials, there is surprisingly little evidence for the validity, reliability, and responsiveness of PROMs frequently used to assess treatment efficacy in narcolepsy. The field needs to establish patient-centered minimal clinically important differences for the PROMs used in these trials.
Amphetamine use and psychiatric admissions: a 10-year perspective.
Publisher: SAGE Publications
Date: 19-05-2021
DOI: 10.1177/10398562211014227
Abstract: We aimed to (i) describe the 10-year trend in admissions associated with hetamine use, (ii) describe the distinguishing characteristics of people with an hetamine-related diagnosis (ARD) and (iii) examine predictors of repeated admissions among people with an ARD. We conducted a retrospective cohort study. We (i) counted the number of admissions with an ARD and evaluated any trends, and using univariate and multivariate tests, (ii) compared those who had an ARD with those who did not and (iii) compared those with an ARD who had one, two to four, and five or more admissions. Admissions associated with hetamine use increased between 2009 and 2015. Those with an ARD had significant differences in demographics, diagnosis and pattern of service use relative to those without an ARD. Amongst those with an ARD, a higher number of admissions was positively associated with a schizophrenia diagnosis but inversely associated with a transient psychotic disorder diagnosis. The increase in admissions associated with hetamine use indicates that people with an ARD posed major demands on inpatient services. Targeting hetamine treatment to those with psychotic disorders, both schizophrenia and transient psychotic disorders, may reduce hospital-related costs and re-admissions.
Adjunctive Internet-delivered cognitive behavioural therapy for insomnia in men with depression: A randomised controlled trial
Publisher: SAGE Publications
Date: 07-09-2018
Abstract: Internet-delivered cognitive behavioural therapy for insomnia is efficacious for insomnia, and post hoc analyses suggest mood improvements. We undertook the first clinical trial evaluating the efficacy of Internet-delivered cognitive behavioural therapy for insomnia on depressive symptoms as an adjunct to guideline-based treatment of depressive disorders. Older men undergoing psychiatrist-coordinated treatment for major depressive disorder or dysthymia and who had significant insomnia symptoms were randomised to either adjunctive Internet-delivered cognitive behavioural therapy for insomnia (Sleep Healthy Using The Internet) or online sleep psychoeducation. The primary outcome was change in depressive symptoms (Centre for Epidemiological Studies Depression scale) from baseline to week 12 (post intervention). Secondary outcomes were insomnia and anxiety symptoms. In all, 87 men were randomised (Internet-delivered cognitive behavioural therapy for insomnia = 45 psychoeducation = 42). The mean observed Centre for Epidemiological Studies Depression scale changes by week 12 were 8.2 (standard deviation = 11.5) and 3.9 (standard deviation = 12.8) for Internet-delivered cognitive behavioural therapy for insomnia and psychoeducation, respectively. The adjunctive effect size of 0.35 in favour of Sleep Healthy Using The Internet programme was not statistically significant (group × time difference in the Mixed effect Model Repeat Measurement analysis difference 4.3 95% confidence interval = [−1.2, 9.8] p = 0.15). There was a statistically significant effect on insomnia symptoms (group × time p = 0.02, difference 2.7 95% confidence interval = [0.2, 5.3] effect size = 0.62). There were no differences in insomnia or depression at 6 months or differential effects on anxiety at any time point. There were no reported adverse trial-related events in the intervention arm. Adjunctive Internet-delivered cognitive behavioural therapy for insomnia for older men being treated for depression can improve insomnia in the short term, without apparent harm. The short-term depressive symptom effect size in this pilot trial was comparable to other adjunctive interventions and may warrant a larger, definitive trial.
Motivators and Motivations to Persist With Online Psychological Interventions: A Qualitative Study of Treatment Completers
Publisher: JMIR Publications Inc.
Date: 22-06-2012
DOI: 10.2196/JMIR.2100
The increasing cost of happiness.
Publisher: Elsevier BV
Date: 12-2021
Colombo Twin and Singleton Study (CoTASS): A description of a population based twin study of mental disorders in Sri Lanka
Publisher: Springer Science and Business Media LLC
Date: 27-06-2008
Abstract: The Sri Lankan twin registry is one of the first to be established in a developing country, and its design has ensured s ling from a wide range of environmental conditions. It thus has great potential to examine environmental and genetic influences on erse phenotypes, including psychiatric disorders, in the context of a ersity of environmental exposures, which may not have been fully explored in previous twin studies in developed countries. This paper presents the rationale for the study, describes its context, and the methods for twin ascertainment and data collection. A population-based twin register was established in the Colombo district of Sri Lanka using infrastructure designed to periodically update the electoral register. We invited a subs le from this register to participate in the project on common mental disorders, using random ascertainment. A separate non-twin s le was randomly selected from the geographical areas where twins were found. Home interviewers collected diagnostic information on common mental disorders, as well as environmental exposures including life events, socio-economic conditions, and the impact of the civil war and the Tsunami of 2004. We identified 19,302 in iduals in the creation of the population based twin register. We randomly selected a subs le, of whom 4,387 were eligible to participate and 4,024 agreed to be interviewed (including data on 1,954 complete pairs of twins and 5 sets of triplets). Those who refused consent had a similar mean age and sex ratio to those who were interviewed. We invited 2,485 singletons to participate and 2,019 were interviewed. Initial exploration of the data suggests the s les are very representative of the Colombo district of Sri Lanka, so we have created a unique resource for understanding the influences on mental disorders in developing countries, and to compare to the influences found in developed countries.
The Scholarly Project in the Royal Australian and New Zealand College of Psychiatrists training program: getting up and running in Stage 1.
Publisher: SAGE Publications
Date: 04-2017
Trends in Effectiveness of Organizational eHealth Interventions in Addressing Employee Mental Health: Systematic Review and Meta-analysis
Publisher: JMIR Publications Inc.
Date: 27-09-2022
DOI: 10.2196/37776
Abstract: Mental health conditions are considered the leading cause of disability, sickness absence, and long-term work incapacity. eHealth interventions provide employees with access to psychological assistance. There has been widespread implementation and provision of eHealth interventions in the workplace as an inexpensive and anonymous way of addressing common mental disorders. This updated review aimed to synthesize the literature on the efficacy of eHealth interventions for anxiety, depression, and stress outcomes in employee s les in organizational settings and evaluate whether their effectiveness has improved over time. Systematic searches of relevant articles published from 2004 to July 2020 of eHealth intervention trials (app- or web-based) focusing on the mental health of employees were conducted. The quality and bias of all studies were assessed. We extracted means and SDs from publications by comparing the differences in effect sizes (Hedge g) in standardized mental health outcomes. We meta-analyzed these data using a random-effects model. We identified a tripling of the body of evidence, with 75 trials available for meta-analysis from a combined s le of 14,747 articles. eHealth interventions showed small positive effects for anxiety (Hedges g=0.26, 95% CI 0.13-0.39 P .001), depression (Hedges g=0.26, 95% CI 0.19-0.34 P .001), and stress (Hedges g=0.25, 95% CI 0.17-0.34 P .001) in employees’ after intervention, with similar effects seen at the medium-term follow-up. However, there was evidence of no increase in the effectiveness of these interventions over the past decade. This review and meta-analysis confirmed that eHealth interventions have a small positive impact on reducing mental health symptoms in employees. Disappointingly, we found no evidence that, despite the advances in technology and the enormous resources in time, research, and finance devoted to this area for over a decade, better interventions are being produced. Hopefully, these small effect sizes do not represent optimum outcomes in organizational settings. PROSPERO CRD42020185859 www.crd.york.ac.uk rospero/display_record.php?RecordID=185859
Selective Prevention of Depression in Workers Using a Smartphone App: Randomized Controlled Trial (Preprint)
Publisher: JMIR Publications Inc.
Date: 25-01-2023
Abstract: here is increasing evidence that depression can be prevented however, universal approaches have had limited success. Appropriate targeting of interventions to at-risk populations has been shown to have potential, but how to selectively determine at-risk in iduals remains unclear. Workplace stress is a risk factor for depression and a target for intervention, but few interventions exist to prevent depression among workers at risk due to heightened stress. his trial aimed to evaluate the efficacy of a smartphone-based intervention in reducing the onset of depression and improving related outcomes in workers experiencing at least moderate levels of stress. randomized controlled trial was conducted with participants who were currently employed and reported no clinically significant depression and at least moderate stress. The intervention group (n=1053) were assigned i Anchored /i , a 30-day self-directed smartphone app-based cognitive behavioral- and mindfulness-based intervention. The attention-control group (n=1031) were assigned a psychoeducation website. Assessment was performed via web-based self-report questionnaires at baseline and at 1-, 3-, and 6-month postbaseline time points. The primary outcome was new depression caseness aggregated over the follow-up period. The secondary outcomes included depressive and anxiety symptoms, stress, well-being, resilience, work performance, work-related burnout, and quality of life. Analyses were conducted within an intention-to-treat framework using mixed modeling. here was no significant between-group difference in new depression caseness ( i z /i score=0.69 i P /i =.49) however, those in the i Anchored /i arm had significantly greater depressive symptom reduction at 1 month (Cohen i d /i =0.02 i P /i =.049) and 6 months (Cohen i d /i =0.08 i P /i =.03). i Anchored /i participants also showed significantly greater reduction in anxiety symptoms at 1 month (Cohen i d /i =0.07 i P /i =.04) and increased work performance at 1 month (Cohen i d /i =0.07 i P /i =.008) and 6 months (Cohen i d /i =0.13 i P /i =.01), compared with controls. Notably, for i Anchored /i participants completing at least two-thirds of the intervention, there was a significantly lower rate of depression onset (1.1%, 95% CI 0.0%-3.7%) compared with controls (9.0%, 95% CI 6.8%-12.3%) at 1 month ( i z /i score=4.50 i P /i & .001). Significant small to medium effect sizes for most secondary outcomes were seen in the highly engaged i Anchored /i users compared with controls, with effects maintained at the 6-month follow-up for depressive symptoms, well-being, stress, and quality of life. lt i Anchored /i was associated with a small comparative reduction in depressive symptoms compared with controls, although selective prevention of case-level depression was not observed in the intention-to-treat analysis. When users adequately engaged with the app, significant findings pertaining to depression prevention, overall symptom reduction, and functional improvement were found, compared with controls. There is a need for a greater focus on engagement techniques in future research. ustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000178943 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378592
Validity of the HSE stress tool: An investigation within four organizations by the Corporate Health and Performance Group
Publisher: Oxford University Press (OUP)
Date: 05-2005
Abstract: To examine the validity and accuracy of the HSE Management Standards Stress Tool. A cross-sectional questionnaire was administered to employees of the occupational health and human resource departments of four of the Corporate Health and Performance Group organizations. The relationship between the six first-pass stress filter questions and self-rated health were examined using the General Health Questionnaire (GHQ12) and the Short Form. The relationship between the filter questions and objective work characteristics such as sickness absence, self-rated performance and job satisfaction was also examined. Two hundred and thirty-five employees participated, giving an overall response rate of 68%. The study s le met the proposed HSE of 85 and 65% pass rates and would not normally progress to further analysis. Almost 40% of the group were above threshold on the GHQ12 19% rated their work as very or extremely stressful. While the filters were highly specific, they were insensitive and at best detected for less than 40% of those with psychological or work stress. All but one of the filters had less than 50% positive predictive value for work stress and the majority of those identified by the filters did not consider themselves stressed, either overall or by work. Five of the filter questions were significantly associated with self-rated performance, three with absence and two with other objective work indicators. Further developmental work on these filter questions is indicated. Use of work absence as a measure of the impact or 'cost' of stress may lead to a significant underestimation of the 'true cost' of psychosocial hazards in the workplace.
The Utility of a Mental Health App in Apprentice Workers: A Pilot Study
Publisher: Frontiers Media SA
Date: 04-09-2020
Prevalence of PTSD and common mental disorders amongst ambulance personnel: a systematic review and meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 05-06-2018
DOI: 10.1007/S00127-018-1539-5
Abstract: There is increasing concern regarding the mental health impact of first responder work, with some reports suggesting ambulance personnel may be at particularly high risk. Through this systematic review and meta-analysis we aimed to determine the prevalence of mental health conditions among ambulance personnel worldwide. A systematic search and screening process was conducted to identify studies for inclusion in the review. To be eligible, studies had to report original quantitative data on the prevalence of at least one of the following mental health outcome(s) of interest (PTSD, depression, anxiety, general psychological distress) for ambulance personnel s les. Quality of the studies was assessed using a validated methodological rating tool. Random effects modelling was used to estimate pooled prevalence, as well as subgroup analyses and meta-regressions for five variables implicated in heterogeneity. In total, 941 articles were identified across all sources, with 95 full-text articles screened to confirm eligibility. Of these, 27 studies were included in the systematic review, reporting on a total of 30,878 ambulance personnel. A total of 18 studies provided necessary quantitative information and were retained for entry in the meta-analysis. The results demonstrated estimated prevalence rates of 11% for PTSD, 15% for depression, 15% for anxiety, and 27% for general psychological distress amongst ambulance personnel, with date of data collection a significant influence upon observed heterogeneity. Ambulance personnel worldwide have a prevalence of PTSD considerably higher than rates seen in the general population, although there is some evidence that rates of PTSD may have decreased over recent decades.
Development and validation of a prediction algorithm for the onset of common mental disorders in a working population
Publisher: SAGE Publications
Date: 12-04-2018
Abstract: Common mental disorders are the most common reason for long-term sickness absence in most developed countries. Prediction algorithms for the onset of common mental disorders may help target indicated work-based prevention interventions. We aimed to develop and validate a risk algorithm to predict the onset of common mental disorders at 12 months in a working population. We conducted a secondary analysis of the Household, Income and Labour Dynamics in Australia Survey, a longitudinal, nationally representative household panel in Australia. Data from the 6189 working participants who did not meet the criteria for a common mental disorders at baseline were non-randomly split into training and validation databases, based on state of residence. Common mental disorders were assessed with the mental component score of 36-Item Short Form Health Survey questionnaire (score ⩽45). Risk algorithms were constructed following recommendations made by the Transparent Reporting of a multivariable prediction model for Prevention Or Diagnosis statement. Different risk factors were identified among women and men for the final risk algorithms. In the training data, the model for women had a C-index of 0.73 and effect size (Hedges' g) of 0.91. In men, the C-index was 0.76 and the effect size was 1.06. In the validation data, the C-index was 0.66 for women and 0.73 for men, with positive predictive values of 0.28 and 0.26, respectively Conclusion: It is possible to develop an algorithm with good discrimination for the onset identifying overall and modifiable risks of common mental disorders among working men. Such models have the potential to change the way that prevention of common mental disorders at the workplace is conducted, but different models may be required for women.
A protocol for the HeadCoach trial: the development and evaluation of an online mental health training program for workplace managers
Publisher: Springer Science and Business Media LLC
Date: 29-01-2018
Moving the Ambulance to the Top of the Cliff: Reducing the Burden of Depressive Symptoms after Stroke
Publisher: SAGE Publications
Date: 06-2009
Discrimination in the workplace, reported by people with major depressive disorder: a cross-sectional study in 35 countries
Publisher: BMJ
Date: 02-2016
Distress and career regret in doctors: are we really that different to other professions?
Publisher: Wiley
Date: 15-03-2023
DOI: 10.5694/MJA2.51875
Web-based decision aid tool for disclosure of a mental health condition in the workplace: A randomised controlled trial
Publisher: BMJ
Date: 14-08-2019
DOI: 10.1136/OEMED-2019-105726
Abstract: Making decisions about disclosing a mental illness in the workplace is complicated. Decision aid tools are designed to help an in idual make a specific choice. We developed a web-based decision aid to help inform decisions about disclosure for employees. This study aimed to examine the efficacy of this tool. We conducted a randomised controlled trial with recruitment, randomisation and data collection all online. Participants had access to the intervention for 2 weeks. Assessments occurred at baseline, postintervention and 6 weeks’ follow-up. The primary outcome was decisional conflict. Secondary outcomes were stage and satisfaction of decision-making and mental health symptoms. 107 adult employees were randomised to READY (n=53) or the control (n=54). The s le was predominantly female (83.2%). Participants using READY showed greater reduction in decisional conflict at postintervention ( F (1,104)=16.8, p .001) ( d =0.49, 95% CI 0.1 to 0.9) and follow-up ( F (1,104)=23.6, p .001) ( d =0.61, 95% CI 0.1 to 0.9). At postintervention the READY group were at a later stage of decision-making ( F (1,104)=6.9, p=0.010) which was sustained, and showed a greater reduction in depressive symptoms ( F (1,104)=6.5, p=0.013). Twenty-eight per cent of READY users disclosed, and reported a greater improvement in mental health than those who did not disclose. READY provides a confidential, flexible and effective tool to enhance employee’s decision-making about disclosure. Its use led to a comparative improvement in depressive symptoms compared with the current information provided by a leading mental health non-governmental organisation, without apparent harm. READY seems worth evaluating in other settings and, if these results are replicated, scaling for wider use. ACTRN12618000229279.
The Course and Impact of Poststroke Insomnia in Stroke Survivors Aged 18 to 65 Years: Results from the Psychosocial Outcomes In StrokE (POISE) Study
Publisher: S. Karger AG
Date: 03-02-2017
DOI: 10.1159/000455751
Abstract: b i Background: /i /b Insomnia symptoms are common in the population and have negative psychosocial and functional sequelae. There are no prospective studies of the course of such symptoms and their impact, if any, in stroke survivors. This prospective cohort study investigated insomnia after stroke in working-age adults and evaluated its impact on psychological and functional outcomes over the subsequent year. b i Methods: /i /b We prospectively recruited 441 young (& #x3c years) consecutive stroke survivors from 20 public hospitals in the New South Wales Stroke Service network. Participants were assessed by self-report and interview at 28 days, 6 months, and 12 months after stroke. Insomnia was defined using a common epidemiological measure of sleep disturbance and daytime consequences. Depression, anxiety, disability, and return to work were assessed through standardized measures. b i Results: /i /b The point prevalence of insomnia at each time point in the year after stroke was stable at 30–37% and more common in females. Fifty-eight (16%) of all participants reported “chronic” insomnia, with symptoms at both baseline and 6 months later. At 12 months, this group was more likely to be depressed (OR 6.75, 95% CI 2.78–16.4), anxious (OR 3.31, 95% CI 1.54–7.09), disabled (OR 3.60, 95% CI 2.07–6.25), and not have returned to work, compared to those without insomnia over the same period. b i Conclusions: /i /b Chronic insomnia has a negative effect on disability and return to work 1 year after stroke even after adjusting for demographic, psychiatric, and disability factors. Identifying and appropriately targeting insomnia through known effective treatments may improve functional outcomes after stroke.
Targeted primary care-based mental health services for young Australians
Publisher: AMPCo
Date: 02-2012
DOI: 10.5694/MJA11.10481
Abstract: To assess the extent to which youth-specific, mental health care centres engage young people (12-25 years of age) in treatment, and to report the degree of psychological distress, and the diagnostic type, stage of illness, and psychosocial and vocational impairment evident in these young people. Standardised clinical and self-report assessments of consecutive presentations at two youth-specific centres from October 2007 to December 2009. Both sites are operated by the Brain and Mind Research Institute in Sydney, Australia, as part of headspace: the National Youth Mental Health Foundation mental health care service. Of 1260 young people assessed, 53% were male, and the mean (SD) age was 18.1 (3.9) years. Over 40% of the young people were self-referred, or their assessment was arranged by family or friends, or by other social agencies 30% of young people were referred from other primary health providers. Almost 70% reported high or very high levels of psychological distress. More than 60% of subjects reported having 2 or more days "unable to function" within the past month, and clinicians rated over 50% as having at least moderate difficulty in social/occupational functioning. Importantly, 25% of subjects were receiving income support. Two-thirds of subjects were rated as being at the early stage of an illness, and almost half were diagnosed with anxiety or depressive syndromes. Targeted youth-specific mental health services, based in primary care settings, are able to engage young Australians, particularly young men, in treatment. Many of these young people report established patterns of psychosocial and vocational impairment.
An Overview of Autism Spectrum Disorder, Heterogeneity and Treatment Options
Publisher: Springer Science and Business Media LLC
Date: 17-02-2017
Effect of interventions for the well-being, satisfaction and flourishing of general practitioners - A systematic review
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJOPEN-2020-046599
Abstract: Clinician well-being has been recognised as an important pillar of healthcare. However, research mainly addresses mitigating the negative aspects of stress or burnout, rather than enabling positive aspects. With the added strain of a pandemic, identifying how best to maintain and support the well-being, satisfaction and flourishing of general practitioners (GPs) is now more important than ever. Systematic review. We searched MEDLINE, PsycINFO, Embase, CINAHL and Scopus from 2000 to 2020. Intervention studies with more than 50% GPs in the s le evaluating self-reported well-being, satisfaction and related positive outcomes were included. The Cochrane Risk of Bias 2 tool was applied. We retrieved 14 792 records, 94 studies underwent full-text review. We included 19 studies in total. Six randomised controlled trials, three non-randomised, controlled trials, eight non-controlled studies of in idual or organisational interventions with a total of 1141 participants. There were two quasi-experimental articles evaluating health system policy change. Quantitative and qualitative positive outcomes were extracted and analysed. In idual mindfulness interventions were the most common (k=9) with medium to large within-group (0.37–1.05) and between-group (0.5–1.5) effect sizes for mindfulness outcomes, and small-to-medium effect sizes for other positive outcomes including resilience, compassion and empathy. Studies assessing other intervention foci or other positive outcomes (including well-being, satisfaction) were of limited size and quality. There is remarkably little evidence on how to improve GPs well-being beyond using mindfulness interventions, particularly for interventions addressing organisational or system factors. This was further undermined by inconsistent reporting, and overall high risk of bias. We need to conduct research in this space with the same rigour with which we approach clinical intervention studies in patients. CRD42020164699. Dr Diana Naehrig is funded through the Raymond Seidler PhD scholarship.
Psychological impact upon London Ambulance Service of the 2005 bombings
Publisher: Oxford University Press (OUP)
Date: 28-07-2009
Abstract: This study was conducted following the London bombings of 7 July 2005. To assess the psychological impact of the 2005 London bombings on London Ambulance Service (LAS) personnel, risk factors for the development of psychological ill-health and employee awareness of post incident support. A total of 525 LAS personnel involved in the bombings, and a control group of uninvolved staff, were sent a questionnaire 2 months after the bombings. Main outcome measures were the presence of probable post-traumatic stress disorder (PTSD) measured using the Trauma Screening Questionnaire and substantial psychological distress using a tool identical to that used to assess the impact of these bombings on the population of London. Fifty-six per cent of those who responded were involved in the bombings. Overall, including controls, the response rate was 32% (341). Four per cent of respondents reported probable PTSD and 13% reported substantial distress. Probable PTSD was more common in those involved in the bombings (6% overall), those working at the disaster scene and, in particular, at one of the incident locations (where 50% of all probable PTSD cases worked). The majority of staff were aware of the post incident support available and how to access this, particularly if personnel were involved in the bombings. The LAS did not report higher levels of probable PTSD and psychological distress than the rest of the London population however, those more proximal to the incident were more likely to have been affected in spite of being aware of various staff support measures put in place.
Acceptability and face validity of two mental health screening tools for use in the routine surgical setting.
Publisher: Springer Science and Business Media LLC
Date: 30-10-2021
DOI: 10.1186/S40359-021-00672-W
Abstract: Preoperative assessment of mental health rarely occurs within routine surgery. Any screening tool selected to form part of this process must be deemed practical, acceptable and valid by clinicians and consumers alike. This study aims to assess the acceptability and face validity of two existing mental health screening tools to select one for further development and use in the routine surgical setting. A survey of clinicians and consumers was conducted from October 2020 to March 2021 at a tertiary hospital in Sydney, Australia. Using a Likert scale (1–5, lowest to highest rating), the clinicians evaluated four domains for acceptability and two for validity (six overall) and the consumers four domains for acceptability and one for validity (five overall) on the preoperative use of the amended Kessler Psychological Distress Scale (K10) and the Somatic and Psychological Health Report-12 (SPHERE-12) . Consensus was achieved through a rating of 4 or 5 being given by 70% or more of participants with domains able to remain unchanged. Free text responses were analysed into themes. A total of 73 participants (51 clinicians 22 consumers) were included. The K10 received consensus scores (≥ 70%) in four out of six domains for clinicians (4/4 acceptability 0/2 validity), and all five domains for consumers (4/4 acceptability 1/1 validity). The SPHERE-12 received consensus scores (≥ 70%) in three domains for clinicians (3/4 acceptability 0/2 validity), and three domains for consumers (3/4 acceptability 0/1 validity). Six qualitative themes were described including (1) amendments to tool structure and language (2) scale response options (3) difficulty with somatic questions (4) practicality and familiarity with K10 (5) challenges for specific patient cohorts and (6) timing considerations for patients. Adequate acceptability was established for the K10. However further development is required to strengthen its validity for this specific surgical cohort and purpose. Future research to determine the feasibility and acceptability of implementing and using the K10 in the routine surgical setting is now needed.
Cross-national variations in reported discrimination among people treated for major depression worldwide: The ASPEN/INDIGO international study
Publisher: Royal College of Psychiatrists
Date: 12-2015
DOI: 10.1192/BJP.BP.114.156992
Abstract: No study has so far explored differences in discrimination reported by people with major depressive disorder (MDD) across countries and cultures. To (a) compare reported discrimination across different countries, and (b) explore the relative weight of in idual and contextual factors in explaining levels of reported discrimination in people with MDD. Cross-sectional multisite international survey (34 countries worldwide) of 1082 people with MDD. Experienced and anticipated discrimination were assessed by the Discrimination and Stigma Scale (DISC). Countries were classified according to their rating on the Human Development Index (HDI). Multilevel negative binomial and Poisson models were used. People living in ‘very high HDI’ countries reported higher discrimination than those in ‘medium/low HDI’ countries. Variation in reported discrimination across countries was only partially explained by in idual-level variables. The contribution of country-level variables was significant for anticipated discrimination only. Contextual factors play an important role in anticipated discrimination. Country-specific interventions should be implemented to prevent discrimination towards people with MDD.
Disability, functioning, and quality of life among treatment-seeking young autistic adults and its relation to depression, anxiety, and stress
Publisher: SAGE Publications
Date: 17-01-2019
Abstract: In this study, we consecutively recruited treatment-seeking young autistic adults without intellectual impairment aged 16–30 years who presented to a mental health service and evaluated general health (distress, quality of life, and disability), functioning (work loss days and social functioning), and mood symptoms (depression, anxiety, and stress) in those diagnosed with autism spectrum disorder ( n = 96). This group was compared to young adults presenting to the same service with primary mental health disorders (depression, n = 343 bipolar, n = 132 psychosis, n = 166 and anxiety, n = 303). This study also investigated the influence of mood symptoms on general health and functioning in the autism spectrum disorder group. Young autistic adults reported significant general health and functioning impairments that were of similar degree to those presenting with primary mental health disorders. Interestingly, the autistic group also reported similarly high levels of mood symptoms to those with primary depressive and anxiety disorders. In the autistic group, depressive symptoms were strongly associated with distress, quality of life, and work loss days, while stress symptoms were strongly associated with disability. This study highlights further research, and mental health services are required specifically targeting young autistic adults to address their significant unmet needs.
A controlled trial of mental illness related stigma training for medical students
Publisher: Springer Science and Business Media LLC
Date: 29-07-2011
Cytokine aberrations in autism spectrum disorder: a systematic review and meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 17-06-2014
DOI: 10.1038/MP.2014.59
Abstract: The role of non-diagnostic features in the pathophysiology of autism spectrum disorders (ASDs) is unclear. Increasing evidence suggests immune system alterations in ASD may be implicated in the severity of behavioral impairment and other developmental outcomes. The primary objective of this meta-analysis was to investigate if there is a characteristic abnormal cytokine profile in ASD compared with healthy controls (HCs). We identified relevant studies following a search of MEDLINE, EMBASE, PsycINFO, Web of Knowledge and Scopus. A meta-analysis was performed on studies comparing plasma and serum concentrations of cytokines in unmedicated participants with ASD and HCs. Results were reported according to PRISMA statement. Seventeen studies with a total s le size of 743 participants with ASD and 592 HC were included in the analysis. Nineteen cytokines were assessed. Concentrations of interleukin (IL)-1beta (P<0.001), IL-6 (P=0.03), IL-8 (P=0.04), interferon-gamma (P=0.02), eotaxin (P=0.01) and monocyte chemotactic protein-1 (P<0.05) were significantly higher in the participants with ASD compared with the HC group, while concentrations of transforming growth factor-β1 were significantly lower (P<0.001). There were no significant differences between ASD participants and controls for the other 12 cytokines analyzed. The findings of our meta-analysis identified significantly altered concentrations of cytokines in ASD compared to HCs, strengthening evidence of an abnormal cytokine profile in ASD where inflammatory signals dominate.
The National Heart Foundation of Australia Consensus Statement on Psychosocial Risk Factors for Coronary Heart Disease
Publisher: Elsevier BV
Date: 2013
Designing smartphone mental health applications for emergency service workers
Publisher: Oxford University Press (OUP)
Date: 23-05-2017
Abstract: Emergency service workers are often exposed to trauma and have increased risk of a range of mental health (MH) conditions. Smartphone applications have the potential to provide this group with effective psychological interventions however, little is known about the acceptability and preferences regarding such initiatives. To describe the preferences and opinions of emergency service workers regarding the use of smartphone MH applications and to examine the impact of age on these preferences. Participants were recruited from four metropolitan Fire and Rescue NSW stations and responded to questionnaire items covering three key domains: current smartphone use, potential future use and preferences for design and content as well as therapeutic techniques. Overall, approximately half the s le (n = 106) claimed they would be interested in trying a tailored emergency-worker MH smartphone application. There were few differences between age groups on preferences. The majority of respondents claimed they would use an app for mental well-being daily and preferred terms such as 'well-being' and 'mental fitness' for referring to MH. Confidentiality, along with a focus on stress, sleep, exercise and resiliency were all considered key features. Behavioural therapeutic techniques were regarded most favourably, compared with other therapies. Emergency workers were interested in utilizing smartphone applications focused on MH, but expressed clear preferences regarding language used in promotion, features required and therapeutic techniques preferred.
Genetic and Environmental Contributions to the Overlap Between Psychological, Fatigue and Somatic Symptoms: A Twin Study in Sri Lanka
Publisher: Cambridge University Press (CUP)
Date: 02-2011
DOI: 10.1375/TWIN.14.1.53
Abstract: Background: Somatic symptoms often co-occur with psychological symptoms but this overlap is poorly understood. Some aspects of this overlap differ in the South Asian context, but it is not clear whether this is a reporting effect or an underlying difference in experienced illness. Methods: Home interviews were administered to 4,024 twins randomly selected from a population-based twin register in the Colombo district of Sri Lanka (the CoTASS study). These included assessments of psychological, somatic and fatigue symptoms. The data were analyzed using factor analytic and quantitative genetic approaches. Results: Confirmatory factor analysis showed that the symptoms from the three scales represented three separate dimensions, rather than all tapping into a single dimension. However, familial correlations among the data were most consistent with a common pathway model. This implies that a portion of the underlying vulnerability is common across psychological, fatigue and somatic symptoms. There were sex differences in the etiology of this model, with shared environmental and genetic influences playing different roles in men and women. Conclusions: There is a complex etiological relationship between psychological, fatigue and somatic symptoms. This is similar in Sri Lanka to Western countries, but there may be a greater influence from the family environment, suggesting that care needs to be taken when generalizing research findings between countries. People who complain of certain fatigue or somatic symptoms may well also have psychological symptoms, or may have genetic or environmental vulnerabilities to such problems.
Sleeping at the limits: The changing prevalence of short and long sleep durations in 10 countries
Publisher: Oxford University Press (OUP)
Date: 22-03-2013
DOI: 10.1093/AJE/KWS308
Abstract: Short (≤6 hours) and long (>9 hours) sleep durations are risk factors for mortality and morbidity. To investigate whether the prevalences of short and long sleep durations have increased from the 1970s to the 2000s, we analyzed data from repeated cross-sectional surveys of 10 industrialized countries (38 nationally representative time-use surveys n = 328,018 adults). Logistic regression models for each country were used to determine changes in the prevalence of short and long sleep durations over time, controlling for s ling differences in gender, age, number of weekend days included, and season of data collection. Over the periods covered by data, the prevalence of short sleep duration increased in Italy (adjusted odds ratio = 2.64, 95% confidence interval (CI): 2.41, 2.89) and Norway (adjusted odds ratio = 2.33, 95% CI: 1.77, 3.08) but decreased in Sweden, the United Kingdom, and the United States. The prevalence of long sleep duration increased in Australia (adjusted odds ratio = 1.14, 95% CI: 1.05, 1.25), Finland (adjusted odds ratio = 1.30, 95% CI: 1.14, 1.48), Sweden (adjusted odds ratio = 1.51, 95% CI: 1.35, 1.69), the United Kingdom (adjusted odds ratio = 2.03, 95% CI: 1.68, 2.46), and the United States (adjusted odds ratio = 1.50, 95% CI: 1.36, 1.65) but decreased in Canada and Italy. No changes were observed in Germany or the Netherlands. Limited increases in short sleep duration challenge the claim of increasingly sleep-deprived societies. Long sleep duration is more widespread than is short sleep duration. It has become more prevalent and thus should not be overlooked as a potential contributor to ill health.
S50.02 The influence of personality on the assessment of disablement
Publisher: Cambridge University Press (CUP)
Date: 10-2000
Return to driving after a diagnosis of epilepsy: A prospective registry study
Publisher: Wiley
Date: 16-01-2018
DOI: 10.1111/EPI.14001
Abstract: To determine the frequency and predictors of return to driving within 1 year after a diagnosis of epilepsy. SEISMIC (the Sydney Epilepsy Incidence Study to Measure Illness Consequences) was a prospective, multicenter, community-wide study of people of all ages with newly diagnosed epilepsy in Sydney, Australia. Demographic, socioeconomic, and clinical characteristics and driving status were obtained as soon as possible after baseline registration with a diagnosis of epilepsy. Multivariate logistic regression was used to determine predictors of return to driving at 12-month follow-up. Among 181 (76%) adult participants (≥18 years old) who reported driving before an epilepsy diagnosis, 152 provided information on driving at 12 months, of whom 118 (78%) had returned to driving. Driving for reasons of getting to work or place of education (odds ratio [OR] = 4.70, 95% confidence intervals [CI] = 1.87-11.86), no seizure recurrence (OR = 5.15, 95% CI = 2.07-12.82), and being on no or a single antiepileptic drug (OR = 4.54, 95% CI = 1.45-14.22) were associated with return to driving (C statistic = 0.79). More than half of participants with recurrent seizures were driving at follow-up. Early return to driving after a diagnosis of epilepsy is related to work/social imperatives and control of seizures, but many people with recurrent seizures continue to drive. Further efforts are required to implement driving restriction policies and to provide transport options for people with epilepsy.
Personalized Help-Seeking Web Application for Chinese-Speaking International University Students: Development and Usability Study
Publisher: JMIR Publications Inc.
Date: 17-02-2023
DOI: 10.2196/35659
Abstract: The mental health of international students is a growing concern for education providers, students, and their families. Chinese international students have low rates of help seeking owing to language, stigma, and mental health literacy barriers. Web-based help-seeking interventions may improve the rate of help seeking among Chinese international students. This study aimed to describe the development of a mental well-being web app providing personalized feedback and tailored psychoeducation and resources to support help seeking among international university students whose first language is Chinese and test the web application’s uptake and engagement. The bilingual MindYourHead web application contains 6 in-app assessments for various areas of mental health, and users are provided with personalized feedback on symptom severity, psychoeducation tailored to the person’s symptoms and information about relevant interventions, and tailored links to external resources and mental health services. A feasibility study was conducted within a school at the University of Sydney to examine the uptake and engagement of the web application among Chinese international students and any demographic characteristics or help-seeking attitudes or intentions that were associated with its engagement. A total of 130 Chinese international students signed up on the web application. There was an uptake of 13.4% (122/908) in the schools’ Chinese student enrollment. Most participants (76/130, 58.5%) preferred to use the web application in Chinese and used informal but not formal help for their mental health. There was considerable attrition owing to a design issue, and only 46 students gained access to the full content of the web application. Of these, 67% (31/46) of participants completed 1 or more of the in-app mental well-being assessments. The most commonly engaged in-app assessments were distress (23/31, 74%), stress (17/31, 55%), and sleep (15/31, 48%), with the majority scoring within the moderate- or high-risk level of the score range. In total, 10% (9/81) of the completed in-app assessments led to clicks to external resources or services. No demographic or help-seeking intentions or attitudes were associated with web-application engagement. There were promising levels of demand, uptake, and engagement with the MindYourHead web application. The web application appears to attract students who wished to access mental health information in their native language, those who had poor mental health in the past but relied on informal support, and those who were at moderate or high risk of poor mental well-being. Further research is required to explore ways to improve uptake and engagement and to test the efficacy of the web application on Chinese international students’ mental health literacy, stigma, and help seeking.
Validation of the 36-item and 12-item self-report World Health Organization Disability Assessment Schedule II (WHODAS-II) in individuals with autism spectrum disorder
Publisher: Wiley
Date: 29-04-2019
DOI: 10.1002/AUR.2115
Abstract: The World Health Organization Disability Assessment Schedule II (WHODAS-II) is one of the most widely used generic assessments for measuring disability levels in both clinical and nonclinical populations, with sound psychometrics that is also aligned with the International Classification of Functioning framework. However, its psychometric properties have not been explored extensively in in iduals with autism spectrum disorder (ASD). This study examined the psychometric properties of the 36-item and 12-item Self-Report WHODAS-II from 109 in iduals diagnosed with ASD and without intellectual disability (IQ ≥ 70). Participants were consecutively recruited from the Brain and Mind Centre in New South Wales, Australia. The WHODAS-II showed adequate internal consistency for all domain scores (α = 0.78-0.97 for 36-item) and for the summary scale (α = 0.95 for 36-item 0.86 for 12-item). All items also exhibited satisfactory correlations with their respective domain (r = 0.39-0.94 for 36-item) and summary scores (r = 0.42-0.71 for 36-item 0.42-0.67 for 12-item), except item 4.5 "sexual activity" from the 36-item WHODAS-II (r = 0.19). Concurrent validity was shown by moderate correlations between similar constructs across the WHODAS-II and the World Health Organization Quality of Life BREF (Ps < 0.05). The second-order 7-factor model showed the best fit for the 36-item WHODAS-II, while the second-order 6-factor model demonstrated an acceptable fit for the 12-item WHODAS-II. The model fit could be improved with some modifications. The Schmid-Leiman transformation further confirmed the appropriateness of the second-order factor structure. Overall, the results indicated that the WHODAS-II is a viable generic self-report measure for disability in autistic in iduals without ID. Autism Res 2019, 12: 1101-1111. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The majority of autistic people have a disability with a profound or severe limitation in their core activities. However, there is currently limited research identifying reliable and valid self-report measures for disability in the autistic population. This study examined the psychometric properties of the World Health Organization Disability Assessment Schedule II (WHODAS-II) from 109 autistic in iduals without intellectual disability. Our results suggest that the WHODAS-II is a viable generic self-report measure for disability in autistic in iduals.
The Disability Discrimination Act 1995 and psychiatry: Lessons from the first seven years
Publisher: Royal College of Psychiatrists
Date: 04-2004
DOI: 10.1192/PB.28.4.126
Abstract: To extract relevant information for clinicians from reported and/or accessible cases involving psychiatric illness brought under the Disability Discrimination Act 1995 (DDA). Institutional databases were searched for DDA cases and relevant guidance from case law extracted. Over half the cases reaching higher courts involve psychiatric illness. A number of decisions provide guidance for clinicians wishing to aid their own patients, and those involved as expert witnesses. These cover which conditions are included as impairments (almost everything in ICD–10), what associated effects are to be considered, and the relevance of comorbidity and treatment. Cases often involve recovery of clinical documents that reveal interesting variation in professional standards. Virtually all patients of psychiatrists in secondary care would be covered by the DDA. Knowledge of this Act could be used to enhance a patient's access to employment and services, and potentially overcome some of the effects of stigmatisation.
Psychological distress among Australian workers accessing the COVID-19 Superannuation Early Access Scheme
Publisher: SAGE Publications
Date: 04-10-2022
Agreement between subjective and objective measures of sleep duration in a low-middle income country setting
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.SLEH.2018.08.008
Abstract: Describe sleep duration in adult Sri Lankans and determine the bias and agreement of self-report and actigraphic assessments. Validation sub-study nested within the Colombo Twin and Singleton Study (2012-2015). Colombo, Sri Lanka. 175 adults with actigraphy, randomly selected from 3497 participants with self-reported sleep assessed in a population-based cohort. Self-reported sleep duration, ascertained by the Pittsburgh Sleep Quality Index (PSQI), was compared to a minimum of four days of actigraphy. Bias and agreement were assessed using the Bland-Altman method and a novel application of criterion cut-point analysis. Objective measurements of wake after sleep onset (WASO) and sleep efficiency were evaluated. Sri Lankans have short sleep duration averaging 6.4h (SD 1.5) self-reported and 6.0h (SD 0.9) actigraphically. Poor sleep quality was prevalent with an average WASO of 49 min., and sleep efficiency <85%. Bias was observed, with self-report consistently over-reporting sleep on average by 27.6 min (95% CI: -0.68, -0.24) compared to objective measures, but wide in idual variation in disagreement, ranging from over-reporting by 3.34h to under-reporting by 2.42h. A criterion cut-point method also failed to define agreed definitions of short and long sleep duration. Sleep in Sri Lankan adults, whether measured subjectively or objectively, is of short duration and suboptimal objective quality by High Income Country consensus standards. Given the high cardiometabolic morbidity in Sri Lanka and poor measurement agreement observed, this warrants further investigation and supports the need for culturally appropriate, reliable, and valid assessment for analytic epidemiology in non-Western settings.
A smartphone application for treating depressive symptoms: Study protocol for a randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 06-2018
A framework to create more mentally healthy workplaces: A viewpoint
Publisher: SAGE Publications
Date: 23-08-2017
Abstract: Mental illness is now the leading cause of long-term sickness absence among Australian workers, with significant costs to the in idual, their employers and society more broadly. However, to date, there has been little evidence-informed guidance as to what workplaces should be doing to enhance their employees' mental health and wellbeing. In this article, we present a framework outlining the key strategies employers can implement to create more mentally healthy workplaces. The five key strategies outlined are as follows: (1) designing work to minimise harm, (2) building organisational resilience through good management, (3) enhancing personal resilience, (4) promoting early help-seeking and (5) supporting recovery and return to work. A narrative review is utilised to outline the theoretical evidence for this framework and to describe the available research evidence for a number of key ex le interventions for each of the five strategies. While each workplace needs to develop tailored solutions, the five strategy framework proposed in this review will hopefully provide a simple framework for employers and those advising them to use when judging the adequacy of existing services and considering opportunities for further enhancements.
Ensuring the affordable becomes accessible–lessons from ketamine, a new treatment for severe depression
Publisher: SAGE Publications
Date: 13-10-2023
Are Organizational EHealth Interventions Becoming More Effective at Addressing Employee Mental Health; A Systematic Review and Meta-Analysis (Preprint)
Publisher: JMIR Publications Inc.
Date: 07-03-2022
Abstract: ental health conditions are considered the leading cause of disability, sickness absence, and long-term work incapacity in most developed countries. EHealth interventions provide employees with access to psychological assistance. There has been widespread implementation and provision of eHealth interventions in the workplace as an inexpensive and anonymous way of addressing common mental disorders he aims of this updated review were to synthesize the literature of the efficacy of eHealth interventions for anxiety, depression, and stress outcomes in employee s les in organisational settings, and evaluate whether their effectiveness has improved over time. ystematic searches in relevant articles published from 2004 - July 2020 of trials of eHealth interventions (App or web-based) focused on the mental health of employees. The quality and bias of all studies was assessed. We extracted means and standard deviations from publications, comparing the difference in effect sizes (Hedge’s g) in standardized mental health outcomes. We meta-analyzed these using a random effects model. e identified a tripling of the body of evidence, with 75 trials available for meta-analysis, with a combined s le of n=14,747. EHealth interventions showed small positive effects for anxiety (g=0.26), depression (g=0.26), and stress (g=0.25) in employees’ post-intervention, with similar effects seen at the medium term follow up. There was evidence for no increase in the effectiveness of these interventions over the past decade. his review and meta-analysis confirm that eHealth interventions have a small, positive impact on reducing mental health symptoms in employees. Disappointingly we found no evidence that, despite the advances in technology, the enormous resources in time, research and finance devoted to this area for over a decade, we are producing better interventions. Hopefully these small effect sizes do not represent the optimum outcome in organisational settings. he systematic review protocol was registered on PROSPERO: CRD42020185859.
Effectiveness of eHealth interventions for reducing mental health conditions in employees: A systematic review and meta-analysis
Publisher: Public Library of Science (PLoS)
Date: 21-12-2017
Sleep Disturbances and Suicidality-A Longitudinal Analysis From a Representative Community Study Over 30 Years.
Publisher: Frontiers Media SA
Date: 16-07-2018
The effect of short sleep duration on ongoing psychiatric morbidity
Publisher: Cambridge University Press (CUP)
Date: 04-2008
Deciding to Disclose a Mental Health Condition in Male Dominated Workplaces; A Focus-Group Study
Publisher: Frontiers Media SA
Date: 19-12-2018
Insomnia Patients' Help-Seeking Experiences
Publisher: Informa UK Limited
Date: 20-03-2014
DOI: 10.1080/15402002.2013.764529
Abstract: Timely access to appropriate treatment is important for optimizing insomnia management. To date, little is known about insomnia patients' treatment experiences or how they access and engage with the available health care resources. This study sought to capture the help-seeking experiences and behavioral patterns of patients with insomnia who are seeking or receiving specialist care. A purposive s le of 26 insomnia patients from specialist sleep and mental health clinics located in metropolitan New South Wales, Australia was recruited. Participants completed a brief questionnaire, followed by an in-depth, semi-structured interview. Interviews were digitally recorded, transcribed verbatim, and analyzed using framework analysis. Three key themes emerged from the data: patients' sleep beliefs, treatment beliefs, and accessing specialized care. The findings show that daytime symptoms arising from insomnia serve as important illness cues for patients to seek medical help. In addition, participants' treatment pathways highlight factors that prevent the widespread use of cognitive behavioral therapy for insomnia (CBT-I), including limited awareness about CBT-I, tentative referral mechanisms, limited service providers, and the high cost of CBT-I.
Social capital and health during pregnancy; an in-depth exploration from rural Sri Lanka
Publisher: Springer Science and Business Media LLC
Date: 27-07-2017
Surgical experience for patients with serious mental illness: a qualitative study.
Publisher: Springer Science and Business Media LLC
Date: 20-01-2021
DOI: 10.1186/S12888-021-03056-X
Abstract: People with serious mental illness (SMI) have significantly worse surgical outcomes compared to the general population. There are many contributing factors to this complex issue, however consideration of the surgical experience from the patient’s own perspective has never been undertaken. This lack of understanding prevents the provision of truly patient centred care and may limit the impact of potential improvement initiatives. Therefore this study aims to describe and better understand the surgical experience from the perspective of patients with SMI. Within this qualitative study, semi-structured, audio-recorded interviews were conducted between August 2019 – June 2020, with 10 consenting participants with SMI who had surgery in the previous 2 years. A thematic analysis approach was used to explore both the positive and negative aspects of the participant’s surgical experience commencing from pre-operative consultation to hospital discharge and follow-up. Four main themes and related subthemes emerged including i) the perceived lack of mental ill health recognition, ii) highly variable patient and clinician interactions, iii) the impact of healthcare services, and iv) strategies for improvement. Surgical patients with SMI want to be treated like everyone else whilst still having their mental ill health acknowledged and proactively managed despite this rarely occurring, which is valuable information for all surgical teams to consider and learn from. Participants were able to describe several readily implementable strategies to potentially improve their care and overall surgical experience, and as such highlight considerable opportunities for these to be tested and evaluated for this underserved patient group.
Supported employment for people with severe mental illness: Systematic review and meta-analysis of the international evidence
Publisher: Royal College of Psychiatrists
Date: 07-2016
DOI: 10.1192/BJP.BP.115.165092
Abstract: In idual 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) growth. 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. In idual 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 vocational rehabilitation.
Development of the Shift Smartphone App to Support the Emotional Well-Being of Junior Physicians: Design of a Prototype and Results of Usability and Acceptability Testing
Publisher: JMIR Publications Inc.
Date: 02-12-2021
DOI: 10.2196/26370
Abstract: Junior physicians report higher levels of psychological distress than senior doctors and report several barriers to seeking professional mental health support, including concerns about confidentiality and career progression. Mobile health (mHealth) apps may be utilized to help overcome these barriers to assist the emotional well-being of this population and encourage help-seeking. This study describes the development and pilot trial of the Shift mHealth app to provide an unobtrusive avenue for junior physicians to seek information about, and help for, well-being and mental health concerns, which is sensitive to workplace settings. A 4-phase iterative development process was undertaken to create the content and features of Shift involving junior physicians using the principles of user-centered design. These 4 phases were—needs assessment, on the basis of interviews with 12 junior physicians prototype development with user experience feedback from 2 junior physicians evaluation, consisting of a pilot trial with 22 junior physicians to assess the usability and acceptability of the initial prototype and redesign, including user experience workshops with 51 junior physicians. Qualitative results informed the content and design of Shift to ensure that the app was tailored to junior physicians’ needs. The Shift app prototype contained cognitive behavioral, mindfulness, value-based actions, and psychoeducational modules, as well as a tracking function that visualized patterns of daily variations in mood and health behaviors. Pilot-testing revealed possible issues with the organization of the app content, which were addressed through a thorough restructuring and redesign of Shift with the help of junior physicians across 3 user experience workshops. This study demonstrates the importance of ongoing end user involvement in the creation of a specialized mHealth app for a unique working population experiencing profession-specific stressors and barriers to help-seeking. The development and pilot trial of this novel Shift mHealth app are the first steps in addressing the mental health and support-seeking needs of junior physicians, although further research is required to validate its effectiveness and appropriateness on a larger scale.
Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey
Publisher: Elsevier BV
Date: 2013
How context matters: Demonstrating microgeographical differences in social capital and its implications for mental wellbeing in pregnancy with a novel bubble diagram technique
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.HEALTHPLACE.2019.102231
Abstract: There has been limited exploration of social capital at the contextual level in relation to maternal health, and in particular with the "obstetric transition" and associated mental health problems. In the North Central Province of Sri Lanka, with socio-culturally erse communities, and a recent history of major conflict, the leading cause of maternal death is suicide. The objective of this study was to identify contextual patterns of social capital constructs that lead to poor maternal mental wellbeing, using a novel bubble visualisation technique, to demonstrate the use of data derived from qualitative approaches. We conducted a qualitative study of pregnant women based on diary entries (n = 41) and interviews (n = 38) in eight different communities of the Anuradhapura district of Sri Lanka. Bubble diagrams were constructed to visualize each context using the frequency and weight of responses given in diaries. Marital, family and neighbourhood cohesion were not homogenous in the district and the bubble diagrams displayed clear microgeographical patterns in which women living in specific communities had poorer mental wellbeing. Such techniques can be used to convey complex social capital implications in digestible way for policy makers and planners to enact locally specific strategies addressing health inequalities.
Digital mHealth Interventions for Employees: Systematic Review and Meta-Analysis of Their Effects on Workplace Outcomes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-05-2021
Protocol for establishing a child and adolescent twin register for mental health research and capacity building in Sri Lanka and other low and middle-income countries in South Asia
Publisher: BMJ
Date: 10-2019
DOI: 10.1136/BMJOPEN-2019-029332
Abstract: Worldwide, 10%–20% of children and adolescents experience mental health conditions. However, most such disorders remain undiagnosed until adolescence or adulthood. Little is known about the factors that influence mental health in children and adolescents, especially in low and middle-income countries (LMIC), where environmental threats, such as poverty and war, may affect optimal neurodevelopment. Cohort studies provide important information on risks and resilience across the life course by enabling tracking of the effects of early life environment on health during childhood and beyond. Large birth cohort studies, including twin cohorts that can be aetiologically informative, have been conducted within high-income countries but are not generalisable to LMIC. There are limited longitudinal birth cohort studies in LMIC. We sought to enhance the volume of impactful research in Sri Lanka by establishing a Centre of Excellence for cohort studies. The aim is to establish a register of infant, child and adolescent twins, including mothers pregnant with twins, starting in the districts of Colombo (Western Province) and Vavuniya (Northern Province). We will gain consent from twins or parents for future research projects. This register will provide the platform to investigate the aetiology of mental illness and the impact of challenges to early brain development on future mental health. Using this register, we will be able to conduct research that will (1) expand existing research capacity on child and adolescent mental health and twin methods (2) further consolidate existing partnerships and (3) establish new collaborations. The initiative is underpinned by three pillars: high-quality research, ethics, and patient and public involvement and engagement (PPIE). Ethical approval for this study was obtained from the Ethics Review Committee of Sri Lanka Medical Association and Keele University’s Ethical Review Panel. In addition to journal publications, a range of PPIE activities have been conducted.
The impact of trauma exposure on the development of PTSD and psychological distress in a volunteer fire service
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.PSYCHRES.2018.06.058
Abstract: Emergency service workers (ESWs) are at increased risk of trauma-related mental disorders. However, volunteer ESWs, who comprise the majority of firefighters in Western countries, have limited access to the necessary support services for mental health problems. This study aimed to examine the impact of the level and types of trauma exposure on the development of mental disorders in a volunteer fire service. Members of an Australian volunteer fire service (N = 459) completed a cross-sectional survey. Information on the number and types of distressing critical incidents involved within the last year was collected. Validated, self-report measures were used to determine probable post-traumatic stress disorder (PTSD) and psychological distress caseness. The risk of probable PTSD was significantly higher for those with the most frequent involvement with distressing incidents and the highest levels of cumulative trauma exposure. Being trapped in a dangerous situation or being assaulted by other people, resulted in the greatest odds of developing a mental disorder. Volunteer fire service members with the highest levels of trauma exposure and involvement with particular types of critical incidents are at elevated risk of mental health problems. The implications for the provision of psychological support measures amongst volunteer emergency services are discussed.
When a win is a draw.
Publisher: Oxford University Press (OUP)
Date: 26-04-2018
DOI: 10.1093/SLEEP/ZSY073
A transdiagnostic study of education, employment, and training outcomes in young people with mental illness
Publisher: Cambridge University Press (CUP)
Date: 10-04-2017
DOI: 10.1017/S0033291717000484
Abstract: Optimizing functional recovery in young in iduals with severe mental illness constitutes a major healthcare priority. The current study sought to quantify the cognitive and clinical factors underpinning academic and vocational engagement in a transdiagnostic and prospective youth mental health cohort. The primary outcome measure was ‘not in education, employment or training’ (‘NEET’) status. A clinical s le of psychiatric out-patients aged 15–25 years ( n = 163) was assessed at two time points, on average, 24 months apart. Functional status, and clinical and neuropsychological data were collected. Bayesian structural equation modelling was used to confirm the factor structure of predictors and cross-lagged effects at follow-up. In idually, NEET status, cognitive dysfunction and negative symptoms at baseline were predictive of NEET status at follow-up ( p 0.05). Baseline cognitive functioning was the only predictor of follow-up NEET status in the multivariate Bayesian model, while controlling for baseline NEET status. For every 1 s.d. deficit in cognition, the probability of being disengaged at follow-up increased by 40% (95% credible interval 19–58%). Baseline NEET status predicted poorer negative symptoms at follow-up ( β = 0.24, 95% credible interval 0.04–0.43). Disengagement with education, employment or training (i.e. being NEET) was reported in about one in four members of this cohort. The initial level of cognitive functioning was the strongest determinant of future NEET status, whereas being academically or vocationally engaged had an impact on future negative symptomatology. If replicated, these findings support the need to develop early interventions that target cognitive phenotypes transdiagnostically.
Understanding the vocational functioning of autistic employees: the role of disability and mental health
Publisher: Informa UK Limited
Date: 02-2023
DOI: 10.1080/09638288.2022.2066207
Abstract: Employment rates for autistic people are low, despite increasing employment-focused programmes. Given the reported complexities for autistic people in finding and keeping work and flourishing there, further exploration is needed to understand how best to help employers accommodate autistic employees. We assessed 88 employed autistic adults, without comorbid intellectual disability and examined whether self-reported disability and mental health symptoms were associated with two measures of vocational functioning: disability days off work and vocational disability. Nearly half (47%) reported at least one disability day absence in the previous month. Autism severity and IQ were not associated with either measure of vocational functioning. Greater disability and higher mental health symptoms were associated with both types of vocational functioning. However, the associations of anxiety and stress with both vocational outcomes were attenuated to null in a multivariable model. Disability ( Clinicians and vocational support programmes addressing modifiable factors may need to focus on addressing mental health comorbidities, specifically depression rather than anxiety, or core features of autism to improve vocational outcomes for autistic people. Implications for RehabilitationIn idual-level interventions that reduce disablement, particularly in social areas, and depressive symptoms as a way of reducing days off work and improving workplace activities in autistic employees are recommended.Organisations can accommodate autistic employees by encouraging use of mental health programmes or looking at how the workplace environment can be adapted to limit social disability.
A prospective cohort study of depression course, functional disability, and NEET status in help-seeking young adults
Publisher: Springer Science and Business Media LLC
Date: 06-08-2016
DOI: 10.1007/S00127-016-1272-X
Abstract: To examine the associations between depression course, functional disability, and Not in Education or Training (NEET) status in a clinical s le of young adults with mental health problems. Young adults aged 15-25 years seeking help from four primary mental health services were invited to participate in a prospective cohort study evaluating the course of psychiatric disorders in youth. Demographic and clinical characteristics, including depressive symptomatology and functioning, were evaluated through clinical interview and self-report at baseline and 12 month follow-up. A total of 448 young adults participated (70 % female M: 20.05 years, SD = 2.85). A significant interaction effect for time and depression course was found, such that those who became depressed reported an increase in functional disability and those whose depression remitted reported a significant reduction in functional disability. Developing depression was not a significant predictor of becoming NEET and vice versa: remitted depression did not make a person more likely to reengage in employment or education. This is the first study to examine the course of depression, functional disability, and NEET rates among help-seeking young adults. This study confirms the importance of symptom reduction for improved functioning however, functional disability remained greater than that seen in young people in the community and there was no association between a change in depression and a change in NEET status. These results argue that services need to address functional outcomes and reengagement with education and employment in addition to symptom reduction.
Chronic fatigue syndrome: It's tiring not knowing much - An in-depth review for occupational health professionals
Publisher: Oxford University Press (OUP)
Date: 2005
The GoodNight study—online CBT for insomnia for the indicated prevention of depression: study protocol for a randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 13-02-2014
Thoughts of death or suicidal ideation are common in young people aged 12 to 30 years presenting for mental health care
Publisher: Springer Science and Business Media LLC
Date: 12-2012
Abstract: Reducing suicidal behaviour is a major public health goal. Expanding access to care has been identified as a key strategy. In Australia, a national network of primary-care based services ( headspace ) has been established for young people with mental ill-health. This study determines the socio-demographic, psychopathological and illness-stage correlates of suicidal ideation in young persons attending headspace services. Suicidal ideation was recorded using the specific suicide item of the Hamilton Depression Rating Scale (HDRS) in a cohort of subjects aged 12-30 years (N = 494) attending headspace services. Of the 494 young persons assessed, 32% (158/494) had a positive response to any level of the HDRS suicide item, consisting of 16% (77/494) reporting that life was not worth living and a further 16% (81/494) reported thoughts of death or suicidal ideation. Young women (19% 94/494) were more likely to report any positive response as compared with young men (13% 64/494) [χ 2 (2,494) = 13.6, p .01]. Those with ‘attenuated syndromes’ reported positive responses at rates comparable to those with more established disorders (35% vs. 34% χ 2 (1,347) = 0.0, p = 0.87). However, more serious levels of suicidal ideation were more common in those with depressive disorders or later stages of illness. In multivariate analyses, the major predictors of the degree of suicidal ideation were increasing levels of clinician-rated depressive symptoms (beta = 0.595, p .001), general psychopathology (beta = 0.198, p .01), and self-reported distress (beta = 0.172, p .05). Feelings that life is not worth living, thoughts of death or suicidal ideation are common in young people seeking mental health care. These at-risk cognitions are evident before many of these in iduals develop severe or persistent mental disorders. Thoughts of death or suicidal ideation may well need to be a primary intervention target in these young people.
Epidemiology and symptomatology of depression in Sri Lanka: A cross-sectional population-based survey in Colombo District
Publisher: Elsevier BV
Date: 06-2010
Early predictors of remission in newly diagnosed epilepsy: a systematic approach to reviewing prognostic factor studies
Publisher: Informa UK Limited
Date: 23-10-2013
Employment in neurological disorders: The role of psychiatric comorbidity
Publisher: Cambridge University Press (CUP)
Date: 04-2008
Can youth at high risk of illness progression be identified by measures of rumination and sleep-wake disturbance.
Publisher: Wiley
Date: 28-11-2019
DOI: 10.1111/EIP.12757
Abstract: Clinical staging models offer a useful framework for understanding illness trajectories, where in iduals are located on a continuum of illness progression from stage 0 (at-risk but asymptomatic) to stage 4 (end-stage disease). Importantly, clinical staging allows investigation of risk factors for illness progression with the potential to target trans-diagnostic mechanisms at an early stage, especially in help-seeking youth who often present with sub-threshold syndromes. While depressive symptoms, rumination and sleep-wake disturbances may worsen syndrome outcomes, the role of these related phenomena has yet to be examined as risk factors for trans-diagnostic illness progression in at-risk youth. This study is a prospective follow-up of 248 in iduals aged 12 to 25 years presenting to headspace services with sub-threshold syndromes (stage 1) classified under the clinical staging model to determine transition to threshold syndromes (stage 2). Factor analysis of depression, rumination and sleep-wake patterns was used to identify key dimensions and any associations between factors and transition to stage 2 at follow-up. At 1 year, 9% of cases met criteria for stage 2 (n = 22). One of three identified factors, namely the factor reflecting the commonalities shared between rumination and sleep-wake disturbance, significantly differentiated cases that transitioned to stage 2 vs those that did not demonstrate transition. Items loading onto this factor, labelled Anergia, included depression severity and aspects of rumination and sleep-wake disturbance that were characterized as introceptive. Common dimensions between rumination and sleep-wake disturbance present a detectable trans-diagnostic marker of illness progression in youth, and may represent a target for early intervention.
Living Well, Living Longer: Working together for better health in people with mental illness
Publisher: Ubiquity Press, Ltd.
Date: 08-12-2014
DOI: 10.5334/IJIC.1888
Using different Facebook advertisements to recruit men for an online mental health study: Engagement and selection bias
Publisher: Elsevier BV
Date: 06-2017
Symptoms of anxiety and depression predict report of whiplash trauma
Publisher: Cambridge University Press (CUP)
Date: 04-2008
Does Psychological Distress Increase the Risk for Motor Vehicle Crashes in Young People? Findings From the DRIVE Study
Publisher: Elsevier BV
Date: 11-2010
DOI: 10.1016/J.JADOHEALTH.2010.03.010
Abstract: Earlier research demonstrates increased and decreased risk of crash related to psychological distress however, previous literature has almost entirely used retrospective study designs and has not been able to adequately control for important confounders such as exposure to driving, alcohol and drug use, or having had a previous crash. This study aimed to assess the relationship between psychological distress and risk of motor vehicle crashes. The DRIVE study is a prospective cohort study of 20,822 novice drivers aged 17-24 years in Australia. Information on risk factors for motor vehicle crash was collected through online questionnaire and subsequently linked to police-reported crashes. Poisson regression was used to analyze risk of various crash types by low, moderate, high, and very high levels of psychological distress, taking into account other known risk factors for crash. Compared to the referent group with low or no distress, a protective effect against crash was observed for young people who reported a moderate amount of psychological distress in unadjusted (RR = .87 95% CI = .76-1.00) and multivariable analyses (RR = .85 95% CI = .74-.97). Severe psychological distress was not significantly associated with an increase or decrease in the risk of crash. Psychological distress was not significantly associated with an increased risk of single vehicle crash. Earlier studies may have overestimated risk for motor vehicle crashes associated with psychological distress. This study found little convincing evidence to support a strong risk relationship for higher levels of distress and indeed found a modest protective association for low levels of distress.
Sydney epilepsy incidence study to measure illness consequences: The SESIMIC observational epilepsy study protocol
Publisher: Springer Science and Business Media LLC
Date: 09-01-2011
Efficacy of a Multi-component m-Health Weight-loss Intervention in Overweight and Obese Adults: A Randomised Controlled Trial
Publisher: MDPI AG
Date: 26-08-2020
Abstract: Background: This study compared the efficacy of two multi-component m-health interventions with a wait-list control group on body weight (primary outcome), and secondary outcomes of cardiovascular risk factors, lifestyle behaviours, and mental health. Methods: Three-arm randomised controlled trial (Enhanced: physical activity, diet, sleep, Traditional: physical activity, diet, Control) with assessments conducted at baseline, 6 and 12 months. Participants (n = 116) were overweight or obese adults aged 19–65 (M = 44.5 [SD = 10.5]). The 6-month intervention was delivered via a smartphone app providing educational materials, goal-setting, self-monitoring and feedback, and also included one face-to-face dietary consultation, a Fitbit and scales. The trial was prospectively registered and conducted between May 2017 and September 2018. Group differences on primary and secondary outcomes were examined between the Pooled Intervention groups (Pooled Intervention = Enhanced and Traditional) and Control groups, and then between Enhanced and Traditional groups. Results: Nineteen participants (16.4%) formally withdrew from the trial. Compared with the Control group, average body weight of the Pooled Intervention group did not differ at 6 (between-group difference = −0.92, (95% CI −3.33, 1.48)) or 12 months (0.00, (95% CI −2.62, 2.62)). Compared with the Control group, the Pooled Intervention group significantly increased resistance training (OR = 7.83, (95% CI 1.08, 56.63)) and reduced energy intake at 6 months (−1037.03, (−2028.84, −45.22)), and improved insomnia symptoms at 12 months (−2.59, (−4.79, −0.39)). Compared with the Traditional group, the Enhanced group had increased waist circumferences (2.69, (0.20, 5.18)) and sedentary time at 6 months (105.66, (30.83, 180.48)), and improved bed time variability at 12 months (−1.08, (−1.86, −0.29)). No other significant differences were observed between groups. Conclusions: Relative to Controls, the Pooled Intervention groups did not differ on body weight but improved resistance training, and reduced energy intake and insomnia symptom severity. No additional weight loss was apparent when targeting improvements in physical activity, diet and sleep in combination compared with physical activity and diet.
Undertreatment Before the Award of a Disability Pension for Mental Illness: The HUNT Study
Publisher: American Psychiatric Association Publishing
Date: 11-2007
DOI: 10.1176/PS.2007.58.11.1479
Abstract: Mental illnesses are consistently underrecognized and undertreated, leading to underestimations of the societal burden of mental illness as a contributor to disability benefit expenditures. This study examined the extent of undertreatment before disability pensions for mental illness were awarded. Norwegian National Insurance Administration data were linked to data from the HUNT-2 study, a population-based health survey, and 403 persons awarded a disability pension for mental illness in the five years before the health survey were identified. The extent of help seeking for any mental illness before the pension was awarded was examined. Of the 403 adults who were pensioned out of the workforce for a disability involving mental illness, 128 (32%, 95% confidence interval=27%-36%) reported never having sought help for any mental health problem. Although self-report of receipt of treatment is a limitation of the study, the results suggest a potential for preventing permanent work-related disability through improved access to effective treatment.
Self reported rates of criminal offending and victimization in young people at-risk for psychosis
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.SCHRES.2015.05.024
Abstract: A significant relationship exists between experiencing psychosis and both engaging in criminal offending and being a victim of crime. A substantial proportion of violence and offending occurs during the first episode of psychosis, but it is unclear whether such behaviour is also evident in the earlier pre-psychotic stage of illness. As part of a prospective study of young people who were seeking help for mental health problems, we enquired about participants' experiences of being charged and/or convicted of a criminal offence and being a victim of crime. This paper uses cross-sectional baseline data to compare the rates of these forensic outcomes in participants at-risk of psychosis (n=271) with those not at-risk (n=440). Univariate logistic regression showed that the at-risk for psychosis group was significantly more likely than the not at-risk participants to report having been charged by police (11.1% vs 5.9% p=.015) and convicted by the courts (4.4% vs. 1.6% p=0.028) with a non-violent offence, as well as to have been convicted of any criminal offence (6.3% vs. 3.0% p=0.037). The at-risk were also more likely to report having been a victim of crime (23.7% vs 14.0% p=.002), particularly violent victimization (16.5% vs 8.2% p=.001). In multivariate logistic regression analyses, being at-risk for psychosis remained a significant predictor of three of the four outcome measures after controlling for other known covariates such as gender, age, substance misuse and unemployment. This is the first study to demonstrate that, relative to their non-psychotic help-seeking counterparts, young people at-risk for psychosis are at higher risk of forensic outcomes, particularly violent crime victimization.
Development and validation of the Social Capital Assessment Tool in pregnancy for Maternal Health in Low and middle income countries (LSCAT-MH)
Publisher: BMJ
Date: 07-2019
DOI: 10.1136/BMJOPEN-2018-027781
Abstract: Social capital which implies ‘features of social organisation, such as trust, norms and networks that can improve the efficiency of society by facilitating coordinated actions’ is rarely assessed in relation to maternal health in low/middle-income countries (LMICs). A main reason for this research gap could be the unavailability of a specific tool to measure social capital in pregnancy. The study developed and validated an instrument to measure social capital among pregnant women. We developed the tool based on World Bank Social Capital Assessment Tool and its adaptations identified as applicable to LMIC from an initial systematic review. The study was conducted in Anuradhapura district in the North Central Province of Sri Lanka. Validation process was conducted in urban, rural and resettled communities. Study participants of the cognitive validation included pregnant women from the three communities, and an expert panel including a social scientist, methodological expert, subject expert, public health officers. The psychometric validation was performed on 439 pregnant women permanently residing in the three communities. The 24-item Low and middle income countries Social Capital Assessment Tool for Maternal Health (LSCAT-MH) demonstrated high internal consistency (Cronbach’s α=0.94). Factor analytical methods suggested a four-factor model of (1) neighbourhood networks (structural bonding), (2) domestic and neighbourhood cohesion (cognitive bonding), (3) social contribution and (4) social participation (structural bridging). Concurrent validity with antenatal mental ill health was confirmed through a negative correlation with the Edinburgh Postpartum Depression Scale. Test–retest reliability was high with intraclass correlation of 0.71 and a Pearson correlation of 0.83. The LSCAT-MH is a psychometrically valid and reliable tool to measure social capital in pregnancy. Predictive validity was not tested as the study was not a longitudinal follow-up.
Smartphone application for preventing depression: Study protocol for a workplace randomised controlled trial
Publisher: BMJ
Date: 07-2018
DOI: 10.1136/BMJOPEN-2017-020510
Abstract: Depression is the leading cause of life years lost due to disability. Appropriate prevention has the potential to reduce the incidence of new cases of depression, however, traditional prevention approaches face significant scalability issues. Prevention programmes delivered by via smartphone applications provide a potential solution. The workplace is an ideal setting to roll out this form of intervention, particularly among industries that are unlikely to access traditional health initiatives and whose workplace characteristics create accessibility and portability issues. The study aims to evaluate the effectiveness of a smartphone application designed to prevent depression and improve well-being. The effectiveness of the app as a universal, selective and indicated prevention tool will also be evaluated. A multicentre randomised controlled trial, to determine the effectiveness of the intervention compared with an active mood monitoring control in reducing depressive symptoms (primary outcome) and the prevalence of depression at 3 months, with secondary outcomes assessing well-being and work performance. Employees from a range of industries will be invited to participate. Participants with likely current depression at baseline will be excluded. Following baseline assessment, participants, blinded to their allocation, will be randomised to receive one of two versions of the application: headgear (a 30-day mental health intervention) or a control application (mood monitoring for 30 days). Both versions of the app contain a risk calculator to provide a measure of future risk. Analyses will be conducted within an intention-to-treat framework using mixed modelling, with additional analyses conducted to compare the moderating effect of baseline risk level and depression symptom severity on the intervention’s effectiveness. The current trial has received ethics approval from the University of New South Wales Human Research Ethics Committee (HC17021). Study results will be disseminated through peer-reviewed journals and conferences. ACTRN12617000548336 Results.
Results of the WHO-DAS II tests in the UK
Publisher: Cambridge University Press (CUP)
Date: 1998
Disability patterns over the first year after a diagnosis of epilepsy
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.CLINEURO.2019.02.022
Abstract: To determine the patterns and predictors of disability over the first 12 months after a diagnosis of epilepsy. The Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC) was a prospective, multicenter, community-based study of people with newly diagnosed epilepsy in Sydney, Australia. Disability was assessed using the World Health Organization's, Disability Assessment Schedule (WHODAS) 2.0 12-item version, at baseline (i.e. within 28 days of diagnosis) and 12 months post-diagnosis. Demographic, socioeconomic, clinical and epilepsy-related data, obtained through structured interviews, were entered into multivariable linear regression and shift analysis to determine predictors of greater disability. Of 259 adults (≥18 years), 190 (73%) had complete WHODAS at baseline (mean ± SD scores 4 ± 6) and follow-up (4 ± 8). After adjustment for age, sex and co-morbidity, greater overall disability at 12 months was associated with lower education (P = 0.05), economic hardship (P = 0.004), multiple antiepileptic medications (P = 0.02) and greater disability (P < 0.001) at the time of diagnosis these variables explained 38.3% of the variance. Among the 12 WHODAS items, "being emotionally affected by health problems" was the most frequent disability problem identified at both time points (all P < 0.0001). The proportion of participants without problems in that domain improved over 12 months (from 24% to 50%, P < 0.0001), whereas the other 11 items remained relatively stable. Independent baseline predictors of a worse emotional outcome at 12 months were severe/extreme emotional distress (odds ratio [OR] 4.52, 95% confidence intervals [CI] 1.67-12.24), economic hardship (OR 2.30, 95% CI 1.24-4.25) and perceived stigma (OR 2.02, 95% CI 1.03-3.93). Most people report problems with emotional health after a diagnosis of epilepsy but many recover over the next 12 months. Services addressing the social and psychological impact of diagnosis may be needed to improve outcome.
Impact of Mental Health Screening on Promoting Immediate Online Help-Seeking: Randomized Trial Comparing Normative Versus Humor-Driven Feedback
Publisher: JMIR Publications Inc.
Date: 23-11-2017
Do gastrointestinal complaints increase the risk for subsequent medically certified long-term sickness absence? The HUSK study
Publisher: Springer Science and Business Media LLC
Date: 29-07-2011
The Colombo Twin and Singleton Follow-up Study: a population based twin study of psychiatric disorders and metabolic syndrome in Sri Lanka
Publisher: Springer Science and Business Media LLC
Date: 17-01-2018
Associations of objective and subjective sleep disturbance with cognitive function in older men with comorbid depression and insomnia
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.SLEH.2017.03.007
Abstract: To examine whether poor objective and subjective sleep quality are differentially associated with cognitive function. Cross-sectional. Participants were recruited from primary and secondary care, and directly from the community, in Sydney, Australia. The s le consisted of 74 men 50years and older (mean [SD], 58.4 [6.2] years), with comorbid depression and above-threshold insomnia symptoms, participating in a trial of online cognitive behavioral therapy for insomnia. Insomnia severity and depression severity were assessed via self-report. Objective sleep efficiency and duration were measured using actigraphy. Objective cognitive function was measured using 3 subtests of a computerized neuropsychological battery. Poor objective sleep efficiency was associated with slower reaction time (r=-0.249, P=.033) and poorer executive functioning (odds ratio, 4.14 95% confidence interval, 1.35-12.69), but not memory. These associations remained after adjusting for age, education, depression severity, cardiovascular risk, and medication. Subjective sleep quality was not related to cognitive function. Among older men with depression and insomnia, objectively measured poor sleep efficiency may be associated with worse cognitive function, independent of depression severity. Objective poor sleep may be underpinned by neurobiological correlates distinct from those underlying subjective poor sleep and depression, and represent a potentially effective modifiable mechanism in interventions to improve cognitive functioning in this population. This supports the use of objective measures of sleep in diagnostic assessments and care.
Driving in stroke survivors aged 18-65 years: The Psychosocial Outcomes In StrokE (POISE) Cohort Study
Publisher: SAGE Publications
Date: 09-07-2016
Abstract: There is limited information regarding return to driving after stroke. To determine the frequency and predictors of return to driving within 1 month of acute stroke in younger (age 18–65 years) adults. POISE (Psychosocial Outcomes In StrokE) was a cohort study conducted in Australia between October 2008 and June 2010. Consecutive patients (age 18–65 years) with a recent (≤28 days) acute stroke were recruited. Validated demographic, clinical, mental health, cognitive, and disability measures including return to driving were obtained. Multivariable logistic regression was used to determine factors associated with return to driving within 1 month of stroke. Among 359 participants who were legally able to drive before stroke, 96 (26.7%) returned to driving within 1 month. Compared to those without an early return to driving ( n = 263), drivers were more often male, the main income earner, in paid work before stroke and without symptoms of depression or fatigue. Independence in activities of daily living (odds ratio (OR) 30.05, 95% confidence interval (CI) 3.85–234.45), not recalling receiving advice on driving cessation (OR 5.55, 95% CI 2.86–11.11), and having returned to paid work (OR 3.93, 95% CI 1.94–7.96) were associated with early return to driving. One in four young adults resumed driving within a month, contrary to guideline recommendations. These data reinforce the importance of deciding who is responsible for determining fitness to drive after stroke, when, and whether it is reasonable to enforce driving restrictions on those with minimal disability who are fit to return to work. Australian New Zealand Clinical Trials Registry ANZCTRN 12608000459325.
Improving Knowledge and Attitudes towards Depression: a controlled trial among Chinese medical students
Publisher: Springer Science and Business Media LLC
Date: 08-03-2011
Returning to Paid Employment after Stroke: The Psychosocial Outcomes In StrokE (POISE) Cohort Study
Publisher: Public Library of Science (PLoS)
Date: 25-07-2012
Replication of the psychometric properties of the WHODAS-II in individuals with autism spectrum disorder
Publisher: Wiley
Date: 08-10-2019
DOI: 10.1002/AUR.2216
Aetiology of fatigue in Sri Lanka and its overlap with depression
Publisher: Royal College of Psychiatrists
Date: 08-2010
DOI: 10.1192/BJP.BP.109.069674
Abstract: Fatigue is a common symptom in Western high-income countries but is often medically unexplained and little is known about its presentation in other populations. To explore the epidemiology and aetiology of fatigue in Sri Lanka, and of its overlap with depression. A total of 4024 randomly selected twins from a population-based register in Sri Lanka (Colombo district) completed home interviews including the Chalder Fatigue Questionnaire. The prevalence of fatigue was similar to that in other countries, although prolonged fatigue may be less common. There was substantial comorbidity with a screen for lifetime depression. Non-shared environmental factors made the largest contributions, although genetic/family factors also contributed. The aetiology appeared consistent across the spectrum of severity. The aetiology of fatigue is broadly similar in Sri Lanka and Western high-income countries. Abnormal experiences of fatigue appear to be the extreme form of more common fatigue, rather than representing independent entities with different genetic or environmental risk factors.
Exploring beyond norms: social capital of pregnant women in Sri Lanka as a factor influencing health
Publisher: Springer Science and Business Media LLC
Date: 06-04-2016
Clinical, neurocognitive and demographic factors associated with functional impairment in the Australian Brain and Mind Youth Cohort Study (2008-2016)
Publisher: BMJ
Date: 12-2018
DOI: 10.1136/BMJOPEN-2018-022659
Abstract: We sought to determine the unique and shared contributions of clinical, neurocognitive and demographic factors to functional impairment in a large, transdiagnostic, clinical cohort of adolescents and young adults. Cross-sectional baseline data from a prospective, cohort study. Help-seeking youth referred from outpatient services were recruited to the Brain and Mind Youth Cohort (2008–2016) in Sydney, Australia. In total, 1003 outpatients were recruited, aged between 12 and 36 years (mean= 20.4 years, 54% female), with baseline diagnoses of affective, psychotic, developmental or behavioural disorders. Treatment as usual. Social and occupational functioning was used to index level of functional impairment. Structural equation modelling was used to examine associations between neurocognition, core clinical symptoms and alcohol and substance use, and clinician-rated and researcher-rated functional impairment. Moderator analyses were conducted to determine the potential influence of demographic and clinical factors (eg, medication exposure). Independent of diagnosis, we found that neurocognitive impairments, and depressive, anxiety and negative symptoms, were significantly associated with functioning. The association of neurocognition with social and occupational functioning remained significant even when constraining for age (15–25-year-olds only) or diagnosis (affective disorders only) in the final model. This study demonstrated that, in a clinically representative s le of youth, the key determinants of functioning may not be disorder specific. Further, evidence of neurocognitive dysfunction suggests that interventions that target cognition and functioning should not necessarily be reserved just for older adults with established illness.
Transitions Study of predictors of illness progression in young people with mental ill health: study methodology
Publisher: Wiley
Date: 24-07-2015
DOI: 10.1111/EIP.12079
Abstract: An estimated 75% of mental disorders begin before the age of 24 and approximately 25% of 13-24-year-olds are affected by mental disorders at any one time. To better understand and ideally prevent the onset of post-pubertal mental disorders, a clinical staging model has been proposed that provides a longitudinal perspective of illness development. This heuristic model takes account of the differential effects of both genetic and environmental risk factors, as well as markers relevant to the stage of illness, course or prognosis. The aim of the Transitions Study is to test empirically the assumptions that underpin the clinical staging model. Additionally, it will permit investigation of a range of psychological, social and genetic markers in terms of their capacity to define current clinical stage or predict transition from less severe or enduring to more severe and persistent stages of mental disorder. This paper describes the study methodology, which involves a longitudinal cohort design implemented within four headspace youth mental health services in Australia. Participants are young people aged 12-25 years who have sought help at headspace and consented to complete a comprehensive assessment of clinical state and psychosocial risk factors. A total of 802 young people (66% female) completed baseline assessments. Annual follow-up assessments have commenced. The results of this study may have implications for the way mental disorders are diagnosed and treated, and progress our understanding of the pathophysiologies of complex mental disorders by identifying genetic or psychosocial markers of illness stage or progression.
Screening, referral and treatment for depression in patients with coronary heart disease: A consensus statement from the national heart foundation of Australia
Publisher: AMPCo
Date: 05-2013
DOI: 10.5694/MJA13.10153
Abstract: In 2003, the National Heart Foundation of Australia position statement on "stress" and heart disease found that depression was an important risk factor for coronary heart disease (CHD). This 2013 statement updates the evidence on depression (mild, moderate and severe) in patients with CHD, and provides guidance for health professionals on screening and treatment for depression in patients with CHD. The prevalence of depression is high in patients with CHD and it has a significant impact on the patient's quality of life and adherence to therapy, and an independent effect on prognosis. Rates of major depressive disorder of around 15% have been reported in patients after myocardial infarction or coronary artery bypass grafting. To provide the best possible care, it is important to recognise depression in patients with CHD. Routine screening for depression in all patients with CHD is indicated at first presentation, and again at the next follow-up appointment. A follow-up screen should occur 2-3 months after a CHD event. Screening should then be considered on a yearly basis, as for any other major risk factor for CHD. A simple tool for initial screening, such as the Patient Health Questionnaire-2 (PHQ-2) or the short-form Cardiac Depression Scale (CDS), can be incorporated into usual clinical practice with minimum interference, and may increase uptake of screening. Patients with positive screening results may need further evaluation. Appropriate treatment should be commenced, and the patient monitored. If screening is followed by comprehensive care, depression outcomes are likely to be improved. Patients with CHD and depression respond to cognitive behaviour therapy, collaborative care, exercise and some drug therapies in a similar way to the general population. However, tricyclic antidepressant drugs may worsen CHD outcomes and should be avoided. Coordination of care between health care providers is essential for optimal outcomes for patients. The benefits of treating depression include improved quality of life, improved adherence to other therapies and, potentially, improved CHD outcomes.
Co-Designing a Web-Based Decision Aid Tool for Employees Disclosure of Mental Health Conditions: A Participatory Study Design Using Employee and Organizational Preferences
Publisher: JMIR Publications Inc.
Date: 06-11-2020
DOI: 10.2196/23337
Abstract: Decisions of whether to disclose mental health conditions are extremely personal and require the consideration of multiple factors associated with the disclosure process (eg, weighing the risks and benefits). Decision aid tools help people make these complex decisions. Such an aid needs to be confidential, easily accessible, and easy to use with the potential to access the tool on multiple occasions. Web programs are well suited to meet these requirements and, if properly developed, can provide feasible, accessible, affordable, and effective workplace interventions. This study aims to gain insights from potential end users, in this case both employees and organizations, into what type of components including language, style, and content would avoid potential stigma and ensure that elements of clear value for users would be built into a web-based decision aid tool that aims to assist employees in making decisions about the disclosure of their mental health condition at work. A participatory design approach was used to allow developers, researchers, experts, and end users to collaborate in co-designing the tool. During the user research phase of the development of the web-based tool, a participatory design workshop approach was selected as a part of a larger study of focus groups. Australian employees and managers in rural, suburban, and urban locations participated in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for a decision aid tool. A total of 2 workshops were conducted with 13 participants. The majority were from a transport company (9/13, 69%), male (8/13, 62%), and employed full time (11/13, 85%). Six employees had previous experience disclosing their own mental health condition, and 7 were in a supervisory role and had previously been disclosed to. In any co-design development, there are certain trade-offs that need to be made between the views of experts, developers, end users, and the available budget. In this specific instance of a very delicate, personal decision, the end users provided valuable design insights into key areas such as language, and they were very antipathetic to a key feature, the avatar, which was thought to be desirable by experts and developers. Findings including aspects of the tool where all stakeholders were in agreement, aspects where some stakeholders disagreed and adaptations were implemented, where disagreements could not be implemented because of financial constraints, and misalignment between stakeholders and how to decide on a balance were shared. The co-design with a lived experience approach is useful for contributing much to the design, language, and features. The key in this study was balancing the needs of the workers and the potential impact for the managers and organizations, while ensuring legislation and regulation requirements were upheld.
Identification and Management of Depression in Australian Primary Care and Access to Specialist Mental Health Care
Publisher: American Psychiatric Association Publishing
Date: 12-2012
DOI: 10.1176/APPI.PS.201200017
Abstract: The authors evaluated management of illness, including access to specialist mental health care, among people identified by general practitioners as clinically depressed. Australian primary care practitioners recruited in 2009 completed case reports and collected self-report assessments from five to seven consecutively presenting patients whom they identified as having clinical depression. Among 735 patients with clinical depression, 55% met criteria for major depressive syndrome, 86% reported clinically significant sleep disturbance, and 47% had been depressed for more than 12 months. Most (77%) were prescribed antidepressants, and 30% were prescribed anxiolytics or hypnotics. Patients under shared care with specialist mental health care providers (42%) had more severe, chronic, and recurrent conditions but no demographic advantages. Depressed patients of general practitioners often had chronic, recurrent, and moderately to severely disabling conditions, but fewer than half received specialist care. Access to specialist care, however, appeared to be based on clinical need, with little inequity in sociodemographic characteristics observed.
Preventing depression using a smartphone app: A randomized controlled trial
Publisher: Cambridge University Press (CUP)
Date: 06-07-2020
DOI: 10.1017/S0033291720002081
Abstract: There is evidence that depression can be prevented however, traditional approaches face significant scalability issues. Digital technologies provide a potential solution, although this has not been adequately tested. The aim of this study was to evaluate the effectiveness of a new smartphone app designed to reduce depression symptoms and subsequent incident depression amongst a large group of Australian workers. A randomized controlled trial was conducted with follow-up assessments at 5 weeks and 3 and 12 months post-baseline. Participants were employed Australians reporting no clinically significant depression. The intervention group ( N = 1128) was allocated to use HeadGear , a smartphone app which included a 30-day behavioural activation and mindfulness intervention. The attention-control group ( N = 1143) used an app which included a 30-day mood monitoring component. The primary outcome was the level of depressive symptomatology (PHQ-9) at 3-month follow-up. Analyses were conducted within an intention-to-treat framework using mixed modelling. Those assigned to the HeadGear arm had fewer depressive symptoms over the course of the trial compared to those assigned to the control ( F 3,734.7 = 2.98, p = 0.031). Prevalence of depression over the 12-month period was 8.0% and 3.5% for controls and HeadGear recipients, respectively, with odds of depression caseness amongst the intervention group of 0.43 ( p = 0.001, 95% CI 0.26–0.70). This trial demonstrates that a smartphone app can reduce depression symptoms and potentially prevent incident depression caseness and such interventions may have a role in improving working population mental health. Some caution in interpretation is needed regarding the clinical significance due to small effect size and trial attrition. Trial Registration Australian and New Zealand Clinical Trials Registry ( www.anzctr.org.au/ ) ACTRN12617000548336
The Long-term Effect of Insomnia on Work Disability
Publisher: Oxford University Press (OUP)
Date: 12-04-2006
DOI: 10.1093/AJE/KWJ145
Abstract: Chronic insomnia is common in the general population. Its effect on functioning and disability is usually attributed to an underlying condition, so the diagnosis of insomnia does not qualify for award of a disability pension in the United States or Europe. The aim of this study was to investigate whether insomnia, defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, contributed to long-term work disability. Using a historical cohort design, the authors gathered baseline data from a population-based Norwegian health study of 37,308 working-age people not claiming a disability pension through 1995-1997. The outcome was subsequent award of a disability pension (18-48 months after the health screening) as registered by the National Insurance Administration. Insomnia was a strong predictor of subsequent permanent work disability (adjusted odds ratio=3.90, 95% confidence interval: 3.20, 4.76). Sociodemographic and shift-work characteristics had little confounding effect (adjusted odds ratio=3.69, 95% confidence interval: 3.00, 4.53), and this association remained significant after adjustment for psychiatric and physical morbidity and for health-related behaviors (adjusted odds ratio=1.75, 95% confidence interval: 1.40, 2.20). This study suggests that insomnia should receive increased attention as a robust predictor of subsequent work disability.
The influence of psychiatric morbidity on return to paid work after stroke in younger adults: The auckland regional community stroke (ARCOS) study, 2002 to 2003
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2008
DOI: 10.1161/STROKEAHA.107.503219
Abstract: Background and Purpose— Few data exist on the determinants of return to paid work after stroke, yet participation in employment is vital to a person’s mental well-being and role in society. This study aimed to determine the frequency and determinants of return to work, in particular the effect of early psychiatric morbidity, in a population-based study of stroke survivors. Methods— The third Auckland Regional Community Stroke (ARCOS) study was a prospective, population-based, stroke incidence study undertaken in Auckland, New Zealand during 2002 to 2003. After a baseline assessment early after stroke, data were collected on all survivors at 1 and 6 months follow-up. Multiple variable logistic regression was used to determine predictors of return to paid work. Data are reported with odds ratios (OR) and 95% confidence intervals (CI). Results— Among 1423 patients registered with first-ever strokes, there were 210 previously in paid employment who survived to 6 months, of whom 155 (74%) completed the GHQ-28 and 112 (53%) had returned to paid work. Among those cognitively competent, psychiatric morbidity at 28 days was a strong independent predictor of not returning to work (Odds Ratio 0.39 95% CI 0.22 to 0.80). Non–New Zealand European ethnicity (OR 0.40 95% CI 0.17 to 0.91), prior part-time, as opposed to full-time, employment 0.36 (0.15 to 0.89), and not being functionally independent soon after the stroke 0.28 (0.13 to 0.59) were the other independent age- and gender-adjusted predictors of not successfully returning to paid work. Conclusions— About half of previously employed people return to paid employment after stroke, with psychiatric morbidity and physical disability being independent, yet potentially treatable, determinants of this outcome. Appropriate management of both emotional and physical sequelae would appear necessary for optimizing recovery and return to work in younger adults after stroke.
Apprentices’ Attitudes Toward Using a Mental Health Mobile App to Support Healthy Coping: Mixed Methods Study
Publisher: JMIR Publications Inc.
Date: 18-08-2022
DOI: 10.2196/35661
Abstract: Apprenticeships are a common pathway for young people transitioning into the workforce. Apprentices often face many employment-related challenges and have high levels of psychological distress, drug and alcohol use, and suicidal ideation. Little is known about the attitudes of apprentices toward using smartphone apps to support their mental health and the content that would engage them. This study explored (1) apprentices’ interest in using an app to support their mental health and (2) the healthy coping strategies used to manage their mental well-being in the face of workplace challenges, in order to inform future app content. A mixed methods study was conducted with 54 apprentices (50/54 male, 93%) with a mean age of 22.7 (SD 5.7) years. Participants completed a survey on preferred ways of using an app to support mental health. Across 8 focus groups, participants were asked to describe healthy strategies they used to cope with occupational stressors. Only 11% (6/54) of participants currently used a well-being app, but there was high interest in using an app to support their friends (47/54 participants, 87%) and develop self-help strategies to manage or prevent mental health issues (42/54 participants, 78%). Four major types of coping behaviors were identified: (1) social connection for disclosure, advice, and socializing (2) pleasurable activities, such as engaging in hobbies, time-outs, and developing work-life separation (3) cognitive approaches, including defusing from thoughts and cognitive reframing and (4) self-care approaches, including exercise, a healthy diet, and getting adequate sleep. There is interest among apprentices to use an app with a positive well-being focus that helps them to develop self-management skills and support their friends. Apprentices utilized a range of healthy behaviors to cope with workplace stressors that can be incorporated into mental health apps to improve uptake and engagement. However, many of the preferred coping strategies identified are not those focused on by currently available apps, indicating the need for more targeted digital interventions for this group.
Exploring User Needs and Preferences for Mobile Apps for Sleep Disturbance: Mixed Methods Study
Publisher: JMIR Publications Inc.
Date: 24-05-2019
DOI: 10.2196/13895
Abstract: Mobile health (mHealth) apps demonstrate promise for improving sleep at scale. End-user engagement is a prerequisite for sustained use and effectiveness. We assessed the needs and preferences of those with poor sleep and insomnia to inform the development of an engaging sleep app. We triangulated results from qualitative (focus groups and app reviews) and quantitative (online survey) approaches. A total of 2 focus groups were conducted (N=9). An online survey tested themes identified from the focus groups against a larger population (N=167). In addition, we analyzed 434 user reviews of 6 mobile apps available on app stores. Common focus group themes included the need to account for erse sleep phenotypes with an adaptive and tailored program, key app features (alarms and sleep diaries), the complex yet condescending nature of existing resources, providing rationale for information requested, and cost as a motivator. Most survey participants (156/167, 93%) would try an evidence-based sleep app. The most important app features reported were sleep diaries (148/167, 88%), sharing sleep data with a doctor (116/167, 70%), and lifestyle tracking (107/167, 64%). App reviews highlighted the alarm as the most salient app feature (43/122, 35%) and data synchronization with a wearable device (WD) as the most commonly mentioned functionality (40/135, 30%). This co-design process involving end users through 3 methods consistently highlighted sleep tracking (through a diary and WD), alarms, and personalization as vital for engagement, although their implementation was commonly criticized in review. Engagement is negatively affected by poorly designed features, bugs, and didactic information which must be addressed. Other needs depend upon the type of user, for ex le, those with severe insomnia.
Rethinking the Dose-Response Relationship Between Usage and Outcome in an Online Intervention for Depression: Randomized Controlled Trial
Publisher: JMIR Publications Inc.
Date: 17-10-2013
DOI: 10.2196/JMIR.2771
The association of insomnia with future mental illness: is it just residual symptoms?
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.SLEH.2018.05.008
Abstract: To evaluate whether the prospective association between insomnia and mental illness in the general population remained after controlling for multiple confounders, or whether this represented partly remitted prior mental illness. Cohort study. Australian general population. The participants were 10,444 people aged 15 or older in the Household, Income and Labour Dynamics in Australia (HILDA) survey who did not meet K10 criteria for likely mental illness at baseline (2013-14). The prospective associations of insomnia (yes/no) at baseline with mental illness (yes/no) approximately 2 years later (2015-16), determined from scores on the K10, were evaluated using logistic regression. These were then adjusted for potential confounders including sociodemographic factors, physical health and health behaviors, and baseline and past mental health. Insomnia at baseline increased risk of mental illness onset at two-year follow up (OR 2.23, 95% CI 1.91-2.59, P < .001). This relationship was attenuated but still significant after adjustment for confounding variables (OR 1.72 95% CI 1.46-2.02). Accounting for reverse causality from prior mental ill health and baseline symptoms reduced this further but the relationship remained (OR 1.30, 95% CI 1.09-1.55, P = .003). This effect appeared more robust among those <65 years of age. Insomnia has a consistent prospective relationship with mental illness at two-year follow-up. Insomnia did not appear to be simply a symptom of past, or baseline subclinical, mental illness. This supports the specific targeting of insomnia symptoms in selective preventive mental health initiatives, particularly among those under 65 years of age.
Preliminary Investigation of Shift, a Novel Smartphone App to Support Junior Doctors’ Mental Health and Well-being: Examination of Symptom Progression, Usability, and Acceptability After 1 Month of Use
Publisher: JMIR Publications Inc.
Date: 21-09-2022
DOI: 10.2196/38497
Abstract: Shift is a novel smartphone app for providing a digital-first mental health resource to junior doctors. It contains psychoeducational material, cognitive behavioral modules, guided mediations, information on common work stressors, and a section on help-seeking options for psychological problems through workplace and private avenues. This study aimed to conduct a preliminary investigation of the use and potential effectiveness of Shift on depressive and anxiety symptoms (primary outcomes) and work and social functioning, COVID-19 safety concerns, and help seeking (secondary outcomes). This study also sought feedback on whether Shift was seen as an acceptable tool. Junior doctors in New South Wales, Australia, were approached through promotional activities from the Ministry of Health, specialist medical colleges, and social media advertisements between June and August 2020. Consenting participants provided web-based baseline data, used the Shift app for 30 days, and were asked to complete a poststudy web-based questionnaire. Outcomes were analyzed under the intention-to-treat principle. A total of 222 (n=156 female, 70.3% mean age 29.2, SD 4.61 years) junior doctors provided full baseline data. Of these, 89.2% (198/222) downloaded the app, logged into the app approximately 6 times (mean 5.68, SD 7.51), completed 4 in-app activities (mean 3.77, SD 4.36), and spent a total of 1 hour on in-app activities (mean 52:23, SD 6:00:18) over 30 days. Postintervention and app use data were provided by 24.3% (54/222) of participants. Depressive and anxiety symptoms significantly decreased between the pre- and postassessment points as expected however, physicians’ COVID-19 safety concerns significantly increased. Work and social functioning, COVID-19 concerns for family and friends, and help seeking did not change significantly. There was no significant relationship between symptom changes and app use (number of log-ins, days between first and last log-in, and total activity time). Most poststudy completers (31/54, 57%) rated Shift highly or very highly. Despite high levels of nonresponse to the poststudy assessment and increases in COVID-19 safety concerns, junior doctors who used the app reported some improvements in depression and anxiety, which warrant further exploration in a robust manner.
Community-based alcohol education intervention (THEATRE) study to reduce harmful effects of alcohol in rural Sri Lanka: design and adaptation of a mixed-methods stepped wedge cluster randomised contro
Publisher: BMJ
Date: 06-2023
DOI: 10.1136/BMJOPEN-2022-064722
Abstract: Alcohol consumption is a leading cause of mortality, morbidity and adverse social sequelae in Sri Lanka. Effective community-based, culturally adapted or context-specific interventions are required to minimise these harms. We designed a mixed-methods stepped wedge cluster randomised control trial of a complex alcohol intervention. This paper describes the initial trial protocol and subsequent modifications following COVID-19. We aimed to recruit 20 villages (approximately n=4000) in rural Sri Lanka. The proposed intervention consisted of health screening clinics, alcohol brief intervention, participatory drama, film, and public health promotion materials to be delivered over 12 weeks. Following disruptions to the trial resulting from the Easter bombings in 2019, COVID-19 and a national financial crisis, we adapted the study in two main ways. First, the interventions were reconfigured for hybrid delivery. Second, a rolling pre–post study evaluating changes in alcohol use, mental health, social capital and financial stress as the primary outcome and implementation and ex-ante economic analysis as secondary outcomes. The original study and amendments have been reviewed and granted ethical approval by Rajarata University of Sri Lanka (ERC/2018/21—July 2018 and February 2022) and the University of Sydney (2019/006). Findings will be disseminated locally in collaboration with the community and stakeholders. The new hybrid approach may be more adaptable, scalable and generalisable than the planned intervention. The changes will allow a closer assessment of in idual interventions while enabling the evaluation of this discontinuous event through a naturalistic trial design. This may assist other researchers facing similar disruptions to community-based studies. The trial is registered with the Sri Lanka Clinical Trials Registry slctr.lk/trials/slctr-2018-037 .
Impact of Mental Health Screening on Promoting Immediate Online Help-Seeking: Randomized Trial Comparing Normative Versus Humor-Driven Feedback (Preprint)
Publisher: JMIR Publications Inc.
Date: 23-11-2017
Abstract: iven the widespread availability of mental health screening apps, providing personalized feedback may encourage people at high risk to seek help to manage their symptoms. While apps typically provide personal score feedback only, feedback types that are user-friendly and increase personal relevance may encourage further help-seeking. he aim of this study was to compare the effects of providing normative and humor-driven feedback on immediate online help-seeking, defined as clicking on a link to an external resource, and to explore demographic predictors that encourage help-seeking. n online s le of 549 adults were recruited using social media advertisements. Participants downloaded a smartphone app known as “Mindgauge” which allowed them to screen their mental wellbeing by completing standardized measures on Symptoms (Kessler 6-item Scale), Wellbeing (World Health Organization [Five] Wellbeing Index), and Resilience (Brief Resilience Scale). Participants were randomized to receive normative feedback that compared their scores to a reference group or humor-driven feedback that presented their scores in a relaxed manner. Those who scored in the moderate or poor ranges in any measure were encouraged to seek help by clicking on a link to an external online resource. total of 318 participants scored poorly on one or more measures and were provided with an external link after being randomized to receive normative or humor-driven feedback. There was no significant difference of feedback type on clicking on the external link across all measures. A larger proportion of participants from the Wellbeing measure (170/274, 62.0%) clicked on the links than the Resilience (47/179, 26.3%) or Symptoms (26/75, 34.7%) measures (χ2=60.35, P .001). There were no significant demographic factors associated with help-seeking for the Resilience or Wellbeing measures. Participants with a previous episode of poor mental health were less likely than those without such history to click on the external link in the Symptoms measure (P=.003, odds ratio [OR] 0.83, 95% CI 0.02-0.44), and younger adults were less likely to click on the link compared to older adults across all measures (P=.005, OR 0.44, 95% CI 0.25-0.78). his pilot study found that there was no difference between normative and humor-driven feedback on promoting immediate clicks to an external resource, suggesting no impact on online help-seeking. Limitations included: lack of personal score control group, limited measures of predictors and potential confounders, and the fact that other forms of professional help-seeking were not assessed. Further investigation into other predictors and factors that impact on help-seeking is needed. ustralian New Zealand Clinical Trials Registry ACTRN12616000707460 www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370187 (Archived by WebCite at y8m8sVxr)
Persistent psychological distress and mortality in patients with stable coronary artery disease.
Publisher: BMJ
Date: 26-06-2017
DOI: 10.1136/HEARTJNL-2016-311097
Abstract: A single assessment of psychological distress, which includes depression and anxiety, has been associated with increased mortality in patients with coronary heart disease, but the prognostic importance of persistence of distress symptoms is less certain. To determine whether intermittent and/or persistent psychological distress is associated with long-term cardiovascular (CV) and total mortality in patients with stable coronary artery disease. 950 participants in the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) trial completed at least four General Health Questionnaires (GHQ-30) at baseline and after ½, 1, 2 and 4 years. In a landmark analysis from 4 years, Cox proportional hazards models evaluated the risk of CV and total mortality by increasing levels of psychological distress: never distressed, sometimes any severity (GHQ score >5), persistent mild (GHQ score >5 on three or more occasions) and persistent moderate distress (GHQ score >10) on three or more occasions, over a median of 12.1 (IQR 8.6-12.5) years. The models were both unadjusted and adjusted for known baseline risk factors. Persistent moderate or greater psychological stress was reported on three or more assessments by 35 (3.7%) subjects. These patients had a higher risk of both CV death (adjusted HR 3.94, 95% CI 2.05 to 7.56, p<0.001) and all-cause mortality (adjusted HR 2.85, 95% CI 1.74 to 4.66, p<0.001) compared with patients with no distress. In contrast, patients who reported persistent mild distress (n=73, 7.7%) on three or more visits, and those who met criteria for distress on only one or two assessments (n=255, 26.8%), did not have an increased risk of CV or all-cause mortality during follow-up. In patients with stable coronary artery disease, persistent psychological distress of at least moderate severity is associated with a substantial increase in CV and all-cause mortality.
Self-harm and risk of motor vehicle crashes among young drivers: findings from the DRIVE Study
Publisher: CMA Joule Inc.
Date: 16-11-2009
DOI: 10.1503/CMAJ.090459
Depression course, functional disability, and NEET status in young adults with mental health problems
Publisher: Cambridge University Press (CUP)
Date: 03-2016
DOI: 10.1016/J.EURPSY.2016.01.376
Abstract: Role functioning is key to optimal health and inoculates against life-long inequality. Depression is a leading cause of functional disability. In most cases, improved symptomatology corresponds with improved functioning however, functioning does not always return to “normal”, despite symptom remission. Furthermore, the relationship between symptom remission and the likelihood of being Not in Employment, Education or Training (NEET) is unknown. To examine the temporal associations between depression course, functioning, and NEET status in young adults with mental health problems. A prospective and multisite clinical cohort study of young people aged 15–25 years seeking help from a primary mental health service ( n = 448). Participants completed a clinical interview (incl. QIDS-C16) and self-report battery (incl. WHODAS 2.0, employment, education) at baseline which was repeated at 12-month follow-up whilst continuing treatment as usual. Remitted depression was significantly associated with improved functioning however, 12 month functioning was still lower than the normative ranges for age-matched peers. Remittance of depression did not change the likelihood of being NEET. Only 10% of those who were NEET had received vocational support during the study. Remittance of depression was associated with improved functioning but it did not reduce the likelihood of being NEET. This may be explained by economic influences or alternatively, a time lag may exist where improvements in functioning do not immediately correspond with reduced NEET rates. Lastly, there may be a scarring effect of depression such that change in NEET status requires an additional intervention to depression treatment. The authors have not supplied their declaration of competing interest.
Mental illness and suicide among physicians
Publisher: Elsevier BV
Date: 09-2021
The comparative mental health of Australian doctors before and during COVID-19: A population-based approach
Publisher: SAGE Publications
Date: 25-06-2022
DOI: 10.1177/00048674221106677
Abstract: Occupational surveys of doctors consistently show higher rates of depression and anxiety than reported in general population surveys, findings replicated in all other occupational groups, suggesting potential selection bias. We evaluated the comparative mental health of different occupations in Australia from the same s ling frame over the past 6 years and assessed whether COVID-19 differentially affected different occupational groups. We analysed six annual data waves (2015–2020) from the nationally representative ‘Household, Income, and Labour Dynamics in Australia’ study. Mental health (Mental Health Inventory–5 from the 36-Item Short Form Survey) and life satisfaction scores of doctors over this period were compared with five other professions and all other employees. Regression models were adjusted for age, gender, income and work hours. Two-way analysis of variance examined the comparative changes in mental health among occupations between 2019 and after exposure to the COVID-19 pandemic in late 2020. The s le of 15,174 employed respondents included 106 doctors. The 5-year mean mental health score for doctors (M = 78.7 SD = 13.1) was significantly higher than that for teachers ( M = 75.6 SD = 14.9), nurses and midwives (M = 76.6 SD = 15.9), lawyers (M = 74.2 SD = 16.1), accountants (M = 74.2 SD = 16.5) and all other employed respondents (M = 73.1, SD = 16.7) ( p 0.001). Cognitive wellbeing comparisons were similar. There were no significant changes in professionals’ mental health over this period except for an improvement in engineers and a decline for teachers. From 2019 to 2020, all occupations suffered mental health declines without any significant inter-occupational differences. Australian doctors identified from a population-based s le rather than occupational surveys reported better levels of mental health and greater life satisfaction than most professions prior to COVID-19 without experiencing the worsening seen in the general employed population over the past 5 years. From 2020, there was a mental health decline in all of the employed population, not disproportionately affecting doctors. Although over-representing Australian trained general practitioners, the results from both this s le and other tentative findings challenge the discourse in medical advocacy, but need more formal comparative studies to confirm.
Managers’ response to mental health issues among their staff
Publisher: Oxford University Press (OUP)
Date: 30-07-2018
Abstract: Many organizations are implementing mental health training for managers to facilitate better communication between managers and employees suffering from mental health problems. Much of this training focuses on improving managers' mental health literacy and reducing stigma. However, it is unclear whether this focus is appropriate or whether other targets, such as improving skills and confidence, should be given greater consideration. To test whether knowledge, attitudes and confidence are associated with managers' behavioural responses to mental health issues among their staff. Managers from a large Australian fire and rescue service completed a questionnaire addressing their knowledge, attitudes, confidence and behavioural responses when managing employee mental health issues. The relationship was assessed using logistic regression. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Eighty-five managers responded (response rate 66%). Managers' confidence was the strongest predictor of their behaviour. Managers who felt confident discussing mental health were significantly more likely to make contact with an employee who was suspected to be suffering from a mental illness (OR 15.79, 95% CI 3.03-82.37, P < 0.01) or was on sickness leave for mental health reasons (OR 19.84, 95% CI 2.25-175.15, P < 0.01). Non-stigmatizing attitudes towards mental illness also significantly predicted contact with a staff member off work due to mental health problems (OR 5.22, 95% CI 1.21-22.54, P < 0.05). Our findings suggest that manager mental health training should focus on building their confidence and reducing stigma in order to have the greatest chance of altering workplace practices.
Hours of service regulations for professional drivers in continental Latin America.
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.SLEH.2018.07.009
Abstract: To describe the hours of service provisions in continental Latin America. Information on regulations of service hours was extracted from either the national transportation authorities or ministries of transportation (or the equivalent institution) from each country. Seventeen sovereign countries in continental Latin America (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, Venezuela). N/A INTERVENTION (IF ANY): N/A MEASUREMENT: Data on (a) limit on work hours, (b) mandatory daily time off (or rest), (c) overall schedule (mandatory weekly time off), and (d) daily breaks were extracted and summarized. Of the 17 countries surveyed, 9 countries have provisions limiting the daily amount of hours of service for professional drivers. Ten have provisions for mandatory daily rest, but only 5 have explicit provisions limiting the number of continuous working days, with mandatory uninterrupted time off >35 hours. Eight countries have provisions for mandatory breaks that limit the hours of continuous driving (ranging from 3 to 5:30 hours). Regulations that govern a population with 6 million injuries and over 100,000 deaths per year due to motor vehicle accidents leave important gaps. A minority, 6, of the countries regulated all 3 aspects daily hours, breaks, and time off, and 3 regulate none of these. The regulations are less precise and restrictive than those in high-income countries, despite the doubled road injury mortality, and likely expose professional drivers and other road users to an increased risk of fatigue-related accidents.
Psychological determinants of primary care requests for urgent outpatient appointments in elective referrals
Publisher: Wiley
Date: 31-01-2007
DOI: 10.1111/J.1365-2753.2006.00685.X
Abstract: Wide variations in referral practice from primary to secondary care have been observed. Clinical, demographic and referrer characteristics explain little of this variation. Patient psychological characteristics have been suggested as a potential explanation of this, biasing referral. The objective of this study is to investigate, in a relatively homogeneous population, the effects of patient's psychological distress and illness beliefs upon GP's requests for urgent outpatient assessment. An inception cohort of 188 primary care referrals to a UK NHS Trust orthopaedic department for potential lower limb arthroplasty was assessed for disease-related pain and impairment, disability, psychological distress and illness beliefs. Associations between these and primary care requests for urgent outpatient appointments were estimated. Twenty-two referrals (12%) requested an urgent outpatient appointment. Illness beliefs of greater personal control (OR 2.18, 95% CI 1.18, 4.05) but not psychological distress (OR 0.39, 95% CI 0.11, 1.36) were independently associated with urgent requests. Greater pain and impairment, co-morbidity and disability were univariately associated with this request. In both fully adjusted and parsimonious models, only patient beliefs of greater control and disability were independent determinants of this request for urgency. Among patients referred for assessment for lower limb arthroplasty primary care practitioner's requests for urgent assessment are influenced by the patient's belief of how well they can control the symptoms, over and above clinical measures, suggesting patients coping better gain faster access. Global disability appears to be the main clinical determinant, which suggests GPs are making urgent referrals appropriately. There is no evidence of any bias on age, gender or socioeconomic status. This request for urgency leads to these patients waiting 2 months less for an outpatient appointment.
Subjective memory complaints, vascular risk factors and psychological distress in the middle-aged: a cross-sectional study
Publisher: Springer Science and Business Media LLC
Date: 07-2011
Mental ill health and fitness for work
Publisher: BMJ
Date: 10-2002
Circadian rhythms and psychiatric profiles in young adults with unipolar depressive disorders
Publisher: Springer Science and Business Media LLC
Date: 09-10-2018
DOI: 10.1038/S41398-018-0255-Y
Abstract: Abnormalities in circadian rhythms have been reported in people with mood disorders, but these abnormalities are marked by considerable inter-in idual variability. This study aimed to identify pathophysiological subgroups on the basis of circadian markers and evaluate how these subgroups relate to psychiatric profiles. Thirty-five young adults (18–31 years old) receiving clinical care for unipolar depressive disorders and 15 healthy controls took part to this study. The Hamilton Rating Scale for Depression and the Young Mania rating scale were used to evaluate the severity of mood symptoms in participants with depressive disorders. All participant underwent ambulatory sleep monitoring with actigraphy for about 12 days before attending a laboratory-based chronobiological assessment which included repeated salivary s les to determine dim light melatonin onset (DLMO) and continuous core body temperature (CBT) monitoring using an ingestible temperature sensor. Cluster analyses were conducted across all participants to identify subgroups with consistent circadian timing profiles based on DLMO and the nocturnal minima of CBT. Two clusters were identified: ‘delayed’ and ‘conventional timing’ circadian phase. Descriptive analyses showed that the delayed cluster was characterised by abnormal time relationships between circadian phase markers and the sleep–wake cycle. Importantly, in iduals from the delayed cluster had worse depression severity ( t (28) = −2.7, p = 0.011) and hypomanic symptoms ( Z = −2.2, p = 0.041) than their peers with conventional circadian timing. These findings suggest that delayed and disorganised circadian rhythms may be linked to worse psychiatric profiles in young people with depressive disorders.
Impact of serious mental illness on surgical patient outcomes.
Publisher: Wiley
Date: 14-05-2018
DOI: 10.1111/ANS.14508
Abstract: People with comorbid mental illness have poorer health status and disparate access to healthcare. Several studies internationally have reported mixed findings regarding the association between mental illness and surgical patient outcomes. This study examines the surgical outcomes in people with decompensated serious mental illness (SMI) within the setting of the Australian universal healthcare system. Retrospective cohort study involving elective overnight surgical patients aged 18 years and above who attended a large public tertiary referral hospital in Sydney, Australia, between 2010 and 2014. Patients were identified using ICD-10-AM diagnosis codes. Outcomes measure including in-hospital mortality, post-operative complications, morbidity, admission and time in intensive care, length and cost of hospitalization, discharge destination and 28-day re-admission rates were examined. Of 23 343 surgical patient admissions, 451 (2%) patients had decompensated comorbid SMI with a subset of 47 (0.2%) having a specific psychotic illness. Patients with SMI comorbidity had significantly higher in-hospital mortality (2% versus 0%), post-operative complications (22% versus 8%), total comorbidity (7.6 versus 3.4 secondary codes), admissions (29% versus 9%) and time in intensive care (34.6 h versus 5.0 h), stay in hospital (12.2 days versus 4.6 days), admission costs ($24 162 versus $12 336), re-admission within 28 days (14% versus 10%) and discharges to another facility (11% versus 3%). Patients with comorbid SMI had significantly worse surgical outcomes and incur much higher costs compared with the general surgical population. These results strongly highlight that specific perioperative interventions are needed to proactively improve the identification, management and outcomes for these disadvantaged patients.
Preliminary investigation of Shift, a novel smartphone application to support junior doctors’ mental health and wellbeing: Examination of symptom progression, usability, and acceptability after one mo
Publisher: JMIR Publications Inc.
Date: 05-04-2022
Abstract: hift is a novel smartphone application (app) to provide a digital-first mental health resource to junior doctors. It contains psychoeducational material, cognitive behavioural modules, guided mediations, information on common work stressors, and a section on help-seeking options for psychological problems through workplace and private avenues. o conduct a preliminary investigation of the usage and potential effectiveness of Shift on depressive and anxiety symptoms (primary outcomes), and work and social functioning, coronavirus safety concerns, and help-seeking (secondary outcomes). This study also sought feedback on whether Shift was seen as an acceptable tool. unior doctors in New South Wales, Australia were approached through promotional activities from the Ministry of Health, specialist medical colleges, and social media advertisements between June and August 2020. Consenting participants provided online baseline data, used the Shift app for 30 days, and were asked to complete a post-study online questionnaire. Outcomes were analysed under the ITT principle. total of 222 (156/222 female, 70% mean age = 29.2 years) junior doctors provided full baseline data. Of those, 198/222 (89%) downloaded the app, logged into the app about 6 times (M = 5.68, SD = 7.51), completed 4 in-app activities (M = 3.77, SD = 4.36), and spent a total of one hour on in-app activities (M = 52:23, SD = 6:00:18) over 30 days. Post-intervention data were provided by 54/222 (24%) of participants. Depressive and anxiety symptoms significantly decreased between the pre- and post-assessment points as expected, however, doctors’ coronavirus safety concerns significantly increased. Work and social functioning, coronavirus concerns for family and friends, and help seeking did not change significantly. There was no significant relationship between symptom changes and app usage (number of logins, days between first and last login, and total activity time). Most post-study completers (31/54, 57%) rated Shift highly or very highly. espite high levels of non-response to the post-study assessment and increases in coronavirus safety concerns, junior doctors who used the app reported some improvements in depression and anxiety that warrant further exploration in a robust manner. he study was prospectively registered with the Australian New Zealand Clinical Trials Registry under the trial number ACTRN12620000571976.
Bias in psychiatric case–control studies
Publisher: Royal College of Psychiatrists
Date: 03-2007
DOI: 10.1192/BJP.BP.106.027250
Abstract: Case–control studies are vulnerable to selection and information biases which may generate misleading findings. To assess the quality of methodological reporting of case–control studies published in general psychiatric journals. All the case–control studies published over a 2-year period in the six general psychiatric journals with impact factors of more than 3 were assessed by a group of psychiatrists with training in epidemiology using a structured assessment devised for the purpose. The measured study quality was compared across type of exposure and journal. The reporting of methods in the 408 identified papers was generally poor, with basic information about recruitment of participants often absent. Reduction of selection bias was described best in the ‘pencil and paper’ studies and worst in the genetic studies. Neuroimaging studies reported the most safeguards against information bias. Measurement of exposure was reported least well in studies determining the exposure with a biological test. Poor reporting of recruitment strategies threatens the validity of reported results and reduces the generalisability of studies.
Mindfulness-Based Stress Release Program for University Employees
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2016
The Sri Lankan Twin Registry: 2012 Update
Publisher: Cambridge University Press (CUP)
Date: 10-01-2013
DOI: 10.1017/THG.2012.119
Abstract: The Sri Lankan Twin Registry (SLTR), established in 1997, is a unique resource for twin and genetic research in a low- and middle-income country (LMIC). It comprises of a volunteer cohort of 14,120 twins (7,060 pairs) and 119 sets of triplets, and a population-based cohort of 19,040 (9,520 pairs) twins and 89 sets of triplets. Several studies have been conducted using this registry, including the Colombo Twin and Singleton Study (CoTaSS 1 4,387 twins, 2,311 singletons), which have explored the prevalence and heritability of a range of psychiatric disorders as well as gene-environmental interplay. Currently, a follow-up study (CoTaSS 2) of the same cohort is underway, looking at the prevalence and interrelationship of key cardiovascular and metabolic risk markers (e.g., metabolic syndrome). A significant feature of CoTaSS 2 is the establishment of a biobank. Current SLTR work is extending beyond mental health and the interface between mental and physical health to new horizons, extending collaborations with the wider global twin research community. Ethics and governance have been given special emphasis in the initiative. Capacity building and public engagement are two crucial components. Establishment of a state-of-the-art genetic laboratory was a major accomplishment. SLTR is a classic showcase of successful North–South partnership in building a progressive research infrastructure in a LMIC.
Attitudes of nursing staff towards co-workers returning from psychiatric and physical illnesses
Publisher: SAGE Publications
Date: 11-2006
Abstract: Background: Co-worker support, or lack of it, plays an important role in the contribution of workplace pressure to psychiatric illness and rehabilitation after sickness. Aims: To develop and validate a measure to compare attitudes towards coworkers with different illnesses to identify specific aspects of colleagues’ attitudes which may hinder the reintegration in the workplace after sickness absence of in iduals with common psychiatric conditions. Method: A measure of co-worker behavioural concern was developed and validated using focus groups and a pilot study to determine questionnaire items. This was followed by a cross-sectional survey of 532 nursing staff within a UK hospital assessing attitudes to vignettes of a co-worker with different embedded diagnoses. Results: A measure of attitudes to co-workers was developed and validated. In the survey of nurses this revealed that attitudes were significantly more negative towards co-workers returning after psychiatric illnesses than to those with diabetes. Those with alcohol problems were held in particularly low esteem. Conclusions: Psychiatric illnesses are stigmatised compared with physical illnesses, with the degree of behavioural blame evidently important. Co-worker reliability, predictability and coping were more important issues than particular work-related skills and could be incorporated into return-to-work plans.
Framework for the Design Engineering and Clinical Implementation and Evaluation of mHealth Apps for Sleep Disturbance: Systematic Review
Publisher: JMIR Publications Inc.
Date: 17-02-2021
DOI: 10.2196/24607
Abstract: Mobile health (mHealth) apps offer a scalable option for treating sleep disturbances at a population level. However, there is a lack of clarity about the development and evaluation of evidence-based mHealth apps. The aim of this systematic review was to provide evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. A systematic search of studies published from the inception of databases through February 2020 was conducted using 5 databases (MEDLINE, Embase, Cochrane Library, PsycINFO, and CINAHL). A total of 6015 papers were identified using the search strategy. After screening, 15 papers were identified that examined the design engineering and clinical implementation and evaluation of 8 different mHealth apps for sleep disturbance. Most of these apps delivered cognitive behavioral therapy for insomnia (CBT-I, n=4) or modified CBT-I (n=2). Half of the apps (n=4) identified adopting user-centered design or multidisciplinary teams in their design approach. Only 3 papers described user and data privacy. End-user acceptability and engagement were the most frequently assessed implementation metrics. Only 1 app had available evidence assessing all 4 implementation metrics (ie, acceptability, engagement, usability, and adherence). Most apps were prototype versions (n=5), with few matured apps. A total of 6 apps had supporting papers that provided a quantitative evaluation of clinical outcomes, but only 1 app had a supporting, adequately powered randomized controlled trial. This is the first systematic review to synthesize and examine evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. The minimal number of apps with published evidence for design engineering and clinical implementation and evaluation contrasts starkly with the number of commercial sleep apps available. Moreover, there appears to be no standardization and consistency in the use of best practice design approaches and implementation assessments, along with very few rigorous efficacy evaluations. To facilitate the development of successful and evidence-based apps for sleep disturbance, we developed a high-level framework to guide researchers and app developers in the end-to-end process of app development and evaluation.
Obstructive sleep apnoea and schizophrenia - A research agenda
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.SMRV.2012.10.003
Abstract: Schizophrenia is associated with significantly increased physical morbidity and mortality particularly secondary to cardiometabolic disorders. In people with schizophrenia, rates of obesity and the metabolic syndrome are high compared to the general population. Whilst the weight gain secondary to antipsychotic medication is largely to blame, other factors include inactivity, poor diet and possibly the illness itself. Obstructive sleep apnoea (OSA) is a common and frequently under-recognized condition which may be associated with disabling symptoms including daytime sleepiness, cognitive impairment, depression, anxiety and long term increases in morbidity and mortality secondary to cardiometabolic disease. As the primary risk factor is obesity, elevated rates of sleep apnoea would therefore seem likely in association with schizophrenia. Thus, OSA might represent a treatable cause of psychiatric and physical co-morbidity in patients with schizophrenia. A review of the literature revealed a paucity of quality research in this area. Available data suggest increased rates of sleep apnoea in schizophrenia and that psychotic symptoms may improve when co-morbid sleep apnoea is treated. Health practitioners may be unaware of the need to screen for sleep apnoea in patients with schizophrenia and the disorder may be significantly under-recognised. Research is required to clarify the epidemiology, consequences and management of sleep apnoea in association with schizophrenia.
A comparison of face-to-face and online training in improving managers' confidence to support the mental health of workers
Publisher: Elsevier BV
Date: 12-2019
Efficacy and safety of a 4-week course of repeated subcutaneous ketamine injections for treatment-resistant depression (KADS study): randomised double-blind active-controlled trial
Publisher: Royal College of Psychiatrists
Date: 14-07-2023
DOI: 10.1192/BJP.2023.79
Abstract: Prior trials suggest that intravenous racemic ketamine is a highly effective for treatment-resistant depression (TRD), but phase 3 trials of racemic ketamine are needed. To assess the acute efficacy and safety of a 4-week course of subcutaneous racemic ketamine in participants with TRD. Trial registration: ACTRN12616001096448 at www.anzctr.org.au . This phase 3, double-blind, randomised, active-controlled multicentre trial was conducted at seven mood disorders centres in Australia and New Zealand. Participants received twice-weekly subcutaneous racemic ketamine or midazolam for 4 weeks. Initially, the trial tested fixed-dose ketamine 0.5 mg/kg versus midazolam 0.025 mg/kg (cohort 1). Dosing was revised, after a Data Safety Monitoring Board recommendation, to flexible-dose ketamine 0.5–0.9 mg/kg or midazolam 0.025–0.045 mg/kg, with response-guided dosing increments (cohort 2). The primary outcome was remission (Montgomery-Åsberg Rating Scale for Depression score ≤10) at the end of week 4. The final analysis (those who received at least one treatment) comprised 68 in cohort 1 (fixed-dose), 106 in cohort 2 (flexible-dose). Ketamine was more efficacious than midazolam in cohort 2 (remission rate 19.6% v . 2.0% OR = 12.1, 95% CI 2.1–69.2, P = 0.005), but not different in cohort 1 (remission rate 6.3% v . 8.8% OR = 1.3, 95% CI 0.2–8.2, P = 0.76). Ketamine was well tolerated. Acute adverse effects (psychotomimetic, blood pressure increases) resolved within 2 h. Adequately dosed subcutaneous racemic ketamine was efficacious and safe in treating TRD over a 4-week treatment period. The subcutaneous route is practical and feasible.
What happened to the predicted COVID-19-induced suicide epidemic, and why?
Publisher: SAGE Publications
Date: 16-10-2023
DOI: 10.1177/00048674221131500
Abstract: Two years ago, in the early stages of the COVID-19 pandemic, there were widespread and grim predictions of an ensuing suicide epidemic. Not only has this not happened but also by the end of 2021 in the majority of countries and regions with available data, the suicide rates had, if anything, declined. We discuss four reasons why the predictions of suicide models were exaggerated: (1) government intervention reduced the economic and mental costs of lockdowns, (2) the pandemic itself and lockdowns had less of an effect on mental health than assumed, (3) the evidence for a link between economic downturns, distress and suicide is weaker and less consistent than the models assumed and (4) predicting suicide is generally hard. Predictive models have an important place, but their strong modelling assumptions need to acknowledge the inherent high degree of uncertainty which has been further augmented by behavioural responses of pandemic management.
Secular changes in sleep duration among Australian adults, 1992-2006
Publisher: AMPCo
Date: 12-2011
DOI: 10.5694/MJA11.10302
Abstract: To determine whether sleep duration of Australian adults has declined over recent years. Analysis of nationally representative data from repeated cross-sectional time-use surveys conducted in 1992, 1997 and 2006. Private households in Australia. Respondents aged 15 years and over (N = 21 195) who completed time-use diaries over two consecutive days. Change in sleep duration by sociodemographic group. Mean sleep duration was 8 h 20 min in 1992, 8 h 33 min in 1997, and 8 h 30 min in 2006 (SEM for all years, 1 min). After adjustment for s ling during weekends and different seasons, there was no significant change in sleep duration from 1992 to 2006 (adjusted difference, 2 min 95% CI, -2 to 5 min P = 0.33). The only significant decreases in sleep duration were observed in people aged 65 years and over (adjusted difference, 12 min 95% CI, 4-19 min P < 0.001), people with no income (adjusted difference, 17 min 95% CI, 7-27 min P = 0.001) and male carers (adjusted difference, 31 min 95% CI, 9-53 min P = 0.002), although people in these groups reported over 8 h sleep on average. Most Australian adults were not sleeping less in 2006 than they did in 1992. Public health concerns over declining sleep duration do not appear to be warranted. Investigation of possible changes in quality of sleep is required.
How patient centric is health policy development? The case of the Parliamentary Inquiry into Sleep Health Awareness in Australia
Publisher: CSIRO Publishing
Date: 05-04-2022
DOI: 10.1071/AH21156
Abstract: Objective Parliamentary inquiries into health-related issues empower everyday Australians to contribute to the development and reform of health policy. We explored how patient and family/carers concerns are translated by this process, using a less well-known disease, narcolepsy, as an ex le. Methods Written submissions made to the Parliamentary Inquiry into Sleep Health Awareness in Australia 2018 by self-identified patients or family/carers with narcolepsy (n = 13) were extracted and thematically analysed using the Framework Approach. Each submission was systematically coded and abstracted into emergent themes before being evaluated against the final policy recommendations. Results Although patients and their family/carers prioritised issues that affected their daily lives (i.e. mental health sequela, workplace accommodations), the policy recommendations in the report focused mainly on issues of healthcare infrastructure, funding and engagement. Our analysis highlighted several barriers that patients and their family/carers face when contributing to this part of healthcare policy formation. Conclusions Our findings suggest that the parliamentary inquiry process in its current form is not an ideal vehicle by which patients and family/carers can contribute or influence healthcare policy. Despite calling for submissions from patients and their family/carers, the final report and subsequent health policy recommendations made by the inquiry do not appear to be patient-centric or reflective of the submissions written by these stakeholders. Increased transparency, development of processes to balance stakeholder priorities and improved accessibility for stakeholders to participate are needed if health-related parliamentary inquiries are to produce healthcare policy that ultimately meets the needs of patients and family/carers.
Development of a joint mental-health and drug health assessment unit and short-stay unit.
Publisher: SAGE Publications
Date: 20-05-2019
Abstract: There is emerging interest in models of care that focus on assessment and brief inpatient treatment (two to three days) including psychiatric emergency care centre units and short-stay units in Australia. We present the development of a functionally integrated Missenden Assessment Unit and six-bed short-stay unit in the new Professor Marie Bashir Centre at Royal Prince Alfred Hospital in inner-city Sydney. The focus was on collaboration between emergency, drug and alcohol and mental-health services in developing the short-stay unit and Missenden Assessment Unit with joint admission and resource use. We outline the models of care and findings from the 2016 evaluation following the initial two years of operation and consider ongoing challenges. The Missenden Assessment Unit provides an alternative point of presentation for mental-health drug and alcohol patients. The short-stay unit provides coordinated, therapeutic interventions. The Missenden Assessment Unit/short-stay unit reduced the burden of presentations to the emergency department while providing the opportunity for training and collaboration. Further refinement of the models of care should occur with policy development and via research.
Are rehabilitation services following stroke accessed equitably in Australia?: findings from the psychosocial outcomes in stroke (POISE) cohort study
Publisher: Springer Science and Business Media LLC
Date: 24-09-2013
Depression and work performance: an ecological study using web-based screening
Publisher: Oxford University Press (OUP)
Date: 27-04-2011
Abstract: Depression is reported to be a major cause of illness-related sub-optimal work performance (presenteeism). However, the majority of studies examining presenteeism have relied on self-report measures of work performance. Furthermore, employers currently face a number of practical challenges in attempting to facilitate early identification of depression. To test whether a web-based screening tool for depression could be used successfully in the workplace and whether it was possible to detect an association between rates of depression and objective measures of impaired workgroup performance. All permanent employees of a telecommunications company with UK-based call centres were encouraged to complete a web-based psychological assessment using the Patient Health Questionnaire depression scale (PHQ-9). In addition to confidential in idual level results, the tool was able to provide anonymized summary statistics for each workgroup. Four objective measures of work performance were collected for each workgroup. During the study period, 1161 web-based PHQ-9 questionnaires were completed. There was a negative linear relationship between rates of depressive symptoms and the overall performance of a workgroup (P < 0.001). The linear relationship between depression and workgroup performance remained after controlling for gender balance, percent of temporary staff, employees' perceived level of engagement and satisfaction with their line manager (P < 0.01). Workgroups with high levels of depressive symptoms tend to perform poorly. Computer-aided web-based screening for symptoms of depression is feasible in a work setting.
Effectiveness of an online insomnia program (SHUTi) for prevention of depressive episodes (the GoodNight Study): a randomised controlled trial
Publisher: Elsevier BV
Date: 04-2016
Body mass, cardiovascular risk and metabolic characteristics of young persons presenting for mental healthcare in Sydney, Australia
Publisher: BMJ
Date: 27-03-2015
Sleep disturbance, personality and the onset of depression and anxiety: Prospective cohort study
Publisher: SAGE Publications
Date: 16-08-2012
Abstract: Previous studies have shown associations between sleep disturbance and the onset of depression and anxiety. However, this relationship may reflect an underlying vulnerability, such as temperament or cognitive style, which accounts for an association between the two. This study aimed to evaluate the relationship between sleep disturbance and the onset of a mental disorder after a 4-year follow-up, and whether this was accounted for by ruminative style and neuroticism. The nine-item Patient Health Questionnaire was used to assess the criteria for major depression, generalized anxiety disorder (GAD) and panic disorder (PD) in a community cohort of 3636 young and middle-aged Australian adults, free of any disorder at baseline, over a 4-year period. Sleep disturbance was based on a factor derived from the sleep items of the Goldberg Depression and Anxiety Scales. The associations between baseline sleep disturbance and a new episode of the assessed disorders were estimated and the impact of temperament and cognitive style on these associations was evaluated. Self-reported sleep disturbance was significantly associated with an onset of major depressive disorder [MDD odds ratio (OR) = 1.33, p = 0.006], GAD (OR = 1.37, p 0.001) and PD (OR = 1.62, p 0.001) after 4 years. However, the relationship for MDD was attenuated to nonsignificance (OR = 1.19, p = 0.116) after adjusting for neuroticism (measured by the Eysenck Personality Questionnaire-Revised) and rumination (measured by the adapted Ruminative Style scale). These data suggest that the often-observed association between sleep disturbance and depression onset may be linked to an underlying ruminative style and/or neuroticism. However, the fact that the effect of sleep disturbance on PD and GAD onset was not accounted for by personality factors is a novel finding and suggests a potential role of early identification in selective preventive interventions.
High alcohol use a strong and significant risk factor for repetitive self-harm in female and male youth: A prospective cohort study
Publisher: Informa UK Limited
Date: 05-08-2015
DOI: 10.3109/00952990.2015.1062023
Abstract: Deliberate self-harm (DSH) is reported by between 5 and 17% of youth aged 14-25 years. Current management measures focus on repetition prevention in high-risk groups. To examine risk factors and predictors of DSH and DSH repetition in a community s le, by gender. A prospective cohort of 20,822 young adults (aged 17-24 years) was recruited when obtaining their driving license. A random s le of 5000 was approached for follow-up 12-18 months 2991 (60%) responded and formed the cohort for this analysis. Patterns of self-harm, using a modified Beck Suicide Inventory, were investigated with logistic regression. DSH was reported by 4.1% (123/2991) at baseline. Over the following 12 months, 3.0% (90/2991) reported new instances of DSH which included 20% (25) respondents who had engaged in DSH at baseline. Psychological distress was a risk factor for engaging in DSH in the past 12 months, OR 3.55 (95% CI 2.06-6.14). Although several clinical risk factors differed between genders, high alcohol use, OR 23.6 (95% CI 3.64-153) and psychological distress, OR 4.97 (95% CI 1.08-22.9) were significant risk factors for repeat DSH in both males and females. In this community cohort, 1 in 25 youth had self-harmed in the year prior of these, 4 in 5 did not repeat DSH over the following year. High alcohol use stands out as a strong risk factor for DSH repetition. Assessing alcohol use may help clinicians identify those who are at greatest risk for repetitive self-harm.
Trajectories of change and long-term outcomes in a randomised controlled trial of internet-based insomnia treatment to prevent depression
Publisher: Royal College of Psychiatrists
Date: 09-2017
DOI: 10.1192/BJPO.BP.117.005231
Abstract: Insomnia treatment using an internet-based cognitive–behavioural therapy for insomnia (CBT-I) program reduces depression symptoms, anxiety symptoms and suicidal ideation. However, the speed, longevity and consistency of these effects are unknown. To test the following: whether the efficacy of online CBT-I was sustained over 18 months how rapidly the effects of CBT-I emerged evidence for distinct trajectories of change in depressive symptoms and predictors of these trajectories. A randomised controlled trial compared the 6-week Sleep Healthy Using the Internet (SHUTi) CBT-I program to an attention control program. Adults ( N =1149) with clinical insomnia and subclinical depression symptoms were recruited online from the Australian community. Depression, anxiety and insomnia decreased significantly by week 4 of the intervention period and remained significantly lower relative to control for months (between-group Cohen's d =0.63, 0.47, 0.55, respectively, at 18 months). Effects on suicidal ideation were only short term. Two depression trajectories were identified using growth mixture models: improving (95%) and stable/deteriorating (5%) symptoms. More severe baseline depression, younger age and limited comfort with the internet were associated with reduced odds of improvement. Online CBT-I produced rapid and long-term symptom reduction in people with subclinical depressive symptoms, although the initial effect on suicidal ideation was not sustained.
Genetic and environmental contributions to depression in Sri Lanka
Publisher: Royal College of Psychiatrists
Date: 12-2009
DOI: 10.1192/BJP.BP.109.063529
Abstract: Susceptibility to depression results from genetic and non-familially shared environmental influences in high-income, Western countries. Environments may play a different role for populations in different contexts. To examine heritability of depression in the first large, population-based twin study in a low-income country. Lifetime depression and a broader measure of depression susceptibility (D-probe) were assessed in 3908 adult twins in Sri Lanka (the CoTASS study). There were gender differences for the broad definition (D-probe), with a higher genetic contribution in females (61%) than males (4%). Results were similar for depression, but the prevalence was too low to estimate heritability for males. Genetic influences on depression in women appear to be at least as strong in this Sri Lankan s le as in higher-income countries. Conclusions are less clear for men but suggest a larger role for environments rather than genes. The nature as well as the magnitude of environmental influences may also differ across populations.
The burden of insomnia on individual function and healthcare consumption in Australia
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1111/J.1753-6405.2012.00845.X
Abstract: To determine the extent to which insomnia poses an independent burden on in idual function and healthcare use in Australia. Cross-sectional data from 8,841 respondents and representative of the Australian population aged 16 to 85 in the 2007 National Mental Health and Wellbeing Survey were analysed. Insomnia was defined as 'sleeping only in short bursts and being awake most of the night' during the past week. This measure was validated against common epidemiological indicators of insomnia. Associations between insomnia, disability and healthcare consumption were explored using multivariate logistic regression. Insomnia was reported by 5.6% of adults and was associated with older age, female gender, pain and psychological distress. Controlling for these and other a priori confounders, insomnia was associated with greater odds of (Adjusted Odds Ratio 95% CI): disability days (1.62 1.20-2.18), difficulties in daily activities (1.60 1.10-2.31), life dissatisfaction (2.34 1.11-4.93), use of sleep medication (1.78 1.12-2.82) and a higher number of visits to general practitioners (1.57 1.06-2.33). Insomnia was not significantly associated with the use of medications for mental health (1.17 0.82-1.67), hospital admissions (1.31 0.82-1.67), the use of complementary and alternative medicine (1.10 0.73-1.67) or unmet need for healthcare (1.22 0.84-1.77). One in twenty adult Australians experience a level of insomnia that is independently associated with impairments in functioning and increased use of healthcare. Increasing public and clinician awareness of the impact of insomnia, and promotion of available insomnia treatments may be warranted.
The relationship between depression symptoms, absenteeism and presenteeism
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.JAD.2019.06.041
Abstract: Mental health problems are common within the working population. Depression is both highly prevalent and debilitating and is linked to increases in absenteeism and presenteeism. The use of summed depression scale scores may conceal differential impacts of depressive symptoms on absenteeism and presenteeism. We aimed to explore both the relationship between absenteeism and presenteeism and both depression severity, along with the independent contributions of different symptoms. Participants (N = 4953) were employees recruited as part of a larger study to evaluate a mental health smartphone app and were recruited via industry partner organisations and social media. Participants completed in-app assessment which included demographic information, the Patient Health Questionnaire-9 depression tool, and items of the World Health Organization Health and Work Performance Questionnaire. The relationship between depressive symptoms, absenteeism and presenteeism was estimated using both total summed scores and in idual symptoms of depression. Univariate linear regression confirmed a negative linear relationship between depression severity and presenteeism, which remained significant after controlling for age, gender, industry, and work position. Similarly, there was a statistically significant relationship between depression severity and the amount of mental health related sickness absence taken over the preceding 28 days. Johnson's relative weights analysis showed contributory differences amongst depression symptoms in relation to presenteeism and absenteeism. Significant relationships between depression severity and both absenteeism and presenteeism were present indicating increases in absence and decreases in performance with increasing severity. There existed differences amongst the contribution of specific symptoms of depression to both outcomes of interest. The symptoms that contribute most to absence were more behavioural in nature, whilst those contributing most to presenteeism were more cognitive. These findings have practical implications for clinicians and employers in making treatment and return-to-work decisions.
Social Cognition Deficits and Psychopathic Traits in Young People Seeking Mental Health Treatment
Publisher: Public Library of Science (PLoS)
Date: 04-07-2013
The Sleep Or Mood Novel Adjunctive therapy (SOMNA) trial: a study protocol for a randomised controlled trial evaluating an internet-delivered cognitive behavioural therapy program for insomnia on outc
Publisher: Springer Science and Business Media LLC
Date: 05-02-2015
The influence of job stress, social support and health status on intermittent and chronic sleep disturbance: An 8-year longitudinal analysis
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.SLEEP.2014.04.007
Abstract: To determine the role of health status and social support in the relationship between job stress and sleep disturbance, for both intermittent and chronic sleep disturbance. A total of 1946 mid-life adults completed three questionnaires spanning an 8-year time frame. Sleep disturbance was assessed at each time point, and participants were classified as experiencing intermittent, chronic or no sleep disturbance across this 8-year period. Independent variables included a range of job stress measures, social support, physical and mental health, and demographic characteristics. After controlling for physical and mental health, perceived lack of job marketability increased risk of intermittent sleep disturbance (odds ratio (OR)=1.33, p=0.012). No other job stress measures were associated with either intermittent or chronic sleep disturbance after adjusting for years of education, social support, and employment status. Poorer mental and physical health status, although significantly increasing odds for intermittent sleep disturbance, represented a significantly greater increase in the odds for chronic sleep disturbance over and above intermittent disturbance (OR=0.96, p<0.001 for both SF-12 mental and physical health). This population-based cohort study found little evidence that job stress had an independent effect on chronic or intermittent sleep disturbance independent of health, social support, and education. Risk profiles for intermittent and chronic sleep disturbance did not differ with regard to job stress however, various demographic and social support factors were distinguishing factors. Health status, both physical and mental, also showed a significantly greater impact on chronic sleep disturbance than intermittent sleep disturbance. Karasek's model of job strain had little value in predicting sleep disturbance outcomes.
Online insomnia treatment and the reduction of anxiety symptoms as a secondary outcome in a randomised controlled trial: The role of cognitive-behavioural factors
Publisher: SAGE Publications
Date: 02-05-2018
Abstract: Insomnia and anxiety commonly co-occur, yet the mechanisms underlying this remain unclear. The current paper describes the impact of an Internet-based intervention for insomnia on anxiety, and explores the influence of two cognitive-behavioural constructs – dysfunctional beliefs about sleep and sleep-threat monitoring. A large-scale, 9-week, two-arm randomised controlled trial ( N = 1149) of community-dwelling Australian adults with insomnia and elevated yet subclinical depression symptoms was conducted, comparing a cognitive behavioural therapy–based online intervention for insomnia (Sleep Healthy Using The Internet) with an attention-matched online control intervention (HealthWatch). Symptoms of anxiety were assessed at pretest, posttest, and 6-month follow-up. Dysfunctional beliefs about sleep and sleep threat monitoring were assessed only at pretest. Sleep Healthy Using The Internet led to a greater reduction in anxiety symptoms at both posttest ( t 724.27 = –6.77, p 0.001) and at 6-month follow-up ( t 700.67 = –4.27, p 0.001) than HealthWatch. At posttest and follow-up, this effect was found to moderated by sleep-threat monitoring ( t 713.69 = –2.39, p 0.05 and t 694.77 = –2.98, p 0.01 respectively) but not by dysfunctional beliefs about sleep at either posttest or follow-up ( t 717.53 = –0.61, p = 0.55 and t 683.79 = 0.22, p = 0.83 respectively). Participants in the Sleep Healthy Using The Internet condition with higher levels of sleep-threat monitoring showed a greater reduction in anxiety than those with lower levels from pretest to posttest, ( t 724.27 = –6.77, p 0.001) and through to 6-month follow-up ( t 700.67 = –4.27, p 0.001). This result remained after controlling for baseline anxiety levels. The findings suggest that online cognitive behavioral therapy interventions for insomnia are beneficial for reducing anxiety regardless of people’s beliefs about their sleep and insomnia, and this is particularly the case for those with high sleep-threat monitoring. This study also provides further evidence for cognitive models of insomnia.
Prospective associations between joint categories of physical activity and insomnia symptoms with onset of poor mental health in a population-based cohort.
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.JSHS.2022.02.002
Abstract: Physical inactivity and insomnia symptoms are independently associated with increased risk of depression and anxiety however, few studies jointly examine these risk factors. This study aimed to prospectively examine the joint association of physical activity (PA) and insomnia symptoms with onset of poor mental health in adults. Participants from the 2013-2018 annual waves of the Household Income and Labour Dynamics in Australia panel study who had good mental health (Mental Health Inventory-5 >54) in 2013, and who completed at least one follow-up survey (2014-2018), were included (n = 10,977). Poor mental health (Mental Health Inventory-5 ≤ 54) was assessed annually. Baseline (2013) PA was classified as high/moderate/low, and insomnia symptoms (i.e., trouble sleeping) were classified as no insomnia symptoms/insomnia symptoms, with six mutually exclusive PA-insomnia symptom groups derived. Associations of PA-insomnia symptom groups with onset of poor mental health were examined using discrete-time proportional-hazards logit-hazard models. There were 2322 new cases of poor mental health (21.2%). Relative to the high PA/no insomnia symptoms group, there were higher odds (odds ratio, 95% confidence interval (95%CI)) of poor mental health among the high PA/insomnia symptoms (OR = 1.87, 95%CI: 1.57-2.23), moderate PA/insomnia symptoms (OR = 1.93, 95%CI: 1.61-2.31), low PA/insomnia symptoms (OR = 2.33, 95%CI: 1.96-2.78), and low PA/no insomnia symptoms (OR = 1.14, 95%CI: 1.01-1.29) groups. Any level of PA combined with insomnia symptoms was associated with increased odds of poor mental health, with the odds increasing as PA decreased. These findings highlight the potential benefit of interventions targeting both PA and insomnia symptoms for promoting mental health.
Exploring User Needs and Preferences for Mobile Apps for Sleep Disturbance: Mixed Methods Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 04-03-2019
Abstract: obile health (mHealth) apps demonstrate promise for improving sleep at scale. End-user engagement is a prerequisite for sustained use and effectiveness. e assessed the needs and preferences of those with poor sleep and insomnia to inform the development of an engaging sleep app. e triangulated results from qualitative (focus groups and app reviews) and quantitative (online survey) approaches. A total of 2 focus groups were conducted (N=9). An online survey tested themes identified from the focus groups against a larger population (N=167). In addition, we analyzed 434 user reviews of 6 mobile apps available on app stores. ommon focus group themes included the need to account for erse sleep phenotypes with an adaptive and tailored program, key app features (alarms and sleep diaries), the complex yet condescending nature of existing resources, providing rationale for information requested, and cost as a motivator. Most survey participants (156/167, 93%) would try an evidence-based sleep app. The most important app features reported were sleep diaries (148/167, 88%), sharing sleep data with a doctor (116/167, 70%), and lifestyle tracking (107/167, 64%). App reviews highlighted the alarm as the most salient app feature (43/122, 35%) and data synchronization with a wearable device (WD) as the most commonly mentioned functionality (40/135, 30%). his co-design process involving end users through 3 methods consistently highlighted sleep tracking (through a diary and WD), alarms, and personalization as vital for engagement, although their implementation was commonly criticized in review. Engagement is negatively affected by poorly designed features, bugs, and didactic information which must be addressed. Other needs depend upon the type of user, for ex le, those with severe insomnia.
Reverse Causality in the Association Between Whiplash and Symptoms of Anxiety and Depression
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2011
Is Managed Care Good for Research and Education?
Publisher: Springer US
Date: 1999
Recent Evidence on Worldwide Trends on Sleep Duration
Publisher: Springer Science and Business Media LLC
Date: 08-10-2015
Sleep-deprived young drivers and the risk for crash the drive prospective cohort study
Publisher: American Medical Association (AMA)
Date: 07-2013
DOI: 10.1001/JAMAPEDIATRICS.2013.1429
Abstract: Short sleep duration is common in adolescents and young adults, and short sleep duration is a risk factor for motor vehicle crash. To assess the association between hours of sleep and the risk for motor vehicle crash, including the time of day of crash and types of crash (single, multiple vehicle, run off road, and intersection). Prospective cohort study. New South Wales, Australia. Questionnaire responses were obtained from 20,822 newly licensed drivers aged 17 to 24 years. Participants held a first-stage provisional license between June 2003 and December 2004 prospectively linked to licensing and police-reported crash data, with an average of 2 years of follow-up. Analyses were conducted on a subs le of 19,327 participants for which there was full information. Sleeping 6 or fewer hours per night. The main outcome variable was police-reported crash. Multivariable Poisson regression models were used to investigate the role of sleep duration on the risk for crash. On average, those who reported sleeping 6 or fewer hours per night had an increased risk for crash compared with those who reported sleeping more than 6 hours (relative risk [RR], 1.21 95% CI, 1.04-1.41). Less weekend sleep was significantly associated with an increased risk for run-off-road crashes (RR, 1.55 95% CI, 1.21-2.00). Crashes for in iduals who had less sleep per night (on average and on weekends) were significantly more likely to occur between 8 pm and 6 am (RR, 1.86 95% CI, 1.11-3.13, for midnight to 5:59 am and RR, 1.66 95% CI, 1.15-2.39, for 8:00 pm to 11:59 pm). Less sleep per night significantly increased the risk for crash for young drivers. Less sleep on weekend nights increased the risk for run-off-road crashes and crashes occurring in the late-night hours. This provides rationale for governments and health care providers to address sleep-related crashes among young drivers.
PT155 The National Heart Foundation of Australia Consensus Statement on Psychosocial Risk Factors for Coronary Heart Disease
Publisher: Ubiquity Press, Ltd.
Date: 03-2014
PT156 National Heart Foundation of Australia Review of Evidence Around Depression In Patients With Coronary Heart Disease
Publisher: Ubiquity Press, Ltd.
Date: 03-2014
Effectiveness of training workplace managers to understand and support the mental health needs of employees: a systematic review and meta-analysis
Publisher: BMJ
Date: 21-03-2018
DOI: 10.1136/OEMED-2017-104789
Abstract: Managers are in an influential position to make decisions that can impact on the mental health and well-being of their employees. As a result, there is an increasing trend for organisations to provide managers with training in how to reduce work-based mental health risk factors for their employees. A systematic search of the literature was conducted to identify workplace interventions for managers with an emphasis on the mental health of employees reporting directing to them. A meta-analysis was performed to calculate pooled effect sizes using the random effects model for both manager and employee outcomes. Ten controlled trials were identified as relevant for this review. Outcomes evaluating managers’ mental health knowledge (standardised mean difference (SMD)=0.73 95% CI 0.43 to 1.03 p .001), non-stigmatising attitudes towards mental health (SMD=0.36 95% CI 0.18 to 0.53 p .001) and improving behaviour in supporting employees experiencing mental health problems (SMD=0.59 95% CI 0.14 to 1.03 p=0.01) were found to have significant pooled effect sizes favouring the intervention. A significant pooled effect was not found for the small number of studies evaluating psychological symptoms in employees (p=0.28). Our meta-analysis indicates that training managers in workplace mental health can improve their knowledge, attitudes and self-reported behaviour in supporting employees experiencing mental health problems. At present, any findings regarding the impact of manager training on levels of psychological distress among employees remain preliminary as only a very limited amount of research evaluating employee outcomes is available. Our review suggests that in order to understand the effectiveness of manager training on employees, an increase in collection of employee level data is required.
The Immune System, Cytokines, and Biomarkers in Autism Spectrum Disorder
Publisher: Springer Science and Business Media LLC
Date: 25-02-2017
Employment status and perceived health in the Hordaland Health Study (HUSK)
Publisher: Springer Science and Business Media LLC
Date: 29-08-2006
'We're here to listen and help them as well': A qualitative study of staff and Indigenous patient perceptions about participating in social and emotional wellbeing research at primary healthcare services
Publisher: Springer Science and Business Media LLC
Date: 07-10-2019
DOI: 10.1186/S12888-019-2263-8
Abstract: Research can inform culturally-appropriate care to strengthen social and emotional wellbeing (SEWB) among Aboriginal and Torres Strait Islander (hereafter, the term ‘Indigenous Peoples’ is respectfully used and refers to all Aboriginal and/or Torres Strait Islander Peoples of Australia). We acknowledge the cultural ersity of Australia’s Indigenous First Peoples and they do not represent a homogenous group.) (hereafter Indigenous) Peoples. We explore the perspectives of primary healthcare staff and Indigenous patients about their willingness to and experiences participating in SEWB research. Process evaluation using grounded theory approaches of Getting it Right : The validation study , a national validation designed Indigenous SEWB research project ( N = 500). Primary healthcare staff ( n = 36) and community members ( n = 4) from nine of ten primary healthcare services involved with the research project completed qualitative semi-structured interviews. Interview data were triangulated with participant feedback (responses to structured questions and free-text feedback collected during Getting it Right ), study administrative data (participant screening logs, communication logs, study protocol, deviation logs and ethics correspondence) and interviewer field notes. Three themes about staff, patient and community perspectives concerning research participation developed: (1) considering the needs, risk, preferences and impact of participation in research for staff, patients and community (2) building staff confidence speaking to patients about research and SEWB problems and (3) patients speaking openly about their SEWB. Some staff described pressure to ensure patients had a positive experience with the research, to respond appropriately if patients became upset or SEWB problems were identified during interviews, or due to their dual role as community member and researcher. Patients and staff reported that patients were more likely to participate if they knew the staff outside of the service, especially staff with a shared cultural background, and they perceived SEWB as a community priority. Staff reported their skills speaking to patients about the research and SEWB improved during the research, which built their confidence. Contrary to staff preconceptions, staff and patients reported that many patients appreciated the opportunity to speak about their SEWB and contributing to research that may eventually enhance SEWB in their community. Our research project was considered acceptable by most staff and patients. The positive outcomes reported by staff and feedback from patients highlights the importance of providing opportunities for people to speak about their SEWB and for research-informed SEWB PHC care. Getting it Right is registered on ANZCTR12614000705684 .
Association of sleep duration and sleep quality with the physical, social, and emotional functioning among Australian adults
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.SLEH.2017.11.006
Abstract: We aimed to evaluate the interaction of two key determinants of sleep health, quantity and quality, with physical, emotional, and social functioning, in the general population. Nationally-representative Australian cross-sectional study. General population. 14,571 people aged 15 or older in Household, Income and Labor Dynamics in Australia (HILDA) in 2013. The associations of sleep quality (good oor) in combination with mid-range (6-8 hours), short ( 8) sleep duration with functioning, determined from the SF-36, were evaluated using logistic regression adjusting for sociodemographic, relationships, health behaviors, obesity, pain, and mental and physical illness confounders. After adjusting for gender, and age, poor sleep quality in combination with short, mid-range and long sleep was associated with worse physical, emotional and social functioning. Pain and comorbid illness explained much of these associations, while attenuation from other covariates was minor. The associations of poor sleep quality with worse functioning remained after full adjustment regardless of sleep duration, while among people with good quality sleep, only those with long sleep duration reported poorer functioning. Poor sleep quality has robust associations with worse functioning regardless of total duration in the general population. There appears to be a substantial number of functional short sleepers with good quality sleep.
The quality of Australian Indigenous primary health care research focusing on social and emotional wellbeing: a systematic review
Publisher: The Sax Institute
Date: 2017
Abstract: Objectives and importance of the study: Primary health care research focused on Aboriginal and Torres Strait Islander (Indigenous) people is needed to ensure that key frontline services provide evidence based and culturally appropriate care. We systematically reviewed the published primary health care literature to identify research designs, processes and outcomes, and assess the scientific quality of research focused on social and emotional wellbeing. This will inform future research to improve evidence based, culturally appropriate primary health care. Systematic review in accordance with PRISMA and MOOSE guidelines. Four databases and one Indigenous-specific project website were searched for qualitative, quantitative and mixed-method published research. Studies that were conducted in primary health care services and focused on the social and emotional wellbeing of Indigenous people were included. Scientific quality was assessed using risk-of-bias assessment tools that were modified to meet our aims. We assessed community acceptance by identifying the involvement of community governance structures and representation during research development, conduct and reporting. Data were extracted using standard forms developed for this review. We included 32 articles, which reported on 25 studies. Qualitative and mixed methods were used in 18 studies. Twelve articles were judged as high or unclear risk of bias, four as moderate and five as low risk of bias. Another four studies were not able to be assessed as they did not align with the risk-of-bias tools. Of the five articles judged as low risk of bias, two also had high community acceptance and both of these were qualitative. One used a phenomenological approach and the other combined participatory action research with a social-ecological perspective and incorporated 'two-way learning' principles. Of the 16 studies where a primary outcome was identified, eight aimed to identify perceptions or experiences. The remaining studies assessed resources, or evaluated services, interventions, programs or policies. We were unable to identify primary outcomes in eight studies. Conducting Indigenous-focused primary health care research that is scientifically robust, culturally appropriate and produces community-level outcomes is challenging. We suggest that research teams use participatory, culturally sensitive approaches and collaborate closely to plan and implement high-quality research that incorporates local perspectives. Research should result in beneficial outcomes for the communities involved.
Effects of Low-Dose and Very Low-Dose Ketamine among Patients with Major Depression: a Systematic Review and Meta-Analysis
Publisher: Oxford University Press (OUP)
Date: 17-11-2015
DOI: 10.1093/IJNP/PYV124
Psychosocial Outcomes in StrokE: the POISE observational stroke study protocol
Publisher: Springer Science and Business Media LLC
Date: 12-06-2009
Preliminary Effectiveness of a Smartphone App to Reduce Depressive Symptoms in the Workplace: Feasibility and Acceptability Study
Publisher: JMIR Publications Inc.
Date: 04-12-2018
DOI: 10.2196/11661
Disability Discrimination Act 1995 and mental illness
Publisher: Royal College of Psychiatrists
Date: 1999
DOI: 10.1192/PB.23.1.3
A Systematic Review of the Impact of Adherence on the Effectiveness of e-Therapies
Publisher: JMIR Publications Inc.
Date: 05-08-2011
DOI: 10.2196/JMIR.1772
Co-Designing a Web-Based Decision Aid Tool for Employees Disclosure of Mental Health Conditions: A Participatory Study Design Using Employee and Organizational Preferences (Preprint)
Publisher: JMIR Publications Inc.
Date: 09-08-2020
Abstract: ecisions of whether to disclose mental health conditions are extremely personal and require the consideration of multiple factors associated with the disclosure process (eg, weighing the risks and benefits). Decision aid tools help people make these complex decisions. Such an aid needs to be confidential, easily accessible, and easy to use with the potential to access the tool on multiple occasions. Web programs are well suited to meet these requirements and, if properly developed, can provide feasible, accessible, affordable, and effective workplace interventions. his study aims to gain insights from potential end users, in this case both employees and organizations, into what type of components including language, style, and content would avoid potential stigma and ensure that elements of clear value for users would be built into a web-based decision aid tool that aims to assist employees in making decisions about the disclosure of their mental health condition at work. participatory design approach was used to allow developers, researchers, experts, and end users to collaborate in co-designing the tool. During the user research phase of the development of the web-based tool, a participatory design workshop approach was selected as a part of a larger study of focus groups. Australian employees and managers in rural, suburban, and urban locations participated in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for a decision aid tool. total of 2 workshops were conducted with 13 participants. The majority were from a transport company (9/13, 69%), male (8/13, 62%), and employed full time (11/13, 85%). Six employees had previous experience disclosing their own mental health condition, and 7 were in a supervisory role and had previously been disclosed to. In any co-design development, there are certain trade-offs that need to be made between the views of experts, developers, end users, and the available budget. In this specific instance of a very delicate, personal decision, the end users provided valuable design insights into key areas such as language, and they were very antipathetic to a key feature, the avatar, which was thought to be desirable by experts and developers. Findings including aspects of the tool where all stakeholders were in agreement, aspects where some stakeholders disagreed and adaptations were implemented, where disagreements could not be implemented because of financial constraints, and misalignment between stakeholders and how to decide on a balance were shared. he co-design with a lived experience approach is useful for contributing much to the design, language, and features. The key in this study was balancing the needs of the workers and the potential impact for the managers and organizations, while ensuring legislation and regulation requirements were upheld. >
Ambulatory sleep-wake patterns and variability in young people with emerging mental disorders
Publisher: CMA Joule Inc.
Date: 2015
DOI: 10.1503/JPN.130247
Sleep disturbances in young and middle-aged adults - Empirical patterns and related factors from an epidemiological survey.
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.COMPPSYCH.2017.07.009
Abstract: Previous research suggests that sleep disorders are highly associated with other mental health problems. However, sleep problems even below the diagnostic threshold of sleep disorders are very common in the general population, which highly affects wellbeing and functioning. In order to broaden the focus beyond those severe cases we explored empirical patterns across the whole spectrum of sleep problems as well as associated clinical and other factors. A representative community s le of N=1274 residents from the canton of Zurich was interviewed for sleep problems and diagnostic criteria for mental disorders as well as was given a number of mental health-related psychometrical checklists. Based on a broader spectrum of sleep problems we conducted a latent class analysis (LCA) to derive distinct classes of such disturbances. Classes were compared regarding their associations to mental health-relevant and other risk factors. The LCA revealed four classes - no sleep disturbances (72.6%), difficulties initiating and maintaining sleep (15.8%), delayed sleep (5.3%), and severe sleep problems (6.4%). Severe sleep problems were related to female gender and generalized anxiety disorder, while depression was linked to all sleep problem classes. Persons with difficulties initiating and maintaining sleep and severe sleep problems reported higher levels of psychopathology, burnout and neuroticism, while all sleep problem types were tied to stress-related variables, but not alcohol use disorder. Sleep problems are highly prevalent among the young and middle-aged adults in our representative s le of young and middle-aged adults and as such represent a serious public mental health problem. Our findings indicate sleep problems to have a multi-dimensional structure with some differential associations. While all subtypes were associated with poorer mental health and particularly more depression, severe sleep problems appeared to be the sleep subtype seen in agoraphobia and GAD, while delayed sleep had no specific associations. The variety of associations assessed leads one to assume that likewise a variety of sleep interventions is required.
Development and responsiveness of a scale to measure clinicians' attitudes to people with mental illness (medical student version)
Publisher: Wiley
Date: 02-07-2010
DOI: 10.1111/J.1600-0447.2010.01562.X
Abstract: We report the rationale, reliability, validity and responsiveness studies of the Mental Illness: Clinicians' Attitudes (MICA) Scale, a 16-item scale designed to measure attitudes of health care professionals towards people with mental illness. Items were generated through focus groups with service users, carers, medical students and trainee psychiatrists. Psychometric testing was completed in a number of student s les. The responsiveness of the scale was tested after a 1.5 h mental illness stigma related intervention with medical students. The MICA scale showed good internal consistency, alpha = 0.79. The test-retest reliability (concordance) was 0.80 (95% CI: 0.68-0.91). The standardised response mean for the scale was 0.4 (95% CI 0.02-0.8) after a mental illness related stigma intervention. The MICA scale is a responsive, reliable and valid tool, which can be used in medical education and mental health promotion settings and studies.
Cytokine levels and associations with symptom severity in male and female children with autism spectrum disorder
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Substance use in youth at risk for psychosis
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.SCHRES.2016.08.026
Abstract: People with schizophrenia have high rates of substance use which contributes to co-morbidity and premature mortality. Some evidence suggests people at-risk for psychosis have high rates of substance use. We aimed to assess substance use in a help-seeking cohort, comparing those at-risk and not at-risk for psychosis, and to establish any relationship with clinical symptoms. Participants were help-seeking youth presenting to mental health services in Sydney and Melbourne. 279 (34.8%) were at-risk for psychosis, and 452 (56.4%) did not meet criteria for a psychotic disorder or risk for psychosis. The excluded in iduals were made up of 59 (7.4%) young people who met criteria for a psychotic disorder and 11 (1.4%) who were unable to be evaluated. We assessed the association of substance use involvement with risk status and clinical symptoms using multivariate regression. In iduals at-risk for psychosis had significantly higher tobacco, alcohol and cannabis use than those not at-risk. Multivariate analysis revealed at-risk status was significantly associated with higher alcohol involvement scores when adjusting for age and gender, but no association was found for cannabis or tobacco. At-risk status was no longer associated with alcohol involvement when cannabis or tobacco use was added into the analysis. Tobacco smoking, alcohol consumption and cannabis use are common in help-seeking youth, particularly those at-risk for psychosis. It is important to consider co-occurring use of different substances in adolescents. Early substance misuse in this phase of illness could be targeted to improve physical and mental health in young people.
Correction: Preliminary Investigation of Shift, a Novel Smartphone App to Support Junior Doctors’ Mental Health and Well-being: Examination of Symptom Progression, Usability, and Acceptability After 1 Month of Use
Publisher: JMIR Publications Inc.
Date: 03-04-2023
DOI: 10.2196/47277
Secular trends in adult sleep duration: A systematic review
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.SMRV.2011.07.003
Abstract: Little evidence exists to support the common assertion that adult sleep duration has declined. We investigated secular trends in sleep duration over the past 40 years through a systematic review. Systematic search of 5 electronic databases was conducted to identify repeat cross-sectional studies of sleep duration in community-dwelling adults using comparable s ling frames and measures over time. We also attempted to access unpublished or semi-published data sources in the form of government reports, theses and conference proceedings. No studies were excluded based on language or publication date. The search identified 278 potential reports, from which twelve relevant studies were identified for review. The 12 studies described data from 15 countries from the 1960s until the 2000s. Self-reported average sleep duration of adults had increased in 7 countries: Bulgaria, Poland, Canada, France, Britain, Korea and the Netherlands (range: 0.1-1.7 min per night each year) and had decreased in 6 countries: Japan, Russia, Finland, Germany, Belgium and Austria (range: 0.1-0.6 min per night each year). Inconsistent results were found for the United States and Sweden. There has not been a consistent decrease in the self-reported sleep duration of adults from the 1960s to 2000s. However, it is unclear whether the proportions of very short and very long sleepers have increased over the same period, which may be of greater relevance for public health.
The conduct of Australian Indigenous primary health care research focusing on social and emotional wellbeing: a systematic review
Publisher: The Sax Institute
Date: 2018
Abstract: Objectives and importance of study: Values and ethics: guidelines for ethical conduct in Aboriginal and Torres Strait Islander health research (Values and ethics) describes key values that should underpin Aboriginal and Torres Strait Islander (Indigenous)-focused health research. It is unclear how research teams address this document in primary health care research. We systematically review the primary health care literature focusing on Indigenous social and emotional wellbeing (SEWB) to identify how Values and ethics and community preferences for standards of behaviour (local protocols) are addressed during research. Systematic review in accordance with PRISMA Guidelines and MOOSE Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies. We searched four databases and one Indigenous-specific website for qualitative, quantitative and mixed-method studies published since Values and ethics was implemented (2003). Included studies were conducted in primary health care services, focused on Indigenous SEWB and were conducted by research teams. Using standard data extraction forms, we identified actions taken (reported by authors or identified by us) relating to Values and ethics and local protocols. A total of 25 studies were included. Authors of two studies explicitly mentioned the Values and ethics document, but neither reported how their actions related to the document's values. In more than half the studies, we identified at least three actions relating to the values. Some actions related to multiple values, including use of culturally sensitive research processes and involving Indigenous representatives in the research team. Local protocols were rarely reported. Addressing Values and ethics appears to improve research projects. The academic community should focus on culturally sensitive research processes, relationship building and developing the Indigenous research workforce, to facilitate acceptable research that affects health outcomes. For Values and ethics to achieve its full impact and to improve learning between research teams, authors should be encouraged to report how the principles are addressed during research, including barriers and enablers that are encountered.
Personalized Help-Seeking Web Application for Chinese-Speaking International University Students: Development and Usability Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 31-01-2022
Abstract: he mental health of international students is a growing concern for education providers, students, and their families. Chinese international students have low rates of help seeking owing to language, stigma, and mental health literacy barriers. Web-based help-seeking interventions may improve the rate of help seeking among Chinese international students. his study aimed to describe the development of a mental well-being web app providing personalized feedback and tailored psychoeducation and resources to support help seeking among international university students whose first language is Chinese and test the web application’s uptake and engagement. he bilingual i MindYourHead web application /i contains 6 in-app assessments for various areas of mental health, and users are provided with personalized feedback on symptom severity, psychoeducation tailored to the person’s symptoms and information about relevant interventions, and tailored links to external resources and mental health services. A feasibility study was conducted within a school at the University of Sydney to examine the uptake and engagement of the web application among Chinese international students and any demographic characteristics or help-seeking attitudes or intentions that were associated with its engagement. total of 130 Chinese international students signed up on the web application. There was an uptake of 13.4% (122/908) in the schools’ Chinese student enrollment. Most participants (76/130, 58.5%) preferred to use the web application in Chinese and used informal but not formal help for their mental health. There was considerable attrition owing to a design issue, and only 46 students gained access to the full content of the web application. Of these, 67% (31/46) of participants completed 1 or more of the in-app mental well-being assessments. The most commonly engaged in-app assessments were distress (23/31, 74%), stress (17/31, 55%), and sleep (15/31, 48%), with the majority scoring within the moderate- or high-risk level of the score range. In total, 10% (9/81) of the completed in-app assessments led to clicks to external resources or services. No demographic or help-seeking intentions or attitudes were associated with web-application engagement. here were promising levels of demand, uptake, and engagement with the i MindYourHead /i web application. The web application appears to attract students who wished to access mental health information in their native language, those who had poor mental health in the past but relied on informal support, and those who were at moderate or high risk of poor mental well-being. Further research is required to explore ways to improve uptake and engagement and to test the efficacy of the web application on Chinese international students’ mental health literacy, stigma, and help seeking.
Obesity and sickness absence: results from the CHAP study
Publisher: Oxford University Press (OUP)
Date: 22-03-2010
Abstract: Obesity is an increasing public health problem. A small number of studies have examined the relationship between obesity and sickness absence, with mixed results, particularly regarding short-term sickness absence. To determine if obesity is associated with short- and long-term sickness absence and to investigate the mechanisms that may underlie any association. Cross-sectional (n = 1489) and prospective (n = 625) analyses were conducted on staff from London Underground Ltd. All participants underwent regular clinical examinations that involved their height and weight being measured, obesity-related medical problems being diagnosed and psychiatric disorders being identified. The number of days taken for short- (<10 days in an episode) and long-term sickness absence were recorded by managers on an electronic database. There was a positive linear association between employees' body mass index (BMI) and the number of days' work missed due to sickness absence on both cross-sectional and prospective analyses (P < 0.001). Obesity was a risk factor for both short- and long-term sickness absence. Obese in iduals typically took an extra 4 days sick leave every year. The majority of the increased risk for long-term sickness absence appeared to be mediated via co-morbid chronic medical conditions. The excess short-term sickness absence was not explained by obesity-related medical problems, psychiatric disorders or workplace factors. Obese employees take significantly more short- and long-term sickness absence than workers of a healthy weight. There is growing evidence to support employers becoming more involved in tackling obesity.
Examining Internet and eHealth Practices and Preferences: Survey Study of Australian Older Adults With Subjective Memory Complaints, Mild Cognitive Impairment, or Dementia
Publisher: JMIR Publications Inc.
Date: 25-10-2017
DOI: 10.2196/JMIR.7981
A Cluster Randomized Controlled Trial to Evaluate Headcoach: An Online Mental Health Training Program for Workplace Managers.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2019
Severe mental illness and work: What can we do to maximise the employment opportunities for individuals with psychosis?
Publisher: SAGE Publications
Date: 11-02-2013
Process evaluation of the Getting it Right study and acceptability and feasibility of screening for depression with the aPHQ-9
Publisher: Springer Science and Business Media LLC
Date: 18-09-2019
DOI: 10.1186/S12889-019-7569-4
Abstract: The Getting it Right study determined the validity, sensitivity, specificity and acceptability of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) people. In this process evaluation we aimed to explore staff perceptions about whether Getting it Right was conducted per protocol, and if the aPHQ-9 was considered an acceptable and feasible screening tool for depression in primary healthcare. This process evaluation will provide information for clinicians and policy makers about the experiences of staff and patients with Getting it Right and what they thought about using the aPHQ-9. Process evaluation using grounded theory approaches. Semi-structured interviews with primary healthcare staff from services participating in Getting it Right were triangulated with feedback (free-text and elicited) from participants collected during the validation study and field notes. Data were thematically analysed according to the Getting it Right study protocol to identify the acceptability and feasibility of the aPHQ-9. Primary healthcare staff ( n = 36) and community members ( n = 4) from nine of the ten participating Getting it Right services and Indigenous participants ( n = 500) from the ten services that took part. Most staff reported that the research was conducted according to the study protocol. Staff from two services reported sometimes recruiting opportunistically (rather than recruiting consecutive patients attending the service as outlined in the main study protocol), when they spoke to patients who they knew from previous interactions, because they perceived their previous relationship may increase the likelihood of patients participating. All Getting it Right participants responded to at least six of the seven feedback questions and 20% provided free-text feedback. Most staff said they would use the aPHQ-9 and most participants said that the questions were easy to understand (87%), the response categories made sense (89%) and that they felt comfortable answering the questions (91%). Getting it Right was predominantly conducted according to the study protocol. The aPHQ-9, the first culturally adapted, nationally validated, freely available depression screening tool for use by Indigenous people, appears to be acceptable and feasible to use. Australian New Zealand Clinical Trial Registry ANZCTR12614000705684 , 03/07/2014.
Daily steps and diet, but not sleep, are related to mortality in older Australians
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.JSAMS.2019.09.018
Abstract: Supporting healthy ageing is a key priority worldwide. Physical activity, diet quality and sleep are all associated with health outcomes, but few studies have explored their independent associations with all-cause mortality in an older population in the same model. The study aim was to examine associations between step-count, self-reported diet quality, restless sleep, and all-cause mortality in adults aged 55-85 years. A prospective cohort study of adults in Newcastle, New South Wales, Australia. Data were from 1697 participants (49.3% women baseline mean age 65.4 ± 7.1 years). Daily steps (measured by pedometer), diet quality (from a modified Australian Recommended Food Score), and frequency of restless sleep (by self-report) were assessed in relation to all-cause mortality using Cox proportional hazard regression with adjustment for sex, age, household income and smoking. Baseline data were collected between January 2005 and April 2008, and last follow-up was in March 2017 (median follow-up 9.6 years). Higher step count (HR: 0.93, 95%CI: 0.88-0.98 per 1000-step increment) and higher diet quality (HR: 0.86, 95%CI: 0.74-0.99 per 8-point increment in diet quality score) were associated with reduced mortality risk. Restless sleep for ≥3 nights/week was not associated with mortality risk (HR: 1.03, 95%CI: 0.78-1.39). Sensitivity analyses, adjusting for chronic disease and excluding deaths <1 year after baseline, did not change these estimates. Increased daily steps and consumption of a greater variety of nutrient-dense foods every week would result in substantial health benefits for older people. Future research should include a greater variety of sleep measures.
Natural disaster and risk preferences: evidence from Sri Lankan twins
Publisher: Informa UK Limited
Date: 26-01-2023
Intraindividual variability in sleep among people with insomnia and its relationship with sleep, health and lifestyle factors: an exploratory study
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.SLEEP.2021.12.006
Abstract: To explore associations between intrain idual variability (IIV) in sleep patterns and sleep problems, lifestyle factors, and mental and physical health in in iduals with chronic insomnia. Cross-sectional study of 1720 adults with chronic insomnia (67.8% female, mean age = 44.5) who completed online self-report questionnaires and kept a sleep diary (for at least 10 out of 14 days). Linear regression analyses examined IIV in sleep patterns as independent variables, and sleep problems, lifestyle factors, and mental and physical health outcomes as dependent variables. Analysis of each sleep variable was separately adjusted for the mean value of the corresponding variable and for selected background factors. IIV in sleep variables was significantly and positively associated with scores on the Insomnia Severity Index (ISI), dysfunctional beliefs and attitudes about sleep (DBAS-16), the Chalder Fatigue Scale (CFQ), body mass index (BMI) and alcohol consumption (AUDIT-C) at study entry. The association between IIV and mental health outcomes (ie the Hospital Anxiety and Depression Scale [HADS] and subjectively reported mental health status [SF-12 Mental health]) were not significant. IIV was associated with higher (ie more positively rated) mean level of sleep quality. IIV of sleep patterns may be a useful construct for understanding subjective experiences of sleep problems, fatigue and health in people with chronic insomnia. Our findings support notions suggesting that IIV offers additional insights beyond those offered by studying mean values alone however, discordant findings regarding sleep quality highlight the need for further studies to examine the consequences of IIV.
Obstructive sleep apnea and depression
Publisher: Elsevier BV
Date: 12-2009
DOI: 10.1016/J.SMRV.2009.04.001
Abstract: There are high rates of depression in people with obstructive sleep apnea (OSA) in both community and clinical populations. A large community study reported a rate of 17% and reports for sleep clinic s les range between 21% and 41%. A large cohort study found OSA to be a risk factor for depression, but we are unaware of any longitudinal study of the reverse association. However correlations have not generally been found in smaller studies. Well-designed longitudinal studies are needed to examine temporal relationships between the two conditions and further research is needed to establish the role of confounders, and effect modifiers such as gender, in any apparent relationship. Symptoms common to OSA and depression, such as sleepiness and fatigue, are obstacles to determining the presence and severity of one condition in the presence of the other, in research and clinically. Sleep clinicians are advised to consider depression as a likely cause of sleepiness and fatigue. Several possible causal mechanisms linking OSA and depression have been proposed but not established. Patients who have depression as well as OSA appear worse off than those with OSA only, and depressive symptoms persist in at least some patients in short term studies of treatment for OSA. Direct treatment of depression in OSA might improve acceptance of therapy, reduce sleepiness and fatigue and improve quality of life, but intervention trials are required to answer this question.
Long term sickness absence.
Publisher: BMJ
Date: 07-04-2005
Course and impact of sleep disturbance in newly diagnosed epilepsy: A prospective registry study
Publisher: Elsevier BV
Date: 08-2020
A Population-Based Cohort Study of the Effect of Common Mental Disorders on Disability Pension Awards
Publisher: American Psychiatric Association Publishing
Date: 08-2006
DOI: 10.1176/AJP.2006.163.8.1412
Abstract: Mental illness is consistently underrecognized in general health care, which may lead to underestimation of its effects on awards for social security payments. The authors investigated empirically the contribution of psychiatric morbidity to the award of disability pensions, in particular those awarded for physical diagnoses. Using a historical cohort design, the authors utilized a unique link between a large epidemiological cohort study and a comprehensive national database. Baseline information on mental and physical health was gathered from a 1995-1997 population-based health study of those of working age (20-66 years) in Nord-Trøndelag County, Norway, who were not recipients of disability pension (N=45,782). The outcome assessed was the awarding of disability pensions ascribed to specific ICD-10 diagnoses within 6 to 30 months as registered in the National Insurance Administration. Anxiety and depression were robust predictors of disability pension awards in general, even when disability pensions awarded for any mental disorder were excluded. These effects were only partly explained by baseline somatic symptoms and diagnoses and were stronger in in iduals aged 20-44 than in those aged 45-66. Somatic symptoms accounted for far more disability pension awards than did somatic diagnoses. The cost of common mental disorders in terms of disability pensions and lost productivity may have been considerably underestimated by official statistics, particularly for younger claimants. The results suggest this might be due both to overuse of physical diagnoses and underrecognition of common mental disorders in primary care.
Erratum to: A prospective cohort study of depression course, functional disability, and NEET status in help-seeking young adults
Publisher: Springer Science and Business Media LLC
Date: 07-02-2017
Research on adults with autism spectrum disorder: Roundtable report
Publisher: Informa UK Limited
Date: 30-07-2015
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Imperial College London
Location: United Kingdom of Great Britain and Northern Ireland
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London School Of Economics
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University Of Oxford
Location: United Kingdom of Great Britain and Northern Ireland
University Of London
Location: United Kingdom of Great Britain and Northern Ireland
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