A prospective study of the impact of floods on the mental and physical health of older adults.

OBJECTIVES: With a longitudinal prospective design, we examined the impact of floods on the mental and physical health of older adults and explored risk and protective factors. METHOD: Two hundred and seventy four older adults (age ≥60) completed surveys before and after a flood event. Both the surveys included measures of anxiety, depression, self-reported health, and satisfaction with life; the post-flood survey also included questionnaires on flood experience, symptoms of post-traumatic stress disorder (PTSD), stoicism, and psychological coping with floods. RESULTS: Compared to those not personally affected (78.8%), personally affected individuals (21.2%) reported significantly higher PTSD symptoms, with about one in six reporting PTSD symptoms that might require clinical attention. Personally affected individuals also reported a greater increase in anxiety post-flood, but changes in their depressive symptoms and self-reported health were not significantly different from those not personally affected. Greater flood exposure and the lack of social support were the risk factors for poorer mental and physical health. Higher stoicism was associated with higher post-flood depression and poorer self-reported mental health. The use of maladaptive coping, such as venting and distraction, was associated with greater deterioration in mental health after floods, whilst emotion-focused coping such as acceptance, positive reframing, and humour, was protective against such deterioration. CONCLUSION: Floods had adverse psychological impacts on some older adults who were personally affected. Despite the evidence of resilience, a small proportion of older adults experienced significant difficulties after the floods. The findings in this study help understand older adults' psychological responses to disasters and have practical implications for service planning and delivery.

Psychiatric morbidity in gynecological outpatients.

AIM: To assess the prevalence of depression and anxiety in women presenting with gynecological symptoms, to determine how many women with these disorders were receiving treatment for them, and to investigate risk factors for these disorders. METHOD: Two hundred and sixty-four women seeking medical care from gynecology clinics at a specialist women's hospital completed a self-report questionnaire asking about sociodemographics, physical and mental health, personality (neuroticism) and psychosocial stressors. RESULTS: A total of 91 women met the diagnostic criteria for one or more Patient Health Questionnaire (PHQ) diagnosis. Forty-six (17.4%) met criteria for major depressive disorder (MDD), 15 (5.7%) for panic disorder (PD) and 73 (27.7%) for generalized anxiety disorder (GAD). Thirty-nine (42.9%) of the 91 women met criteria for two or more disorders. An additional 23 (8.7%) met DSM-IV-TR criteria for minor (sub-threshold) depression. Fifty percent with MDD, 4% with minor depression, 53% with PD and 22% with GAD reported they were receiving treatment. Psychosocial stressors and the neuroticism score were risk factors for both anxiety and depression. CONCLUSIONS: Anxiety and depression are common amongst women attending a gynecology clinic. Clinicians should be alert to the possibility of these disorders and make specific enquiries about their emotional wellbeing.

Long-term psychological morbidity, sexual functioning, and relationship outcomes in women with gestational trophoblastic disease.

OBJECTIVE: Clinical observation suggests a protracted psychosocial recovery after gestational trophoblastic disease (GTD), although this has not been well studied. We describe long-term psychological morbidity, sexual functioning, and relationship outcomes after GTD. MATERIALS AND METHODS: Cross-sectional analysis was made of 176 Australian women previously diagnosed with GTD recruited from a statewide registry. Participants comprised 149 women (85%) who did not require chemotherapy and 27 women (15%) who required chemotherapy for malignant or persistent GTD/molar disease (gestational trophoblastic tumor [GTT]). Data were collected from medical records and via validated self-report questionnaires. RESULTS: The participants were 94 women (53%) with partial mole, 75 women (43%) with complete mole, 4 women (2%) with choriocarcinoma, and 3 women (2%) with hydatidiform mole not otherwise specified. The mean (SD) age at diagnosis and time since diagnosis were 32.1 (6.3) and 4.7 (3.3) years, respectively. Elevated levels of depression and anxiety were reported by 22% and 26% of the women, respectively. One fifth to half of the women experienced some GTD-related avoidant and intrusive phenomena, the latter being more prominent among women who had not had chemotherapy. Sexual dysfunction was reported by 52% of the women. Most women (81%) felt well supported by their partners during the illness, 19% thought the relationship had changed, and 26% perceived that GTD had negatively affected sex life. This perception was stronger in those who received chemotherapy, although objective measures of sexual morbidity showed no group differences. Socially disadvantaged women and those who did not conceive subsequent to the diagnosis had poorer psychosocial outcomes. CONCLUSIONS: Notwithstanding limitations, this study is the largest of its type to date. Psychological morbidity rates exceeded community norms, but sexual dysfunction rates, although high, are likely consistent with local norms. These findings highlight the long-term burden of GTD and the importance of a supportive care component in management, even among those who do not require chemotherapy. Socially disadvantaged women and those who do not conceive subsequent to GTD diagnosis require greater psychosocial support.

The Early Motherhood Service: an acceptable and accessible perinatal mental health service.

OBJECTIVES: The aims of this paper are to quantify the effect of an innovative perinatal mental health program, the Early Motherhood Service, to identify factors contributing to its success, and to make recommendations as to its general applicability across other rural services. METHOD: The study involved stakeholder evaluation, analysis of available outcome data and analysis of consumer feedback data. RESULTS: Service functions were grouped into four key areas: increasing awareness of perinatal mental health problems; providing information and advice; providing treatment and support; and education, training and capacity building. Women accessing the service showed significant improvement in outcomes as measured by change over time in the Edinburgh Postnatal Depression Scale and the Health of the Nation Outcome Scale. Consumer feedback demonstrated that the service was highly valued. Key factors identified as contributing to the service's success were broad coverage of perinatal mental health problems; inclusion of early intervention and prevention; outreach capacity; partnership with, support for and capacity building of other health providers; a location which is accessible and non-stigmatizing; and staff comprising senior and skilled clinicians. CONCLUSIONS: The Early Motherhood Service is an innovative perinatal mental health service. It provides a useful model for the development of such services in rural communities.