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1.
Int J Eat Disord ; 57(2): 423-436, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38149436

RESUMO

OBJECTIVE: To investigate the acceptability, feasibility, and preliminary effectiveness of "SupportED," a novel, online, self-paced skills-based program for carers/support people of those with lived and/or living experience of an eating disorder (ED). METHOD: Carers of a loved one with an ED were invited to undertake a five-module skills-based (one core module, four optional modules) online program at their own pace. Modules cover general information about EDs, communication, practical skills, treatment engagement, and recovery. Participants completed demographics and were assessed using EDSIS, CASK, and DASS-21 for caregiver burden, skills, and distress, respectively, at program completion and 3-month follow-up. Feedback on the program and modules was also collected. RESULTS: Most carers (65%; 82/126) completed the core module of the program, which is on par with other online learning programs. Nearly half of program completers responded to the 3-month follow-up (n = 39). On average, carers rated the program as relevant and useful and found the information validating and easy to understand, albeit a few carers found the program time-consuming and technically challenging. Intent-to-treat (ITT) linear mixed models demonstrated the preliminary effectiveness of the program for improving carer burden and skills, although the change in carer distress was non-significant. CONCLUSIONS: Results of this case series evaluation suggest SupportED is an acceptable and feasible program for carers and may improve burden and support skill development. Although the online, self-paced format was highly rated, small improvements to improve acceptability were suggested. Reasons for a lack of impact on carer distress are discussed. PUBLIC SIGNIFICANCE: This article describes a case series evaluation of "SupportED," an online skills-based support program for families, carers, and supporters of people with lived experience of an eating disorder. This is the first online carer support program that is designed to be inclusive of all carer types (e.g., partners, siblings) for all eating disorder presentations. Findings suggest the program's suitability and helpfulness for reducing carers' load and bolstering skills and knowledge.


Assuntos
Cuidadores , Transtornos da Alimentação e da Ingestão de Alimentos , Humanos , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Comportamentos Relacionados com a Saúde , Inquéritos e Questionários , Intenção
2.
Med Educ ; 58(3): 338-353, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-37709343

RESUMO

CONTEXT: Western mental healthcare system reforms prioritise person-centred care and require clinicians to adjust their professional positions. Realising these reforms will necessitate clinicians-including clinical psychologists-acquiring professional identities that align with them. Learners develop professional identities through socialisation activities: within interactional spaces such as supervision learners come to understand the self (clinician) and, by extension, the other (client). A clinician's understanding of who I am is intertwined with an understanding of who they are. Our study offers a moment-by-moment examination of supervision interactions of clinical psychology trainees to illuminate processes through which the identities of therapists and clients are constructed. AIM: We examined how clinical psychology trainees and supervisors construct identities for themselves and clients in supervision. METHODS: We used positioning analysis to explore identity construction during interactions between supervisors (n = 4) and trainees (n = 12) in a clinical psychology training clinic. Positioning analysis focuses on the linguistic choices participants make as they position themselves (and others) in certain social spaces during everyday interactions. Twelve supervision sessions were audio recorded and transcribed. We found that clients were frequently positioned as fragile and subsequently analysed these sequences (n = 12). RESULTS: Clients' identities were constructed as fragile, which co-occurred with clinical psychologists' claiming positions as responsible for managing their distress. Supervisors played an active role in linguistically positioning clients and trainees in this way. Trainees rarely contested the identities made available to them by supervisors. DISCUSSION AND CONCLUSION: We suggest that linguistically positioning clients as fragile perpetuates paternalistic clinical discourses that do not align with mental healthcare reform priorities. We make visible how this is achieved interactionally through language and influenced by organisational power relations. Intentional efforts are required to support the professional identity construction of clinical psychologists in ways that do not perpetuate paternalism. We offer recommendations for education and clinical practice to support these efforts.


Assuntos
Serviços de Saúde Mental , Psicologia Clínica , Humanos , Psicologia Clínica/educação , Autoimagem
3.
Med Educ ; 57(7): 612-626, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-36922739

RESUMO

INTRODUCTION: Our professional identity refers to our sense of who we are and how we should behave as professionals. Professional identities are developed through socialisation processes: Established ways of knowing and doing are acquired and reproduced. The professional identities of health care professionals have implications for the realisation of health care reforms that require new ways of being and doing from clinicians. Tension and frustration can arise when professional identities are incongruent with reform directions. More knowledge is required about the professional identities of mental health care professionals-including clinical psychologists-so that they can be supported to develop professional identities that align with health care system reforms. METHOD: We undertook a scoping review of existing literature aiming to (i) identify the relevant literature; (ii) review the literature quality; (iii) thematically summarise the literature findings; (iv) consult with clinical psychologists; and (v) identify recommendations for research, training and practice. RESULTS: A systematic database search (PsycINFO, CINAHL, Scopus and Web of Science) identified 24 relevant published articles and dissertations. Quantitative studies were excluded due to their markedly different research focus. Included studies were independently reviewed and findings summarised. Findings were organised around three themes: 'integration of personal and professional identities', 'intersectionality' and 'changes in professional identity over time'. Research quality issues were identified. The trustworthiness of the findings was corroborated in consultation with clinical psychologists. DISCUSSION: Clinical psychologists recognise their professional identities as being interrelated with their personal identities and changing over time. They recognised professional identity as important yet inadequately considered in the profession. The research area is emerging yet remains undertheorised and requires improved research methodologies. Future theoretically informed research is required to build up a credible research base to better understand the development of clinical psychologists' professional identities so that this process can be facilitated to enable the realisation of health care reforms.


Assuntos
Pessoal de Saúde , Identificação Social , Humanos , Atenção à Saúde , Autoimagem
4.
BMC Med Inform Decis Mak ; 23(1): 65, 2023 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-37024880

RESUMO

BACKGROUND: Despite high rates of mental health disorders among cancer patients, uptake of referral to psycho-oncology services remains low. This study aims to develop and seek clinician and patient feedback on a patient decision aid (PDA) for cancer patients making decisions about treatment for anxiety and/or depression. METHODS: Development was informed by the International Patient Decision Aid Standards and the Ottawa Decision Support Framework. Psycho-oncology professionals provided feedback on the clinical accuracy, acceptability, and usability of a prototype PDA. Cognitive interviews with 21 cancer patients/survivors assessed comprehensibility, acceptability, and usefulness. Interviews were thematically analysed using Framework Analysis. RESULTS: Clinicians and patients strongly endorsed the PDA. Clinicians suggested minor amendments to improve clarity and increase engagement. Patient feedback focused on clarifying the purpose of the PDA and improving the clarity of the values clarification exercises (VCEs). CONCLUSIONS: The PDA, the first of its kind for psycho-oncology, was acceptable to clinicians and patients. Valuable feedback was obtained for the revision of the PDA and VCEs.


Assuntos
Tomada de Decisões , Neoplasias , Humanos , Técnicas de Apoio para a Decisão , Depressão/terapia , Neoplasias/terapia , Ansiedade/terapia , Participação do Paciente
5.
Eur Child Adolesc Psychiatry ; 32(1): 53-62, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34046746

RESUMO

The objectives of this study are to assess the association between childhood bullying and preference-based health-related quality of life (QoL) in Australian school children and their parents and estimate quality-adjusted life years (QALYs) associated with bullying chronicity. Children aged 8-10 years completed the child health utilities (CHU-9D), while parents completed the Australian quality of life (AQoL-8D). Children were grouped into four categories of bullying involvement (no bullying, victim, perpetrator, or both perpetrator and victim) based on the Revised Olweus Bully/Victim Questionnaire. Parental data were compared across two bullying involvement groups (bullying vs. no bullying). QALYs were calculated for children over two years and comparisons made based on the number of assessments where bullying was reported (baseline, 1- and 2-year follow up). Children who were involved in bullying (victims and/or perpetrators) reported statistically significantly lower mean utility scores compared to children who were not involved in bullying. Parents whose child was involved in bullying had significantly lower mean utility scores compared to parents of children not involved with bullying. There appeared to be a dose-response relationship, with higher QALY losses associated with increasing frequency of reported bullying. Bullying among Australian school children was associated with significantly lower preference-based QoL for themselves and their parents. This study also confirmed the significant burden of disease for bullying among children measured by an incremental decrease in QALY with an increasing chronicity of bullying over time.


Assuntos
Bullying , Vítimas de Crime , Humanos , Criança , Qualidade de Vida , Austrália , Grupo Social
6.
Death Stud ; 46(2): 257-279, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-31809665

RESUMO

Recent research suggests that the transdiagnostic construct of death anxiety may be a basic fear underlying a range of anxiety disorders. Although the investigation of death anxiety in clinical populations is relatively recent, the death anxiety literature as a whole has a longer history evidenced by the number of instruments developed to measure this construct. This systematic review aimed to evaluate the evidence supporting the psychometric properties of self-report death anxiety measures. Relevant studies were identified via a systematic search of four electronic databases in addition to reference list searches. Two independent reviewers evaluated relevant studies using the established Terwee et al. quality appraisal tool. Of the 1831 studies identified, 89 met inclusion criteria. These studies investigated the psychometric properties of 21 self-report scales of death anxiety as well as six subscales. No measure was found to possess evidence of adequacy on all evaluated quality criteria. The Templer Death Anxiety Scale, Concerns about Dying Instrument and Death Concern Scale were found to possess the most evidence supporting their validity and reliability. Overall findings suggest that additional research is needed to establish the psychometric adequacy of death anxiety instruments, especially given increased utilization of these measures in both clinical and research settings.


Assuntos
Transtornos de Ansiedade , Ansiedade , Ansiedade/diagnóstico , Humanos , Psicometria , Reprodutibilidade dos Testes , Autorrelato
7.
Behav Cogn Psychother ; 50(6): 590-603, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36093926

RESUMO

BACKGROUND: Peer victimization and anxiety frequently co-occur and result in adverse outcomes in youth. Cognitive behavioural treatment is effective for anxiety and may also decrease children's vulnerability to victimization. AIMS: This study aims to examine peer victimization in youth who have presented to clinical services seeking treatment for anxiety. METHOD: Following a retrospective review of clinical research data collected within a specialized service, peer victimization was examined in 261 children and adolescents (55.6% male, mean age 10.6 years, SD = 2.83, range 6-17 years) with a diagnosed anxiety disorder who presented for cognitive behavioural treatment. Youth and their parents completed assessments of victimization, friendships, anxiety symptoms, and externalizing problems. RESULTS: High levels of victimization in this sample were reported. Children's positive perceptions of their friendships were related to lower risk of relational victimization, while conduct problems were related to an increased risk of verbal and physical victimization. A subsample of these participants (n = 112, 57.1% male, mean age 10.9 years, SD = 2.89, range 6-17 years) had completed group-based cognitive behavioural treatment for their anxiety disorder. Treatment was associated with reductions in both self-reported anxiety and victimization. Results confirm the role of friendships and externalizing symptoms as factors associated with increased risk of victimization in youth with an anxiety disorder in a treatment-seeking sample. CONCLUSIONS: Treatment for anxiety, whether in a clinic or school setting, may provide one pathway to care for young people who are victimized, as well as playing a role in preventing or reducing victimization.


Assuntos
Bullying , Vítimas de Crime , Adolescente , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Bullying/psicologia , Criança , Cognição , Vítimas de Crime/psicologia , Feminino , Humanos , Masculino , Grupo Associado
8.
Australas Psychiatry ; 29(4): 446-449, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33626307

RESUMO

OBJECTIVE: Clinical psychologists are practitioners with expertise in mental health, who apply advanced psychological theory and knowledge to their practice in order to assess and treat complex psychological disorders. Given their robust specialised mental health training, clinical psychology is an integral component of the Australian mental health workforce, but is under-utilised. Recent reviews have identified significant problems with Australia's mental health system, including unequal access to clinical psychology services and fragmentation of service delivery, including convoluted pathways to care. CONCLUSIONS: Clinical psychology is well placed to contribute meaningfully to public mental health services (PMHS). We describe what clinical psychologists currently contribute to team-based care in PMHS, how we could further contribute and the barriers to making more extensive contributions. We identify significant historical and organisational factors that have limited the contribution made by clinical psychologists and provide suggestions for cultural change to PMHS.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Psicologia Clínica , Austrália , Humanos , Transtornos Mentais/terapia , Psicologia , Recursos Humanos
9.
Aggress Behav ; 46(3): 193-209, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32064639

RESUMO

Despite the extensive evaluation of school-based interventions for bullying, victimization remains a significant problem in schools. Bullying victimization is significantly predicted by contextual (school-related) factors. As a consequence whole-school programs have been commonly used to prevent and reduce bullying victimization. Evidence also points to individual risk factors (such as emotional distress) in predicting victimization, yet programs to prevent bullying victimization by changing these individual risks are far less developed. Few studies have approximated "real-world" implementation conditions in their trials. The current effectiveness trial evaluated the combination of a whole-school program designed to prevent bullying perpetration and victimization together with a targeted intervention for at-risk students, teaching them individual and dyadic strategies to reduce their anxiety and manage victimization, allowing schools some latitude to implement programs as they typically would. Students from Grades 3 and 4 (N = 8,732) across 135 schools were randomly assigned to one of four conditions: combined intervention; whole-school intervention only; individual intervention only; and care as usual. Victimization decreased significantly and similarly across all four conditions at 12 and 24 months following baseline. Similar reductions and failure to discriminate conditions were found on other key constructs: anxiety; bullying perpetration; and depression. Possible reasons for the failure to demonstrate victimization prevention differences and lessons learned from this large, effectiveness trial are considered.


Assuntos
Agressão/psicologia , Bullying/prevenção & controle , Bullying/psicologia , Vítimas de Crime/psicologia , Estudantes/psicologia , Bullying/estatística & dados numéricos , Humanos , Avaliação de Programas e Projetos de Saúde , Instituições Acadêmicas , Estudantes/estatística & dados numéricos
10.
Epilepsia ; 60(10): 2068-2077, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31560136

RESUMO

OBJECTIVE: The study objective was to develop and validate the first epilepsy-specific anxiety survey instrument (Epilepsy Anxiety Survey Instrument [EASI]) alongside a briefer screening instrument to detect anxiety disorders in routine clinical practice (brEASI). METHODS: The instruments were developed utilizing a mixed-methods approach in four related studies. Pilot items were developed following qualitative interviews with people with epilepsy (PWE; Study 1) and consultation with multidisciplinary experts in anxiety and epilepsy (Study 2). PWE (n = 314) then completed pilot items alongside existing measures of anxiety and depression (Study 3). Factor analysis was conducted to refine the scale and select well-performing items for a briefer diagnostic screener (brEASI). The brEASI was validated against a gold standard diagnostic interview in 106 PWE recruited from an outpatient epilepsy service (Study 4). Receiver operating characteristic analysis was conducted to determine the brEASI's diagnostic performance. RESULTS: Twenty-six pilot items were generated based on the findings of Studies 1 and 2. Analyses in Study 3 resulted in an 18-item EASI, and eight well-performing items were selected for the brEASI. The area under the curve (AUC) of brEASI was excellent (AUC = 0.89, 95% confidence interval = 0.82-0.94). At a cutoff of 7, it demonstrated a sensitivity of 76% and specificity of 84% for identifying Diagnostic and Statistical Manual of Mental Disorders, 5th edition anxiety disorders. SIGNIFICANCE: The EASI and brEASI represent the first valid and reliable epilepsy-specific anxiety instruments. The EASI has been designed to comprehensively assess anxiety in PWE, whereas the brEASI may be used within busy neurology settings to provide rapid information to aid diagnoses of anxiety disorders. Given the significant prevalence and burden of anxiety in PWE, these tools are important potential solutions to improve the understanding and detection of anxiety in epilepsy.


Assuntos
Transtornos de Ansiedade/diagnóstico , Epilepsia/complicações , Adulto , Transtornos de Ansiedade/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
12.
J Adolesc ; 73: 26-35, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30953842

RESUMO

INTRODUCTION: Parental behavioural control is believed to be beneficial for young children. However, with increased need for independence during adolescence, parental rules may undermine self-beliefs. METHODS: The current study examined the effect of behavioural control, plus parental support and psychological control, on the self-esteem and self-criticism of 243 Australian adolescents (mean age = 12.08, 52% female) over two years. RESULTS: Behavioural control largely did not predict self-esteem. Furthermore, in girls it predicted higher self-criticism 12 and 24 months later. Behavioural control does not appear to benefit adolescents' self-cognitions and, in fact, increases self-criticism in girls. CONCLUSIONS: By providing copious rules around appropriate behaviours, parents may possibly indicate to girls that they are not capable of becoming independent, thus reducing feelings of competence.


Assuntos
Relações Pais-Filho , Autoimagem , Autoavaliação (Psicologia) , Adolescente , Comportamento do Adolescente/psicologia , Austrália , Criança , Feminino , Humanos , Masculino , Fatores Sexuais , Inquéritos e Questionários
13.
Aggress Behav ; 45(4): 450-462, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30900277

RESUMO

Over the last several years, researchers have become increasingly interested in the influence of moral factors on bullying behaviors. This is the first meta-analytic review to exclusively examine the relationship between moral disengagement (MD) and the key bullying roles of bully, victim, defender, and bystander. Forty-seven independent samples examining a total of 43,809 children/adolescents (aged 7-19) were included in this meta-analysis. Results indicated a positive relationship between MD and bullying (r = 0.31; 95% CI [0.27, 0.34]), MD and victimization (r = 0.08; 95% CI [0.05, 0.12]), and a negative relationship between MD and defending (r = -0.11; 95% CI [-0.17, -0.04]). No significant relationship was found for MD and bystanding behavior. Moderators of bullying type (traditional vs. cyberbullying), reporting type (self vs. peer report), age, and gender were included in the analyses. The results are discussed in the context of relevant literature with particular emphasis on the importance of distinguishing between guilty and unconcerned bystanders, and the significant overlap between bullying and victimization in the cyber context.


Assuntos
Agressão/psicologia , Bullying/psicologia , Vítimas de Crime/psicologia , Princípios Morais , Estudantes/psicologia , Adolescente , Comportamento do Adolescente/psicologia , Criança , Comportamento Infantil/psicologia , Feminino , Humanos , Masculino , Grupo Associado , Autoeficácia , Comportamento Social
14.
Eur Child Adolesc Psychiatry ; 27(7): 823-837, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28936622

RESUMO

This meta-analysis aimed to update existing data on the comparison of prevalence rates of psychopathology primarily among offspring with at least one parent with bipolar disorder (BD) and offspring of parents without psychiatric illness. Seventeen studies were derived from a systematic search of PsychInfo, Medline, Scopus and Embase. Inclusion criteria were use of a control offspring group, standardized diagnostic procedures and reporting of clear frequency data. Risk of psychopathology was estimated by aggregating frequency data from selected studies. Compared to control offspring, high-risk BD offspring are nine times more likely to have a bipolar-type disorder, almost two and a half times more likely to develop a non-BD affective disorder and over two times more likely to develop at least one anxiety disorder. High-risk offspring also showed a significant increased risk of other non-mood psychopathology such as attention deficit hyperactivity disorder (ADHD), any type of behavioral disorder and substance use disorder (SUDs). Risk of developing a broad range of affective and non-affective psychopathology is significantly higher in high-risk BD offspring. Identifying clinical presentations of this genetically high-risk cohort is important in establishing appropriate preventative treatment.


Assuntos
Transtorno Bipolar/psicologia , Psicopatologia/métodos , Adolescente , Criança , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Irmãos
15.
Epilepsia ; 58(6): 973-982, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28470748

RESUMO

OBJECTIVE: Comorbid anxiety and depressive disorders in people with epilepsy (PWE) are highly prevalent and associated with various adverse outcomes. However, the prevalence of anxiety disorders in PWE across studies is highly variable. Our aim was to estimate the prevalence and moderating factors of anxiety and depressive disorders in PWE. METHODS: Following prospective registration (PROSPERO; CRD42015027101), electronic databases were searched for studies that reported the prevalence of both anxiety and depressive disorders in samples of PWE up until July 2016. Data extracted included the prevalence of anxiety and depressive disorders, and moderators of interest (e.g., method of diagnosis, prevalence of drug-resistant epilepsy). Meta-analysis of the overall pooled prevalence of anxiety and depressive disorders was conducted. RESULTS: The search yielded 8,636 unique articles, with 27 studies meeting final inclusion criteria (3,221 PWE). The pooled prevalence of anxiety and depressive disorders was 20.2% (95% confidence interval [CI] 15.3-26.0%) and 22.9% (95% CI 18.2-28.4%), respectively. Method of diagnosis significantly moderated anxiety disorder prevalence (Q statistic with one degree of freedom [Q1 ] = 36.29, p < 0.0001); the prevalence of anxiety disorders based on unstructured clinician assessment was 8.1% (95% CI 5.7-11.4%), compared to a prevalence of 27.3% (95% CI 22.1-33.3%) based on a structured clinical interview. There were no significant moderators of depressive disorder diagnosis. SIGNIFICANCE: Findings suggest the prevalence of anxiety and depressive disorders in PWE are equivalent, and variability in prevalence of anxiety disorders across studies can be attributed partly to the method of diagnosis. These findings also challenge widely held assumptions that psychiatric comorbidity is more common in people with drug-resistant epilepsy. Future research should aim to improve the detection and management of these comorbidities in PWE, particularly anxiety disorders, which have remained relatively neglected.


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtorno Depressivo/epidemiologia , Epilepsia/epidemiologia , Transtornos de Ansiedade/diagnóstico , Comorbidade , Estudos Transversais , Transtorno Depressivo/diagnóstico , Epilepsia/diagnóstico , Humanos , Probabilidade , Prognóstico , Estudos de Amostragem
16.
Aggress Behav ; 43(3): 291-303, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27859353

RESUMO

Physical aggression (PA) in the toddler years is common and developmentally normal, however, longitudinal research shows that frequent PA is highly stable and associated with long-term negative outcomes. Significant research has demonstrated the efficacy of parenting interventions for reducing externalizing behavior in children yet their typical length may overburden families, leading to low participation rates and high attrition rates. To increase the reach of parenting interventions and impact on the prevalence of externalizing behavior problems, brief interventions are needed. This RCT compared a standard (8 session) group Triple P to a brief (3 session) discussion group and a waitlist control for reducing toddler PA, dysfunctional parenting and related aspects of parent functioning. Sixty-nine self-referred families of toddlers with PA were randomized to the respective conditions. At post-assessment, families in the standard intervention had significantly lower levels of observed child aversive behavior, mother reports of PA and dysfunctional parenting, and higher levels of mother- and partner-rated behavioral self-efficacy than the waitlist control. Families in the standard intervention also had significantly lower levels mother-rated dysfunctional parenting than the brief intervention, and the brief intervention had significantly lower levels of mother-rated dysfunctional parenting than waitlist. There were no significant group differences at post-assessment for measures of parental negative affect or satisfaction with the partner relationship. By 6 month follow-up, families in the brief and standard intervention did not differ significantly on any measure. The implications of the findings to delivery of brief parenting interventions are discussed. Aggr. Behav. 43:291-303, 2017. © 2016 Wiley Periodicals, Inc.


Assuntos
Agressão/psicologia , Comportamento Infantil/psicologia , Terapia Familiar/métodos , Poder Familiar/psicologia , Comportamento Problema/psicologia , Psicoterapia Breve/métodos , Adulto , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
Bipolar Disord ; 18(5): 389-403, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27530107

RESUMO

OBJECTIVES: To identify clinical characteristics and adverse outcomes associated with an earlier age of onset of bipolar disorder. METHODS: A comprehensive search yielded 15 empirical papers comparing clinical presentation and outcomes in individuals with bipolar disorder grouped according to age of onset (total N=7370). The following variables were examined to determine odds ratios (ORs) and 95% confidence intervals (CIs): presence of Axis I comorbidity, rapid cycling, psychotic symptoms, mixed episodes (DSM-IV), lifetime suicide attempts, lifetime alcohol and substance abuse, symptom severity, and treatment delay. RESULTS: Early age of onset was found to be associated with longer delay to treatment (Hedges' g=0.39, P=.001), greater severity of depression (Hedges' g=0.42, P<.001), and higher levels of comorbid anxiety (OR=2.34, P<.001) and substance use (OR=1.80, P<.001). Surprisingly, no association was found between early age of onset and clinical characteristics such as psychotic symptoms or mixed episodes as defined by DSM-IV. CONCLUSIONS: Earlier age of onset of bipolar disorder is associated with factors that can negatively impact long-term outcomes such as increased comorbidity. However, no association was found between early onset and indicators of severity or treatment resistance such as psychotic symptoms. Clinical features found to have the strongest relationship with early age of onset were those potentially amenable to pharmacological and psychological treatment. Results highlight the importance of early identification and provide potential areas of focus for the development of early intervention in bipolar disorder.


Assuntos
Sintomas Comportamentais/diagnóstico , Transtorno Bipolar , Idade de Início , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/psicologia , Transtorno Bipolar/terapia , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Gerenciamento Clínico , Humanos , Prognóstico , Escalas de Graduação Psiquiátrica , Fatores de Risco
18.
Health Expect ; 19(6): 1290-1301, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-26552017

RESUMO

PURPOSE: This pilot study aimed to obtain feedback on the feasibility, safety and acceptability of a psychosexual rehabilitation booklet developed for women undergoing pelvic radiation therapy (PRT) and to explore women's sexual, informational and supportive care needs post-PRT rehabilitation. METHODS: Twenty women treated with PRT for gynaecological or anorectal cancer within the last 5 years, who had received vaginal dilators, provided feedback on the format, content and utility of the booklet and discussed their post-treatment information needs, via a semi-structured phone interview. Women completed standardized (HADS, IES-R) and study-specific scales to characterize psychological status of the sample and to assess participants' booklet knowledge and feedback, respectively. RESULTS: The booklet was perceived as very helpful, informative and not distressing, providing additional information to that discussed with clinicians. After reading the booklet, women had good understanding of strategies to reduce the sexual impact of PRT. Many women reported that discussion of sexuality was often avoided during consultations, despite them experiencing distressing sexual experiences and difficulties post-PRT. CONCLUSIONS: This novel resource which addresses an important component of post-pelvic radiation care appears acceptable and highly valued. Findings have highlighted a need for sexual health communication training for clinicians who treat this population so that they can initiate conversations about vaginal health and sexual health in an informed and comfortable manner. The impact of the revised booklet on psychosexual and clinical outcomes is being evaluated in a multicentre RCT.


Assuntos
Neoplasias dos Genitais Femininos/psicologia , Neoplasias dos Genitais Femininos/radioterapia , Aceitação pelo Paciente de Cuidados de Saúde , Educação de Pacientes como Assunto , Neoplasias Retais/psicologia , Neoplasias Retais/radioterapia , Comportamento Sexual/psicologia , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Folhetos , Projetos Piloto , Escalas de Graduação Psiquiátrica , Qualidade de Vida
19.
Soc Psychiatry Psychiatr Epidemiol ; 51(5): 735-46, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26880009

RESUMO

PURPOSE: Communication of a mental health diagnosis can be a difficult process and is a poorly understood area of service provision. The aim of this qualitative study was to examine clinicians' perceptions of barriers and helpful strategies to discussing information about a mental health condition. METHOD: Qualitative interviews with 19 Australian clinicians (general practitioners, mental health nurses, psychiatrists, and psychologists) working in several settings (community, hospital inpatient, outpatient, accident and emergency) and locations (urban, suburban and rural) were conducted and analysed thematically. RESULTS: After theme saturation was reached, four primary themes relating to barriers and facilitators to communication at the time of diagnosis were identified in the data. Outside a recognised lack of focus on this area in training, themes included (1) engagement and timing of conversations; (2) stigma and its reduction; (3) perceived and desired knowledge for diagnostic information; and (4) working with distress. The synthesis of themes is demonstrated in a flowchart of suggestions for communicating news of mental health diagnosis that tracks the patient journey in receiving information from initial engagement to follow-up. CONCLUSIONS: Talking with an individual about a mental health diagnosis is a non-linear, complex and changeable situation. However, health professionals report using specific strategies to aid this communication process, to meet the specific individual's needs. Strategies such as tailoring to the person's situation, utilising collaborative practice, effective coordination, and addressing stigma may be useful to inform clinician training and support whilst diagnosis remains a key feature of the mental health system in Australia.


Assuntos
Atitude do Pessoal de Saúde , Comunicação , Transtornos Mentais/diagnóstico , Serviços de Saúde Mental , Relações Médico-Paciente , Adaptação Psicológica , Adulto , Austrália , Feminino , Humanos , Capacitação em Serviço , Comunicação Interdisciplinar , Colaboração Intersetorial , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Pesquisa Qualitativa
20.
J Adolesc ; 49: 134-45, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27060847

RESUMO

Bullying is common and harms all involved, yet there is no clarity regarding factors that influence bullying and victimisation for adolescent samples. This meta-analysis aims to synthesise the literature and identify reliable risk and protective factors to adolescent bullying and victimisation. A systematic search of the literature using databases; PsycINFO and Scopus, was undertaken to identify relevant publications from 1985 until July 2014. Inclusion criteria included longitudinal data, an adolescent sample and a focus on predictive factors of bullying or victimisation. From 4698 articles identified, 18 were included. Four predictors of victimisation (prior victimisation, conduct problems, social problems and internalising problems) and four predictors of bullying (conduct problems, social problems, school problems and age) were identified. The literature provides little consistency in predictors assessed and replication is needed for clarification, however, social problems and conduct problems are consistent risk factors and a potential focus for future interventions.


Assuntos
Bullying , Vítimas de Crime , Adolescente , Fatores Etários , Bullying/estatística & dados numéricos , Vítimas de Crime/estatística & dados numéricos , Humanos , Psicologia do Adolescente/estatística & dados numéricos , Fatores de Risco
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