Trajectories of Psychological Distress in Australians Living in Urban Poverty: The Impact of Interpersonal Trauma.

Childhood maltreatment and interpersonal trauma experience is an important factor underpinning the apparent perpetuation of the cycle of social disadvantage experienced by homeless adults. This paper aimed to examine longitudinal patterns of psychological distress in a sample of 1,504 socially disadvantaged adult participants from the Journeys Home Study in Australia. The current paper utilized the "conservation of resources" theory and the concept of "risk factor caravans" to investigate the nature and implications of childhood trauma in the context of homelessness. Growth mixture modeling revealed four distinct trajectories of psychological distress as measured by the Kessler 6 across six time points (covering a period of 2.5 years): chronic, escalating, attenuating, and resistant. Our results also indicated that experiences of different types of trauma during childhood were associated with these psychological distress trajectories. In particular, adults experiencing chronic psychological distress were significantly more likely than those exhibiting distress resistance to have experienced multiple and varied childhood maltreatment, adjusted odds ratio (AOR) = 3.30, 95% CI [0.37, 6.05], p = .002. Furthermore, adult experiences of assault were found to be associated with psychological distress. These findings have important implications for mental health, as well as interventions aimed at breaking the cycle of urban poverty. Specific focus on interpersonal trauma vulnerabilities is important. Prioritizing socioecological stability, with mental health needs assessed on an individual level, may be most appropriate. This work also highlights the need to direct future attention to barriers to access and facilitation of social support services.

Exploration of Sedentary Behavior in Residential Substance Abuse Populations: Results From an Intervention Study.

BACKGROUND: There is a growing body of research linking sedentary behavior with increased risk of chronic disease and all-cause mortality. It is increasingly recommended that service providers address the multiple behavioral risk factors associated with these chronic diseases as part of routine substance abuse treatment. OBJECTIVES: The study objective was to investigate rates of physical activity and sedentary behavior in a residential substance abuse population. In addition, efficacy of a sedentary behavior intervention, "Sit Switch," was examined for feasibility in this context. METHODS: Participants (n = 54) were residents of The Salvation Army Recovery Service Centres located in Canberra and on the Gold Coast, Australia. Actigraph GT3X+ accelerometers were used to measure rates and patterns of sedentariness and physical activity. A nonrandomized controlled study of a single-session group intervention aimed at decreasing prolonged sitting ("Sit Switch") was conducted. Education, motivational-interviewing, and goal setting components underpinned the "Sit Switch" intervention. RESULTS: Individuals were highly sedentary, spending 73% of daily activity at sedentary intensity engaged in inadequate levels of moderate physical activity (6.6%/day). The single session educational program did not lead to any significant changes in sedentary behavior. Conclusion/Importance: High levels of sedentariness and low levels of physical activity engagement are evident in residents in substance abuse treatment programs. It is strongly recommended that sedentariness, a modifiable risk behavior with independent consequences for cardiovascular disease and cancer, be addressed within residential programs.

Study protocol: a stepped wedge cluster randomised controlled trial of a healthy lifestyle intervention for people attending residential substance abuse treatment.

BACKGROUND: Cardiovascular disease and cancer are leading causes of mortality for people with a history of alcohol or other substance use disorders. These chronic diseases share the same four primary behavioural risk factors i.e. excessive alcohol use, smoking, low intake of fruit and vegetables and physical inactivity. In addition to addressing problematic alcohol use, there is the potential for substance abuse treatment services to also address these other behaviours. Healthy Recovery is an 8-session group-based intervention that targets these multiple behavioural health risk factors and was developed specifically for people attending substance abuse treatment. This protocol describes a Cancer Institute NSW funded study that assesses the effectiveness of delivering Healthy Recovery for people who are attending residential alcohol and other substance abuse treatment. METHODS/DESIGN: The study uses a stepped wedge randomised controlled design, where randomisation occurs at the service level. Participants will be recruited from residential rehabilitation programs provided by The Australian Salvation Army. All participants who (1) currently smoke tobacco and (2) are expected to be in the residential program for the duration of the 5-week intervention will be asked to participate in the study. Those participants residing at the facilities assigned to the treatment condition will complete Healthy Recovery. The intervention is manual guided and will be delivered over a 5-week period, with participants attending 8 group sessions. All participants will continue to complete The Salvation Army residential program, a predominantly 12-step based, modified therapeutic community. Participants in the control condition will complete treatment as usual. Research staff blind to treatment allocation will complete the primary and secondary outcome assessments at baseline and then at weeks 8, 20 and 32 weeks post intervention. DISCUSSION: This study will provide comprehensive data on the effect of delivering a healthy lifestyle intervention (i.e. Healthy Recovery) within a residential substance abuse setting. If shown to be effective, this intervention can be disseminated within other residential substance abuse programs. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12615000165583. Registered 19(th) February 2015.

Australian men's help-seeking intentions for anxiety symptoms: The impact of masculine norm conformity and gender role conflict.

Research highlights a discrepancy between the number of men experiencing mental illness and those seeking professional help, particularly for anxiety. Conformity to masculine norms (CMN) and gender role conflict (GRC) have been recognised as barriers to men's mental health help-seeking, but few studies have examined these relationships for anxiety. This study aimed to examine the relationship between anxiety severity and help-seeking intentions in Australian men, and the additional impact of CMN and GRC. A total of 610 Australians aged 18-89 years (M = 46.02, SD = 17.14) participated in an online survey, which included demographic information and four standardised questionnaires measuring anxiety, help-seeking intentions, CMN, and GRC. CMN but not GRC was found to fully mediate the relationship between anxiety severity and anxiety-related help-seeking intentions. The results have theoretical implications for the study of masculinity and clinical implications for therapeutic approaches for men with anxiety symptoms.

Developing Psychological Resilience to the Impact of Drought.

BACKGROUND: Drought is a slow-onset natural hazard with significant socioeconomic, environmental and psychological impacts. The extant literature has predominately focused on the physical and economic dimensions of resilience, which mainly address the socioeconomic and environmental consequences of drought. However, the mental health effects of chronic environmental adversity, such as prolonged drought, remain an under-researched area, and frameworks that build and strengthen the psychological aspect of the social resilience of communities are lacking. METHODS: This feasibility study will employ a mixed-method design sub-divided into three phases. Phase 1 will utilise social network analysis (SNA) to identify leadership patterns and their intersections across communities. While phase 2 will use semi-structured interviews to ascertain the perceived roles of identified leaders in preparing for and recovering from drought impacts, the third phase will adopt the Delphi method to unpack existing perceptions of control, coherence and connectedness.

The Tern Programme Study protocol for an implementation trial of a flexible, long-term psychosocial intervention for complex posttraumatic stress in young people.

Background: Complex Trauma (CT) is a term used to refer to multiple or prolonged traumatic experiences. Such experiences are often first encountered during childhood and may impact key developmental periods. CT is a risk for a broad range of deleterious physical, psychological, social, and occupational outcomes. The diagnosis of Complex Posttraumatic Stress Disorder (C-PTSD) has been proposed to capture the symptomatology resulting from CT exposure.In Australia, there are few publicly funded services that target, and are purposely designed to support, the mental health needs of young people with symptoms of complex post-traumatic stress (C-PTSD). The Tern Programme has been designed as a purpose-built model of care for providing mental health support to young people with C-PTSD. Methods: This implementation trial will involve a longitudinal examination of Tern participants for a fixed 24-month period. Participants will be recruited from the young people referred to Tern at headspace centres in regional Australia where Tern operates. Eligible participants will have reported a history of complex trauma, and present with symptoms of C-PTSD. All participants will be invited to complete a series of surveys during their participation in the programme. Survey items will assess C-PTSD symptom change, quality of life and occupational functioning.The Tern model of care is delivered in a semi-structured format to accommodate a person-centred flexible approach. Fidelity will be monitored through the completion of a clinician post-session checklist and through group supervision. Discussion: This study will provide the first quantitative data on the new Tern model of care and evaluate mental health and functional outcomes of its participants. If effective, Tern may be suitable for replication in other Australian or international youth mental health services where complex post-traumatic stress is prevalent. Trial Registration: Australia and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000079842p. Prospectively registered on 29 January 2021. Abbreviations: CT = Complex Trauma; C-PTSD = Complex Posttraumatic Stress Disorder.

Antecedentes: El trauma complejo (TC) es un término que se utiliza para referirse a experiencias traumáticas múltiples o prolongadas. A menudo, estas experiencias se encuentran por primera vez durante la infancia y pueden afectar períodos clave del desarrollo. El TC es un riesgo para una amplia gama de secuelas perjudiciales físicas, psicológicas, sociales y ocupacionales. Se ha propuesto el diagnóstico de trastorno de estrés postraumático complejo (TEPT-C) para capturar la sintomatología resultante de la exposición al TC. En Australia existen pocos servicios financiados con fondos públicos dirigidos a las necesidades de salud mental de los jóvenes con síntomas de estrés postraumático complejo (TEPT-C) y que estén específicamente diseñados para respaldarlos. El Programa Tern ha sido diseñado como un modelo de atención especialmente orientado para brindar apoyo de salud mental a los jóvenes con TEPT-C.Métodos: Esta implementación implicará un examen longitudinal de los participantes del programa Tern durante un período fijo de 24 meses. Los participantes serán reclutados entre los jóvenes derivados al programa Tern en los centros de referencia en la región de Australia donde opera Tern. Los participantes elegibles informarán un historial de trauma complejo y presentarán síntomas de TEPT-C. Se invitará a todos los participantes a completar una serie de encuestas durante su participación en el programa. Los ítemes de la encuesta evaluarán el cambio en los síntomas de TEPT-C, la calidad de vida y el funcionamiento ocupacional. El modelo de atención Tern se ofrece en un formato semiestructurado para adaptarse a un enfoque flexible centrado en la persona. La fidelidad se controlará mediante la realización de una lista de verificación posterior a la sesión por parte del clínico y mediante supervisión grupal.Discusión: Este estudio proporcionará los primeros datos cuantitativos sobre el nuevo modelo de atención Tern, y evaluará la salud mental y resultados funcionales de sus participantes. Si es eficaz, el programa Tern puede ser adecuado para su reproducción en otros servicios de salud mental para jóvenes australianos o internacionales donde prevalece el estrés postraumático complejo.Registro de Ensayo Clínico: Australia and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000079842p. Registrado prospectivamente el 29 de enero del 2021.

Routine outcome measurement in specialist non-government alcohol and other drug treatment services: Establishing effectiveness indicators for the NADAbase.

INTRODUCTION AND AIMS: The collection of routine outcome measurement (ROM) data provides an opportunity for service providers to conduct benchmarking to inform quality assurance practices. To conduct comparative benchmarking, it is important that services have access to comparative data. This paper aims to establish effectiveness indicators for ROM data collected within the alcohol and other drug (AOD) sector. DESIGN AND METHODS: ROM data were collected by specialist non-government AOD treatment services within the Network of Alcohol and other Drugs Agencies online database (i.e. NADAbase). All participants were attending treatment within New South Wales, Australia (N = 21 572). Effectiveness indicators were calculated by using effect sizes, standard error of measurement, and rates of reliable and clinically significant change. The study focused on quality of life (EUROHIS Quality of Life Scale), psychological distress (Kessler-10) and substance dependence (Substance Dependence Scale). RESULTS: Since 2010, 21 572 unique people have completed at least one NADAbase Client Outcome Measure. Amphetamines (36%) and alcohol (32%) were the most commonly reported primary substances of concern. Effectiveness indicators were established for the total sample, as well as for people attending residential rehabilitation (n = 8161) and community-based (n = 10 306) treatment services. Standard error of measurement was the least stringent effectiveness indicator (i.e. a higher proportion of people demonstrated improvement), while the clinically significant change was the most stringent approach. DISCUSSION AND CONCLUSIONS: The study demonstrated the utility of the NADAbase to establish effectiveness indicators for benchmarking purposes. Recommendations are provided for the use of benchmarking to inform quality assurance activities in the sector.

Healthy recovery: A stepped wedge cluster randomised controlled trial of a healthy lifestyle intervention for people attending residential alcohol and other drug treatment.

BACKGROUND: Unhealthy lifestyle behaviours contribute to the poor health of people attending alcohol and other drug (AOD) treatment. Healthy Recovery is an 8-session group-based intervention that targets smoking, diet and physical inactivity as part of an integrated healthy lifestyle approach. The current study aimed to examine the effectiveness of Healthy Recovery when delivered within residential AOD treatment settings. METHODS: The study design was a stepped-wedge cluster randomised trial. Participants were 151 current smokers attending residential AOD programs provided by the Australian Salvation Army (n = 71, Control condition; n = 80, Intervention condition). The primary outcome was number of cigarettes smoked per day. Secondary outcomes examined other smoking behaviours (7-day point prevalence, use of nicotine replacement therapy [NRT]), diet (servings and variety of fruit and vegetables), and physical activity. RESULTS: The mean number of cigarettes smoked per day was significantly lower in the Intervention condition at 2-, 5-, and 8-month follow-up. There were also significant differences in favour of the Intervention condition for number of quit attempts, use of NRT and variety of fruit. There were no other significant differences for other dietary or physical activity variables. CONCLUSIONS: Healthy Recovery had a positive impact on smoking behaviours. Future research should consider strategies to further promote smoking cessation (e.g. promoting longer-term use of NRT), as well as addressing physical activity and dietary behaviours. The introduction of broader organisational approaches (e.g. smoke free policies, organised group exercise and cooking activities) might help to enhance healthy lifestyle approaches within AOD treatment settings.

Complex Trauma and Ecological Vulnerability: Development of a Resources Perspective Framework to Inform Longitudinal Examination.

Translation and application of current complex trauma knowledge for high-risk groups such as the homeless is needed. Existing research in this area has been limited by lack of a cohesive theoretical framework that captures the dynamic and heterogeneous nature of complex trauma within the context of ecological vulnerability (e.g. homelessness). This paper aims to address these gaps by proposing an integrated resources perspective framework situating Layne and colleagues' (Layne et al. 2009, 2010) concept of 'risk factor caravans' as central focus. We demonstrate how the 'risk factor caravan' representation captures current theoretical and clinical insights into the pervasive and enduring consequences of complex trauma exposure. Personal resources are highlighted as key for understanding resource loss and gain in the current context. Longitudinal person-centered approaches as integral methodological considerations for future application of this proposed framework are examined. Implications for reducing barriers to access of available support services are discussed.

Is there Complex Trauma Experience typology for Australian's experiencing extreme social disadvantage and low housing stability?

Traumatic childhood experiences predict many adverse outcomes in adulthood including Complex-PTSD. Understanding complex trauma within socially disadvantaged populations has important implications for policy development and intervention implementation. This paper examined the nature of complex trauma experienced by disadvantaged individuals using a latent class analysis (LCA) approach. Data were collected through the large-scale Journeys Home Study (N=1682), utilising a representative sample of individuals experiencing low housing stability. Data on adverse childhood experiences, adulthood interpersonal trauma and relevant covariates were collected through interviews at baseline (Wave 1). Latent class analysis (LCA) was conducted to identify distinct classes of childhood trauma history, which included physical assault, neglect, and sexual abuse. Multinomial logistic regression investigated childhood relevant factors associated with class membership such as biological relationship of primary carer at age 14 years and number of times in foster care. Of the total sample (N=1682), 99% reported traumatic adverse childhood experiences. The most common included witnessing of violence, threat/experience of physical abuse, and sexual assault. LCA identified six distinct childhood trauma history classes including high violence and multiple traumas. Significant covariate differences between classes included: gender, biological relationship of primary carer at age 14 years, and time in foster care. Identification of six distinct childhood trauma history profiles suggests there might be unique treatment implications for individuals living in extreme social disadvantage. Further research is required to examine the relationship between these classes of experience, consequent impact on adulthood engagement, and future transitions though homelessness.