Mental health-related knowledge, attitudes and behaviours in a cross-sectional sample of australian university students: a comparison of domestic and international students.

BACKGROUND: There are growing concerns about the mental health of university students in Australia and internationally, with universities, governments and other stakeholders actively developing new policies and practices. Previous research suggests that many students experience poor mental health while at university, and that the risk may be heightened for international students. Mental health-related knowledge, attitudes and behaviours are modifiable determinants of mental health and thus suitable targets for intervention. This study assessed the mental health-related knowledge, stigmatising attitudes, helping behaviours, and self-reported experiences of mental health problems in the student population of a large multi-campus Australian university, and conducted a comparative assessment of international and domestic students. METHODS: Participants were 883 international and 2,852 domestic students (overall response rate 7.1%) who completed an anonymous voluntary online survey that was sent to all enrolled students in July 2019 (n = ~ 52,341). Various measures of mental health-related knowledge, attitudes and helping behaviours were assessed. A comparative analysis of international and domestic students was conducted, including adjustment for age and sex. RESULTS: Overall, there was evidence of improvements in mental health-related knowledge, attitudes and behaviours relative to previous studies, including higher depression recognition, intentions to seek help, and reported help-seeking behaviour. Comparative analysis indicated that international students scored predominantly lower on a range of indicators (e.g., depression recognition, awareness of evidence-based forms of help); however, differences were narrower difference between the two groups compared to what has been reported previously. Finally, some indicators were more favourable among international students, such as higher help-seeking intentions, and lower prevalence of self-reported mental health problems compared to domestic students. CONCLUSION: Though there were some important differences between domestic and international students in this study, differences were narrower than observed in previous studies. Study findings are informing the on-going implementation and refinement of this university's student mental health strategy, and may be used to inform evolving policy and practice in the university sector.

A Scoping Review of Family Focussed Interventions to Prevent Prison Violence.

Violence is an ongoing concern for many people who live and work in correctional settings and yet relatively little is known about the effects of institutional violence prevention efforts. This paper reports the findings of a scoping review of recent research relevant to understanding the influence of one factor, contact with family, that potentially influences institutional violence in countries such as Aotearoa New Zealand where Indigenous peoples are over-represented in prison settings. A total of 15 different studies were identified that provided consistent evidence of an association between family contact and prison violence. The implications of this work for the development of evidence-based prison violence prevention strategies are discussed.

Through the Looking Glass: Remote Versus In-Person Videotaped Neurologic Assessment of Essential Tremor.

BACKGROUND: Remote assessment of essential tremor (ET) is unverified. OBJECTIVES: To compare assigned tremor scores from a remote videotaped research protocol with those from an in-person videotaped research protocol and assess the validity of remote and in-person videotape-based diagnoses when compared against the intake diagnosis (ET vs. control). METHODS: Participants with intake diagnoses of ET (11) or controls (15) completed a tremor examination that was filmed both remotely and in person. RESULTS: Agreement between the tremor ratings assigned during remote and in-person videos was substantial (composite κw, 0.67; mean Gwet's AC2 score, 0.92; mean percent agreement, 63.7%). In ET cases with less severe tremor, agreement was lower (p = 0.008). Diagnostic validity was high for both remote and in-person videos compared to the intake diagnosis. CONCLUSIONS: Remote video is a reasonable alternative to in-person video for the assessment of tremor severity and assignment of ET diagnoses. However, at low tremor amplitudes, agreement declines.

General practitioner knowledge and practice in relation to unintended pregnancy in the Grampians region of Victoria, Australia.

INTRODUCTION: Abortion has been legal in the Australian state of Victoria since 2008 and medical termination of pregnancy (MTOP) available since 2012. While these developments were expected to improve Victorian rural women's access to abortion, this has not been borne out in practice. General practitioners (GPs), particularly in rural areas, are women's first point of contact when faced with an unintended pregnancy. The objective of this study was to understand rural GPs' knowledge and practice in relation to unintended pregnancy and referral for abortion, using the Grampians region of Victoria as a case study. Parts of this region, like other rural and regional areas, experience teenage pregnancy rates double the national average and more than four times that of major cities, and access to abortion services is known to be limited. Findings from the study will inform rural health service development to improve rural women's access to abortion. METHODS: This article reports on the findings from a mixed methods study which explored GP knowledge, understanding and practice in relation to unintended pregnancy services in seven local government areas in the Grampians. Data were collected between April and August 2017. GPs from all practices in this region were invited to participate. A total of 84 GPs were approached, 23 (27%) completed the survey and, of these, five also took part in a semi-structured telephone interview. The quantitative survey data were analysed descriptively while the open-ended survey responses and qualitative interviews were analysed thematically. RESULTS: Of the GPs surveyed, 38% indicated that they 'refer to a colleague due to a conscientious objection' when women present with an unintended pregnancy. No GP always discussed telehealth medical abortion with women and only 27% said that they 'always' discussed medical abortion with women. A range of views were expressed about the adequacy and location of services, with the majority indicating services in the region were limited or inadequate. Interviews with GPs who had conscientious objections to abortion indicated that 'conscientious objection' occurred in different forms and included a range of behaviours. Rural GPs who were interested in becoming MTOP providers faced barriers such as lack of access to timely ultrasounds and surgical backup. CONCLUSION: The results indicate high levels of conscientious objection and wide variation in knowledge of services. In addition, the provision of tele-abortion and medical abortion is extremely limited in this region, even while these are considered ideal ways to address rural access to abortion. It is likely the promise of tele-abortion is far from fulfilled in the Grampians region and possibly in other rural areas in Victoria. There is a need to improve GPs' knowledge of available services and adherence to legal and professional obligations, and there are clear opportunities to achieve this, with all interview participants expressing strong support for the prevention of unintended pregnancy, and many highlighting the need for good support for women up until the point of termination.

The challenge of cultural competence in the workplace: perspectives of healthcare providers.

BACKGROUND: Cross-cultural educational initiatives for professionals are now commonplace across a variety of sectors including health care. A growing number of studies have attempted to explore the utility of such initiatives on workplace behaviors and client outcomes. Yet few studies have explored how professionals perceive cross-cultural educational models (e.g., cultural awareness, cultural competence) and the extent to which they (and their organizations) execute the principles in practice. In response, this study aimed to explore the general perspectives of health care professionals on culturally competent care, their experiences working with multi-cultural patients, their own levels of cultural competence and the extent to which they believe their workplaces address cross-cultural challenges. METHODS: The perspectives and experiences of a sample of 56 health care professionals across several health care systems from a Mid-Western state in the United States were sourced via a 19-item questionnaire. The questionnaire comprised both open-ended questions and multiple choice items. Percentages across participant responses were calculated for multiple choice items. A thematic analysis of open-ended responses was undertaken to identify dominant themes. RESULTS: Participants largely expressed confidence in their ability to meet the needs of multi-cultural clientele despite almost half the sample not having undergone formal cross-cultural training. The majority of the sample appeared to view cross-cultural education from a 'cultural awareness' perspective - effective cross-cultural care was often defined in terms of possessing useful cultural knowledge (e.g., norms and customs) and facilitating communication (the use of interpreters); in other words, from an immediate practical standpoint. The principles of systemic cross-cultural approaches (e.g., cultural competence, cultural safety) such as a recognition of racism, power imbalances, entrenched majority culture biases and the need for self-reflexivity (awareness of one's own prejudices) were scarcely acknowledged by study participants. CONCLUSIONS: Findings indicate a need for interventions that acknowledge the value of cultural awareness-based approaches, while also exploring the utility of more comprehensive cultural competence and safety approaches.

Conscientious objection to abortion, the law and its implementation in Victoria, Australia: perspectives of abortion service providers.

BACKGROUND: In Victoria, Australia, the law regulating abortion was reformed in 2008, and a clause ('Section 8') was introduced requiring doctors with a conscientious objection to abortion to refer women to another provider. This study reports the views of abortion experts on the operation of Section 8 of the Abortion Law Reform Act in Victoria. METHODS: Nineteen semi-structured qualitative interviews were conducted with purposively selected Victorian abortion experts in 2015. Interviews explored the impact of abortion law reform on service provision, including the understanding and implementation of Section 8. Interviews were transcribed verbatim and analysed thematically. RESULTS: The majority of participants described Section 8 as a mechanism to protect women's right to abortion, rather than a mechanism to protect doctors' rights. All agreed that most doctors would not let moral or religious beliefs impact on their patients, and yet all could detail negative experiences related to Section 8. The negative experiences arose because doctors had: directly contravened the law by not referring; attempted to make women feel guilty; attempted to delay women's access; or claimed an objection for reasons other than conscience. Use or misuse of conscientious objection by Government telephone staff, pharmacists, institutions, and political groups was also reported. CONCLUSION: Some doctors are not complying with Section 8, with adverse effects on access to care for some women. Further research is needed to inform strategies for improving compliance with the law in order to facilitate timely access to abortion services.

An analysis of high-risk offending pathways for young females in custody.

Adolescent females who have engaged in severe and/or chronic offending are an understudied population internationally. The literature on female offending pathways has indeed advanced, and there is a better understanding of how female offending behaviours manifest and how correctional agencies should be responding. However, much of the existing research has focused on the risk factors and retrospective biographical narratives of adult female offenders. The present study focused on thematically exploring the self-reported life experiences and offending pathways of 36 detained adolescent females. Findings identified multiple themes including disconnection from education, early care-giver disruption/family separation, personal and family mental health problems, poly-substance abuse, anti-social peers, victimisation and anger problems. The study identifies that early family disruption is an important factor that may contribute to later offending behaviour and other negative life events. Prevention efforts should begin with the family when it comes to high-risk young females.

Exploring professionals' perceptions of the barriers and enablers to young people with physical disabilities accessing sexual and reproductive health services in Australia.

Background There is a lack of research on young people with physical disabilities' access to sexual and reproductive health (SRH) services in Australia. Research has found that there are attitudinal, physical and communication barriers for people with disability, in general, accessing health services, including SRH services. This paper explores key informant perceptions of the barriers and enablers to young people with physical disabilities accessing SRH services in Australia. METHODS: This research used a qualitative approach and involved semi-structured interviews with key informants. Key informants were identified using purposive and snowball sampling, and included health professionals working in SRH services and disability-focussed organisations. Thematic analysis was used to analyse the data. RESULTS: Key informant interviews were carried out with nine health professionals and professionals from disability-focussed organisations. Key themes were: attitudes, role and capacity of health professionals; and additional supports. These three broad areas can either act as barriers or enablers for young people with physical disabilities to access SRH services. This research highlighted that heterosexual and gender bias creates additional barriers for young women with physical disabilities and young people with physical disabilities who identify as lesbian, gay, bisexual, queer, transgender or intersex (LGBQTI). CONCLUSION: Young people with physical disabilities face barriers accessing SRH services. Additional barriers are faced by young women and LGBQTI young people with physical disabilities. This paper suggests strategies to overcome these barriers.

The Impact of Vocational Education and Training Programs on Recidivism: A Systematic Review of Current Experimental Evidence.

Although the association between unemployment and offending is well established, relatively little is known about the impact of vocational education and training programs on re-offending, with much of the previous work in this area failing to control for, or correct, selection bias. This article reports the findings of a systematic review, which considers the findings of only those studies that have used experimental or quasi-experimental designs to evaluate vocational training and employment program outcomes for adult offenders. The analysis identifies key features, based on these studies, of those programs associated with the best outcomes and recommends selection criteria for those who are most likely to benefit from prison vocational education and training.

How do women seeking abortion choose between surgical and medical abortion? Perspectives from abortion service providers.

BACKGROUND: Depending on availability, many Australian women seeking an abortion will be faced with the choice between surgical or medical abortion. Little is known about the factors that influence Australian women's choice of method. AIM: Through the perspectives of abortion service providers, this study aimed to explore the factors that contribute to Australian women's decision to have a surgical or medical abortion. MATERIALS AND METHODS: In 2015, in-depth interviews were conducted with fifteen Victorian-based key informants (KIs) directly providing or working within a service offering medical abortion. Ten KIs were working at a service that also provided surgical abortion. Interviews were semi-structured, conducted face-to-face or over the telephone, transcribed verbatim and analysed thematically. RESULTS: KIs described varying levels of awareness of medical abortion, with poorer awareness in regional areas. When it comes to accessing information, women were informed by: their own research (often online); their own experiences and the experiences of others; and advice from health professionals. Women's reasons for choosing surgical or medical abortion range from the pragmatic (timing and location of the method, support at home) to the subjective (perceived risk, emotional impact, privacy, control, and physical ability). CONCLUSIONS: Women benefit from an alternative to surgical abortion and are well-placed to choose between the two methods, however, challenges remain to ensure that all women are enabled to make an informed choice. KIs identify the need to: promote the availability of medical abortion; address misconceptions about this method; and increase general practitioner involvement in the provision of medical abortion.

' a one stop shop in their own community': Medical abortion and the role of general practice.

BACKGROUND: The introduction to Australia of modern medical abortion methods, which require less specialist expertise and equipment than the more traditional surgical methods, have brought an as yet unrealised potential to improve access to abortion services. AIMS: To investigate the potential for expanding the role of general practice in the provision of medical abortion in Victoria. MATERIALS AND METHODS: In 2015, in-depth interviews were conducted with 19 experts in abortion service provision in Victoria. A semi-structured interview schedule was used to guide the interviews. Interviews were transcribed verbatim and transcripts analysed thematically. RESULTS: Participants were largely very supportive of the provision of early medical abortion in general practice as a way of increasing abortion access for women, particularly in rural and regional communities. Access to abortion was seen as an essential component of women's comprehensive health care and therefore general practitioners (GPs) were perceived as ideally placed to provide this service. However, this would require development and implementation of new service models, careful consideration of GP and nurse roles, strengthening of partnerships with other health professionals and services in the community, and enhanced training, support and mentoring for clinicians. CONCLUSION: The application of these findings by relevant health services and agencies has the potential to increase provision of medical abortion services in general practice settings, better meeting the health-care needs of women seeking this service.

Substance Use, Offending, and Participation in Alcohol and Drug Treatment Programmes: A Comparison of Prisoners with and without Intellectual Disabilities.

BACKGROUND: Many offenders with intellectual disabilities have substance use issues. Offending behaviour may be associated with substance use. MATERIALS AND METHODS: Prisoners with and without intellectual disabilities were compared in terms of their substance use prior to imprisonment, the influence of substance use on offending, and their participation in alcohol and drug treatment programmes. RESULTS: Substance use was similar in prisoners with and without intellectual disabilities in the year prior to their current prison terms. Prisoners with intellectual disabilities were much less likely to report that substance use was an antecedent to the offences leading to their imprisonment. The completion rate of alcohol and drug treatment programmes was much lower for those with intellectual disabilities. CONCLUSIONS: Substance use may be as common in prisoners with intellectual disabilities as those without this condition. Services may need to reflect on whether their treatment programmes are meeting the needs of all prisoners.

'Less like a drug than a drug': the use of St John's wort among people who self-identify as having depression and/or anxiety symptoms.

OBJECTIVE: St John's wort (SJW) is one of the most commonly used complementary medicines (CM) for the self-treatment of depression which can be accessed with or without health professional advice. While there is evidence to support its effectiveness in depression it has potential for serious side effects and interactions with many pharmaceuticals and herbs. Despite the potential risks, we know little about consumer perspectives on the use of SJW. Our research aimed to understand, from their own perspective, how and why people use SJW for management of self-identified 'depression, stress or worries'. DESIGN: A qualitative design, focusing on understanding the reasons for SJW use. A purposive sampling strategy was used to recruit 41 people who self-identified as having used SJW for 'depression stress or worries' from the community in Melbourne, Australia. In-depth face-to-face interviews were conducted. Interviews were taped, transcribed and analysed thematically. RESULTS: Three themes emerged as to why participants used SJW - ease of access of SJW, perceptions of effectiveness and safety of SJW enabling control over its use, and the perceived benefits of using a natural product. Generally, participants did not reserve use of SJW only for mild depressive symptoms. CONCLUSIONS: People use many self-care strategies to manage symptoms of depression, including more severe symptoms. While there is often a preference for more natural approaches like SJW, people experiment and continue to use what they perceive is most effective for them.

Women's experiences of pelvic inflammatory disease: implications for health-care professionals.

This study explored the health-care experiences of women diagnosed with pelvic inflammatory disease. Semi-structured interviews were conducted with 23 women diagnosed with pelvic inflammatory disease. Many women felt empowered about their health post-diagnosis; however, a smaller number reported becoming hyper-vigilant towards symptoms. Infertility was the greatest concern for women. Inadequate information and treatment resulted in negative health experiences, whereas clinician honesty and concern were viewed positively. The findings highlight the need for community education encouraging early presentation for the treatment of pelvic pain and emphasise the need for health practitioners to be responsive to the psychosocial aspects of pelvic inflammatory disease.

Feasibility and acceptability of nurse-led youth clinics in Australian general practice.

Internationally, youth access to primary health care is problematic due to documented barriers such as cost, concerns about confidentiality, and knowledge about when to attend and available services. The treatment of health problems earlier in life together with engagement in prevention and health education can optimise youth health and maximise the potential of future wellbeing. This study investigated the feasibility, acceptability and cost of establishing nurse-led youth clinics in Victoria, Australia. Three general practices in rural and regional areas of Victoria implemented the nurse-led youth health clinics. The clinics were poorly attended by young people. Practice nurses identified several barriers to the clinic attendance including the short timeframe of the study, set times of the clinics and a lack of support for the clinics by some GPs and external youth health clinics, resulting in few referrals. The clinics cost from $5912 to $8557 to establish, which included training the practice nurses. Benefits of the clinics included increased staff knowledge about youth health issues and improved relationships within the general practice staff teams. The implementation of youth health clinics is not feasible in a short timeframe and to maximise use of the clinics, all members of the general practice team need to find the clinics acceptable.

Key informant perceptions of youth-focussed sexual health promotion programs in Australia.

BACKGROUND: This paper explores key informant (KI) perceptions of the barriers to effective sexual health promotion programs in Australia and suggests strategies to overcome these barriers. Three types of sexual health promotion programs were explored in this study: those targeting all young people (under 30), Aboriginal young people, and young people from culturally and linguistically diverse (CALD) backgrounds. METHODS: The study utilised a qualitative approach and involved 33 semistructured interviews with sexual health professionals involved in funding or delivering Australian sexual health promotion programs or working clinically with individuals diagnosed with sexually transmissible infections. RESULTS: Fourteen barriers to effective sexual health promotion programs were identified. Barriers included: difficulties associated with program evaluation, lack of involvement of the target community, the short-term nature of programs, problems with program resources and concerns about the content of programs. Additional barriers to programs targeting Aboriginal and CALD young people were also identified and included: a lack of cultural sensitivity; a failure to acknowledge differences in literacy, knowledge, and language skills; stigma and shame associated with sexual health; and the continued use of programs that lack inclusivity. KIs suggested strategies to overcome these barriers. CONCLUSION: Sexual health promotion in Australia suffers from several barriers that are likely to impede the effectiveness of programs. In particular, poor or nonexistent program evaluation and lack of community involvement are among the key areas of concern. It is hoped that the findings of this study will be useful in informing and shaping future Australian sexual health promotions.

The prevalence of Chlamydia trachomatis infection in Australia: a systematic review and meta-analysis.

BACKGROUND: Chlamydia trachomatis is a common sexually transmitted infection in Australia. This report aims to measure the burden of chlamydia infection by systematically reviewing reports on prevalence in Australian populations. METHODS: Electronic databases and conference websites were searched from 1997-2011 using the terms 'Chlamydia trachomatis' OR 'chlamydia' AND 'prevalence' OR 'epidemiology' AND 'Australia'. Reference lists were checked and researchers contacted for additional literature. Studies were categorised by setting and participants, and meta-analysis conducted to determine pooled prevalence estimates for each category. RESULTS: Seventy-six studies met the inclusion criteria for the review. There was a high level of heterogeneity between studies; however, there was a trend towards higher chlamydia prevalence in younger populations, Indigenous Australians, and those attending sexual health centres. In community or general practice settings, pooled prevalence for women <25 years in studies conducted post-2005 was 5.0% (95% CI: 3.1, 6.9; five studies), and for men <30 years over the entire review period was 3.9% (95% CI: 2.7, 5.1; six studies). For young Australians aged <25 years attending sexual health, family planning or youth clinics, estimated prevalence was 6.2% (95% CI: 5.1, 7.4; 10 studies) for women and 10.2% (95% CI: 9.5, 10.9; five studies) for men. Other key findings include pooled prevalence estimates of 22.1% (95% CI: 19.0, 25.3; three studies) for Indigenous women <25 years, 14.6% (95% CI: 11.5, 17.8; three studies) for Indigenous men <25 years, and 5.6% (95% CI: 4.8, 6.3; 11 studies) for rectal infection in men who have sex with men. Several studies failed to report basic demographic details such as sex and age, and were therefore excluded from the analysis. CONCLUSIONS: Chlamydia trachomatis infections are a significant health burden in Australia; however, accurate estimation of chlamydia prevalence in Australian sub-populations is limited by heterogeneity within surveyed populations, and variations in sampling methodologies and data reporting. There is a need for more large, population-based studies and prospective cohort studies to compliment mandatory notification data.

Managing depression among ethnic communities: a qualitative study.

PURPOSE: Clinical care for depression in primary care negotiates a path between contrasting views of depression as a universal natural phenomenon and as a socially constructed category. This study explores the complexities of this work through a study of how family physicians experience working with different ethnic minority communities in recognizing, understanding, and caring for patients with depression. METHODS: We undertook an analysis of in-depth interviews with 8 family physicians who had extensive experience in depression care in 3 refugee patient groups in metropolitan Victoria and Tasmania, Australia. RESULTS: Although different cultural beliefs about depression were acknowledged, the physicians saw these beliefs as deeply rooted in the recent historical and social context of patients from these communities. Traumatic refugee experiences, dislocation, and isolation affected the whole of communities, as well as individuals. Physicians nevertheless often offered medication simply because of the impossibility of addressing structural issues. Interpreters were critical to the work of depression care, but their involvement highlighted that much of this clinical work lies beyond words. CONCLUSIONS: The family physicians perceived working across cultural differences, working with biomedical and social models of depression, and working at both community and individual levels, not as a barrier to providing high-quality depression care, but rather as a central element of that care. Negotiating the phenomenon rather than diagnosing depression may be an important way that family physicians continue to work with multiple, contested views of emotional distress. Future observational research could more clearly characterize and measure the process of negotiation and explore its effect on outcomes.

Negotiations of distress between East Timorese and Vietnamese refugees and their family doctors in Melbourne.

Recent critiques of depression have contested its coherence as a concept and highlighted its performance in medicalising distress. Studies of depression in a cross-cultural context have focused on language and belief systems as technical barriers to practice that need to be overcome in enacting depression work. This paper seeks to locate culture within the broader socio-structural context of depression care in general practice. The paper draws on interviews with five general practitioners (GPs), and 24 patients from Vietnamese and East Timorese backgrounds who predominantly have left their home as refugees. Each had been diagnosed with depression or prescribed antidepressants. These patients gave accounts of distress deeply embedded within, and inseparable from, lives fraught with frightening pre-migration experiences, traumatic escape and profound dislocation and alienation in their new 'home'. Fragmented lives were contrasted with the nourishing social fabric of homes left behind. GP participants were involved in a process of engaging with a profoundly communal and structural account of emotional distress while defending and drawing on an individualised notion of depression in performing their work and accounting for the pain presented to them.

Sexually transmitted infections: impact on individuals and their relationships.

The impact of having genital herpes and genital human papilloma virus (HPV) on individuals and their relationships was investigated. A qualitative research methodology explored the lived experiences of 30 adults with genital herpes (15 men, 15 women), and 30 adults with HPV (15 men, 15 women). This study addressed individuals' feelings about the impact of stigma associated with having an STI, the impact of having an STI on sexuality and on intimate relationships, and feelings surrounding the process of disclosure. Implications of the findings for research and clinical practice are discussed.