Risk prevalence, readiness and confidence to change lifestyle risk factors among clients of community mental health services.

OBJECTIVE: People with mental health conditions have high rates of chronic physical diseases, partially attributable to lifestyle risks factors. This study examined risk prevalence among community mental health service clients, their readiness and confidence to change, and associations with participant characteristics. METHODS: Cross-sectional survey of adult clients from 12 community mental health services across 3 local health districts in New South Wales, Australia, collected from 2021 to 2022. Participants (n = 486) completed a telephone interview determining five risk factors, and readiness and confidence to change these. Multiple binary logistic regression models determined associations between readiness and confidence (for each risk), and participant characteristics (demographics and diagnosis). RESULTS: Participants most commonly reported a diagnosis of schizophrenia (36.7%) or depression (21.1%). Risk factors were prevalent: ranging from 26% (harmful alcohol use) to 97% (poor nutrition). High readiness was greatest for smoking (68%), weight (66%) and physical inactivity (63%), while confidence was highest for changing alcohol use (67%). Two significant associations were identified; females were more likely than males to have high readiness to change nutrition (odds ratio = 1.14, confidence interval = [1.13, 2.34], p = 0.0092), with males more likely to have high confidence to change physical activity (odds ratio = 0.91, confidence interval = [0.45, 0.99], p = 0.0109). CONCLUSIONS: Many participants were ready and confident to change risk factors. Gender influenced readiness to change nutrition and physical activity confidence. Training to upskill mental health clinicians in provision of preventive care that builds confidence and readiness levels may aid in supporting positive behaviour change.

Talking about borderline personality disorder, shaping care: The multiple doings of narratives.

This article focuses on the narratives that circulate about borderline personality disorder (BPD) in health-care settings in Australia and the effects such narratives can have on how people practice and seek out care. People with a BPD diagnosis frequently access health-care services, often encountering stigma and discrimination. Drawing on narrative theory, we critically unpack the circulation and capacities of BPD narratives and the ways they can often contribute to poor and troubling experiences. This article is based on qualitative interviews with people living with a BPD diagnosis, as well as health practitioners who work with people with a BPD diagnosis. Our findings identified insidious and powerful BPD narratives that circulate in health-care settings, particularly in short-term, acute, or non-specialist contexts, such as emergency departments and in-patient units. These narratives influenced the ways that participants both practiced and sought out care. To improve health service quality for people with a BPD diagnosis, or those experiencing mental distress, it is important to challenge the sociocultural-political norms and relations that can influence approaches to care and practice. Disrupting and reframing negative BPD narratives and raising awareness about the impact of stories that are told about BPD have the potential to generate social change.

Much Ado About Nothing? The Role of Land-Based Gambling Venue Employees in Facilitating Problem Gambling Harm Reduction and Help-Seeking.

Over the past decade, greater emphasis has been placed on the role of the land-based gambling industry to respond to problem gambling behaviour in their venues. Despite this, there is a lack of clear information advising best practice responses by gambling venue employees. This article reviews strategies, practices, and policies employed by land-based gambling venues concerning their employees' role in preventing gambling-related harm and responding to problem gambling behaviours. A systematic search strategy was applied to source peer-reviewed literature which identified 49 articles. The synthesised results were arranged and presented across five categories: (1) the identification of gamblers with potential problems in the venue; (2) gambling venue staff responses to gamblers with potential problems; (3) gamblers' perspectives around venue responsibilities and interactions with gamblers with potential problems; (4) corporate social responsibility programs and the identification of gamblers with problems in the venue; and (5) gambling venue staff needs. The results suggest that most activity performed by venue staff concerning their response to problem gambling is limited to observing and documenting risky behaviours and then discussing this internally with other venue staff. Action which moves beyond this, such as approaching and interacting with identified gamblers of concern, rarely occurs. The results of this review suggest that a focus on the identification and intervention specifically with identified gamblers of concern is a particularly unhelpful aspect of the role of venue staff. The results also indicate that a re-thinking of the role frontline staff play in addressing problem gambling is necessary.

Comorbidities and their management in women with breast cancer-an Australian survey of breast cancer survivors.

PURPOSE: Breast cancer survivors experience significant burden from comorbid chronic conditions, but little is known about how well these conditions are managed. We conducted a national survey of Australian breast cancer survivors to examine the burden of chronic conditions, their impact and care alignment with the principles of chronic condition management. METHODS: A study-specific survey incorporated questions about chronic conditions using the Charlson Comorbidity Index (CCI), functional status using the Vulnerable Elders Survey (VES) and perceived quality of care for cancer and non-cancer conditions using the Patient Assessment of Care for Chronic Conditions Survey (PACIC). Members of Breast Cancer Network Australia (BCNA) were invited via email to complete the survey either online or through direct mail. RESULTS: The survey was sent to 2198 BCNA members and 177 responses were received (8.1%). Respondents were women aged 32-88 years (median 60.1 years). The majority were married (116; 67.7%) and had private insurance (137; 80.0%) and reported good to excellent health (119; 73.5%). Other health conditions were reported by 157 (88.7%), the most common being chronic pain (27.1%) and fatigue (22.0%). When asked about management of comorbidities or cancer, less than 20% were routinely asked about management goals, helped to set goals or asked about health habits. CONCLUSIONS: In this population of survivors with good health status and high rates of private insurance, comorbidities were common and their management, as well as management of breast cancer, was poorly aligned with chronic condition management principles.

"Somebody was standing in my corner": a mixed methods exploration of survivor, coach, and hospital staff perspectives and outcomes in an Australian cancer survivorship program.

PURPOSE: Cancer survivorship in Australia continues to increase due to new methods for early detection and treatment. Cancer survivors face challenges in the survivorship phase and require ongoing support. A telephone-delivered cancer survivorship program (CSP), including health and mental health coaches, was developed, piloted, and evaluated in Eastern Australia. METHODS: Cancer survivors' (n = 7), coaches' (n = 7), and hospital staff (n = 3) experiences of the CSP were explored through semi-structured interviews. Quantitative data routinely collected throughout the pilot of the CSP was described (N = 25). RESULTS: Three syntheses and 11 themes were generated through thematic analysis. The first synthesis centred around operational factors and highlighted a need to streamline communication from the point of recruitment, through to program delivery, emphasising that the program could be beneficial when timed right and tailored correctly. The second synthesis indicated that the CSP focused on appropriate information, filled a gap in support, and met the needs of cancer survivors by empowering them. The third synthesis focussed on the value of mental health support in the CSP, but also highlighted challenges coaches faced in providing this support. Descriptive analysis of quantitative data indicated improvements in self-management, weekly physical activity, and meeting previously unmet needs. CONCLUSIONS: Cancer survivors expressed appreciation for the support they received through the CSP and, in line with other cancer survivorship research, predominantly valued just having somebody in their corner. IMPLICATIONS FOR CANCER SURVIVORS: Recommendations are made for improving cancer survivorship programs in the future.

Mental health outcome measures in the Australian context: what is the problem represented to be?

BACKGROUND: There is growing interest in the use of routine outcome measures (ROM) in mental health services worldwide. Australia has been at the forefront of introducing ROM in public mental health services, with the aim of improving services and consumer outcomes. METHODS: An in-depth policy and document analysis was conducted using Carol Bacchi's 'What is the problem represented to be?' approach to critically analyse the use of ROM. This approach was used to identify and analyse the problem representations relating to the need for, and the choice of, outcome measures in Australian public mental health services, and the potential consequences of policy and practice. Data included in the analysis were seven policy documents, four reports on the introduction of outcome measures in Australia, the Australian Mental Health Outcomes and Classifications Network website, and the content of the outcome measures themselves. RESULTS: Two dominant representations of the 'problem' were identified: 1) the 'problem' of mental health service quality and accountability, relating to the need for mental health outcome measures; and 2) the 'problem' of addressing deficits in biopsychosocial functioning of mental health consumers, which relates to the choice of outcome measures. Framing the 'problem' of mental health outcomes in these ways locates the problem within individual health providers, services, and consumers, ignoring the broader socioeconomic conditions underpinning mental health and effective service provision. CONCLUSIONS: This critical analysis of the introduction and use of ROM in public mental health services in Australia highlights the need to consider the role of the social determinants of mental health, mental health service funding, and recovery-oriented care in ensuring services are meeting consumer needs and expectations. Broader governmental engagement is central to genuine change and opportunities.

Family involvement to support cardiovascular self-management care for people with severe mental illness: a systematic review.

BACKGROUND: Family members play a pivotal role in supporting cardiovascular self-management-based care of community-living adults with severe mental illness (SMI). However, little is known about what strategies caregivers employ as part of their caring roles. AIM: This paper aims to explore what caregiving strategies work (or not), why and how by collating and synthesising existing evidence on this issue. METHODS: A systematic search of peer-reviewed qualitative and mixed-method studies published between 2000 and 2019 was employed. This comprehensive process generated only nine papers for subsequent meta-synthesis of qualitative data. RESULTS: Findings suggested that caregivers have a complex yet comprehensive role to play in initiating and perpetuating self-management-based cardiovascular care. The elements of recovery such as promoting hope, normality, autonomy and identity were flagged as critical underpinning factors that motivated the person with SMI to adopt a healthy lifestyle. However, it was evident that caregivers needed to walk alongside the person, at times, to help them reach their maximum potential in sustaining improved self-management behaviours. CONCLUSION: Caregivers sit in a favourable bridging position between healthcare systems and community-living individuals with SMI, to support their cardiovascular health. However, this powerful but invisible 'workforce' clearly needs further support involving finance, skill-development and acknowledgement.

The Australian version of IAPT: clinical outcomes of the multi-site cohort study of NewAccess.

BACKGROUND: The United Kingdom IAPT (Improving Access to Psychological Therapies) approach of delivering low intensity therapies for symptoms of depression and anxiety was adapted for Australia and named NewAccess. Clinical outcomes of the service were evaluated in three sites between October 2013 and 2016. AIMS: This paper describes the clinical outcomes in the Australian health setting. METHODS: Prospective cohort study with repeated measures. Both intent-to-treat and per protocol analyses were conducted for primary outcomes measures Patient Health Questionnaire-9 (nine item), and Generalised Anxiety Disorder (seven item). Secondary measures were Phobia Scale and Work and Social Adjustment Scale. RESULTS: Three thousand nine hundred and forty-six individuals were assessed, and 3269 attended at least two treatment sessions. Forty percent were males. There was a clinically meaningful reduction (improvement) shown by reliable recovery rates in both depression and anxiety symptoms at post-treatment assessment (68%; 95% CI: 66-70%) with large effect sizes (1.23 for depression and 1.25 for anxiety). Outcomes in PHQ-9 and GAD-7 were not influenced by age or sex, but recovery rates were significantly reduced by relationship status (single or separated). Unemployment reduced PHQ-9 outcomes but not GAD-7 outcomes. CONCLUSION: NewAccess demonstrated positive clinical outcomes in Australia, that compared favourably with international studies with the same methodology.

Families' experiences of supporting Australian veterans to seek help for a mental health problem: a linked data analysis of national surveys with families and veterans.

BACKGROUND: Families play a critical role in supporting currently serving and transitioned veterans' wellbeing and help-seeking for mental health concerns; however, little is known about families' experiences. AIMS: This study used Australian national survey linked-data (n = 1217) from families (Family Wellbeing Study-FWS) and veterans (Mental Health Wellbeing Transition Study-MHWTS) to understand veteran-family help-seeking relationships. METHODS: Veterans' and family members' responses to mental health and help-seeking questions in FWS and MHWTS datasets from perspective of family members were cross-tabulated. Help-seeking support provided by family members was compared by veterans' probable disorder. RESULTS: Results highlighted high levels of involvement and continuous assistance provided by families. Two in three family members thought the veteran had probable mental health concerns although they have never been diagnosed or treated. Clear disparities between family and veteran perspectives regarding mental health concerns indicates the extent of non-treatment seeking in this population, missed opportunities for early intervention, and need for greater support to families to promote help-seeking. CONCLUSIONS: Encouraging help-seeking is complex for veteran families particularly where veterans' reluctance to seek help may lead to family relationship strain and conflict. Families need early information, support, and recognition by service agencies of the role of the family in encouraging help-seeking.

Tobacco smoking and mental disorders in Australian adolescents.

OBJECTIVES: This study aimed to (1) examine the strength of the association between mental disorders/mental health problems, risk behaviours and tobacco smoking among Australian adolescents, (2) compare rates of tobacco smoking among Australian adolescents with major depressive disorder, attention-deficit/hyperactivity disorder and/or conduct disorder in 2013/14 vs 1998, and (3) identify the extent to which an association between tobacco smoking and mental health problems among adolescents can be attributed to non-mental health risk factors. METHODS: The study utilised data from the first (1998) and second (2013/14) child and adolescent components of the National Surveys of Mental Health and Wellbeing. Both surveys identified nationally representative samples of Australian young people aged 4-17 years, living in private dwellings. Information was collected from parents and 13- to 17-year-olds about mental disorders, mental health problems, risk behaviours and tobacco smoking. RESULTS: In the 2013/14 survey, the rate of current tobacco smoking among those with a mental disorder was 20% compared to 5% in those without a mental disorder. Rates were highest for young people with conduct disorder (50%), major depressive disorder (24%) and anxiety disorders (19%). In 2013/14, 38% of current tobacco smokers had a mental disorder and 32% reported self-harm and/or suicidal ideation vs 10% and 5%, respectively, among adolescents who had never smoked. Females with mental disorders or reporting self-harm or suicidal ideation had higher rates of current smoking than males. Other significant factors associated with current smoking included school-related problems, binge eating and having had more than one sexual partner. CONCLUSION: While smoking rates in 13- to 17-year-olds with mental disorders had declined since 1998, the strength of the association between mental disorders and smoking had increased, especially among females. Our findings highlight the need to address the tobacco smoking among adolescents with mental disorders, particularly females.

Nurse Led Clinics; a Novel Model of Care for Compensated Liver Cirrhosis: A Qualitative Analysis.

A nurse-led cirrhosis clinic model for management of stable, compensated cirrhotic patients is practised in our unit since 2013, wherein these patients are reviewed every six months by specialist nurses in community clinics under remote supervision of hepatologists. We evaluated the experiences of patients and healthcare providers involved in the model to understand the acceptability, strengths, and limitations of the model and obtain suggestions to improve. A qualitative design using in-depth interviews was employed, followed by thematic analysis of eight patients, one attending physician both nurse and hospital clinics, four hepatologists, and three experienced specialist nurses running the nurse-led cirrhosis clinic. Patients expressed satisfaction and a good understanding of the nurse-led cirrhosis clinic, preferring it to hospital clinics for better accessibility and the unique nurse-patient relationship. Upskilling and provision of professional care in a holistic manner were appreciated by specialist nurses. The hepatologists expressed confidence and satisfaction, although they acknowledged the difference between the medical training of specialist nurses and hepatologists. The greater availability of hospital clinic time for sick patients was welcomed. Increased specialist nurse staffing, regular forums to promote specialist nurse learning, and formalization of the referral process were suggested. No adverse experiences were reported by patients or staff. The nurse-led cirrhosis clinic model for compensated liver cirrhosis was well received by patients, hepatologists, and specialist nurses. Wider implementation of the model could be considered after further investigations in other settings.

Community treatment orders and care planning: How is engagement and decision-making enacted?

BACKGROUND: In many jurisdictions worldwide, individuals with a mental illness may be forced to receive care and treatment in the community. In Australia, legislation states that such care should be driven by a care plan that is recovery-focussed. Key components in the care planning process include engagement and decision-making about a person's support needs and care options, with trust being an essential component of care planning relationships. OBJECTIVE: This study examines how these components were enacted during service care contacts for individuals on community treatment orders. METHODS: The study was located at two community mental health teams in South Australia. Ethnographic observations of care planning discussions between consumers, their carers and clinicians, and interviews with individuals from these groups, were conducted over 18 months. Carspecken's critical ethnography provided a rigorous means for examining the data to identify underlying cultural themes that were informing day-to-day care interactions. RESULTS: Care planning was not occurring as it was intended, with service culture and structures impeding the development of trusting relationships. Clinicians striving to work collaboratively with consumers had to navigate a service bias and culture that emphasized a hierarchy of 'knowing', with consumers assumed to have less knowledge than clinicians. CONCLUSIONS: Services and clinicians can challenge prejudicial ethical injustice and counter this through testimonial justice and implementation of tools and approaches that support genuine shared decision-making. PATIENT OR PUBLIC CONTRIBUTION: This study included individuals with lived experience of mental illness, their carers and clinicians as participants and researchers.

Determining what constitutes an effective psychosocial 'return to work' intervention: a systematic review and narrative synthesis.

PURPOSE: Work can offer a myriad of social and health benefits. Long-term sick leave can be detrimental to employers, individuals, families, and societies. The burden of long-term sick leave has motivated the development of return to work (RTW) interventions. This study sought to determine what constitutes an effective psychosocial RTW intervention, which included exploring whether the level of intervention intensity and intervention characteristics matter to RTW outcomes. METHODS: A systematic review and narrative synthesis were undertaken. Studies were identified through six databases (Ovid Medline, CINAHL (EBSCOhost), PsycInfo (Ovid), ProQuest, Scopus, and Google Scholar) between 2011 and 3 September 2019. Randomised controlled trials (RCTs) or reviews published in English were eligible for inclusion if they targeted adults who were on sick leave/unemployed trying to return to full-capacity employment, had at least one structured psychosocial RTW intervention, and assessed RTW. Study quality was assessed using checklists from the Joanna Briggs Institute. RESULTS: Database searching yielded 12,311 records. Eighteen RCTs (comprising 42 intervention/comparison groups), seven reviews (comprising 153 studies), and five grey literature documents were included. Included studies were of moderate-to-high quality. Research was primarily conducted in Europe and focused on psychological or musculoskeletal problems. RTW outcomes included RTW status, time until RTW, insurance claims, and sick days. Participating in a RTW program was superior to care-as-usual. RTW outcomes were similar between diverse interventions of low, moderate, and high intensity. Common foundational characteristics seen across effective RTW interventions included a focus on RTW, psychoeducation, and behavioural activation. CONCLUSIONS: Evidence suggests that a low intensity approach to RTW interventions may be an appropriate first option before investment in high intensity, and arguably more expensive interventions, as the latter appear to provide limited additional benefit. More high-quality RCTs, from diverse countries, are needed to provide stronger evidence.

Self-reported suboptimal sleep and receipt of sleep assessment and treatment among persons with and without a mental health condition in Australia: a cross sectional study.

BACKGROUND: Poor sleep and poor mental health go hand in hand and, together, can have an adverse impact on physical health. Given the already disproportionate physical health inequities experienced by people with a mental health condition worldwide, the need to consider and optimise sleep has been highlighted as a means of improving both physical and mental health status. Sleep recommendations recently developed by the United States' National Sleep Foundation incorporate a range of sleep parameters and enable the identification of 'suboptimal' sleep. Among community-dwelling persons with and without a 12-month mental health condition in Australia, this study reports: [1] the prevalence of 'suboptimal' sleep and [2] rates of sleep assessment by a health care clinician/service and receipt of and desire for sleep treatment. METHODS: A descriptive study (N = 1265) was undertaken using self-report data derived from a cross-sectional telephone survey of Australian adults, undertaken in 2017. RESULTS: Fifteen per cent (n = 184) of participants identified as having a mental health condition in the past 12 months. Across most (7 of 8) sleep parameters, the prevalence of suboptimal sleep was higher among people with a mental health condition, compared to those without (all p < 0.05). The highest prevalence of suboptimal sleep for both groups was seen on measures of sleep duration (36-39% and 17-20% for people with and without a mental health condition, respectively). In terms of sleep assessment and treatment, people with a mental health condition were significantly more likely to: desire treatment (37% versus 16%), have been assessed (38% versus 12%) and have received treatment (30% versus 7%). CONCLUSIONS: The prevalence of suboptimal sleep among persons with a mental health condition in Australia is significantly higher than those without such a condition, and rates of assessment and treatment are low for both groups, but higher for people with a mental health condition. Population health interventions, including those delivered as part of routine health care, addressing suboptimal sleep are needed.

Family perspectives on the acceptability and usefulness of the FAB Positive Behaviour Support program: A pilot study.

Purpose: This pilot feasibility study aimed to gain preliminary insight into the acceptability and usefulness of the FAB-PBS program for providing behavior support to families following acquired brain injury (ABI) in community settings. The FAB-PBS program is based on a Positive Behavior Support (PBS) framework and principles of Family-Centered Care and Family-Directed Intervention. It consists of an education phase followed by individualized sessions during which the family is supported to develop and implement a PBS plan.Methods: A mixed-methods design was utilized, with feedback obtained from family members via short questionnaires and semi-structured interviews post education phase and individualized sessions, and at three-month follow up.Results: Two family members completed the full FAB-PBS program and reported high satisfaction with the program and increased confidence in providing behavior support. Findings also suggested an increase in desired behaviors and a decrease in challenging behaviors presented by family members with ABI.Conclusions: The FAB-PBS program may be an acceptable and feasible approach to increasing the capability of family caregivers in providing behavior support following ABI. Further pilot testing is required to inform the development of a larger feasibility study.

Effectiveness of self-management programmes for adolescents with a chronic illness: A systematic review.

AIM: To assess what is known about the effectiveness of face-to-face self-management programmes designed specifically for adolescents (10-19 years) with a chronic illness. DESIGN: A systematic review and synthesis without meta-analysis (SWiM). DATA SOURCES: Six international web-based reference libraries were searched with a date range of 1946 to July 2020. REVIEW METHOD: The PRISMA statement and SWiM guideline were used for reporting the methods and results. The PICO format was used to develop a focused clinical question and the eligibility criteria of our review. Quality assessment of the included studies was performed using the Cochrane Effective Practice Organisation of Care criteria. RESULTS: Eight studies (four randomized controlled trials and four descriptive designs) met the inclusion criteria and were published between 2003 and 2017. Results of the review: Three studies demonstrated measures of illness control which showed initial improvements in adherence as a result of the interventions but failed to demonstrate sustained adherence over time. Booster sessions were identified as an effective strategy to improve adherence, but were often omitted. CONCLUSIONS: There is a limited body of evidence on the effectiveness of self-management programmes specifically developed for adolescents with a chronic illness, an important but under researched area. Future research lies in the development of more rigorous studies that focus on quantitative outcome measures for evaluating the effectiveness of self-management programmes to guide the development of future programmes. IMPACT: It is crucial for adolescents with a chronic illness to develop independence and the self-management skills required to effectively manage their chronic condition as they transition to adulthood. On current evidence, in planning future self-management interventions should include booster sessions. Nurses with additional training and experience have a key role in supporting adolescents with a chronic illness to develop self-management skills as they assume responsibility for their own healthcare.

The role of comorbidity assessment in guiding treatment decision-making for women with early breast cancer: a systematic literature review.

PURPOSE: Comorbidity in breast cancer patients impacts treatment choice, toxicity, and outcomes. While comorbidity measurement tools are frequently used by researchers, little is known about their use in clinical practice. The aim of this review was to examine the use of comorbidity measurement tools in clinical practice and their role in treatment decision-making in breast cancer. METHODS: Six electronic databases were searched from inception to 21 March 2019. Quantitative or mixed methods studies addressing primary treatment of breast cancer and identifying a comorbidity measurement tool used in clinical practice treatment decision-making were included. Data was extracted on tool utilized, impact on treatment decisions or outcomes, pattern of use, and psychometric properties. RESULTS: A systematic search of literature yielded 752 studies. Of the four studies that met inclusion criteria, each utilized a comprehensive geriatric assessment tool, though only in a subset of patients. No studies found direct comorbidity measurement tools utilized independently of geriatric assessment. Assessment results had variable impact on treatment decisions. Impacts on patient mortality and treatment toxicity, cost-effectiveness, and psychometric characteristics of the tools were not identified. CONCLUSIONS: There is little evidence on use of specific comorbidity tools in clinical decision-making in breast cancer outside of comorbidity assessment as part of geriatric assessment tools. There was limited impact on decision-making or patient outcomes when these were utilized. Further research is needed to identify barriers to comorbidity assessment in clinical practice and identify comorbidity tools that have the potential to improve patient outcomes.

The effects of emergency medical service work on the psychological, physical, and social well-being of ambulance personnel: a systematic review of qualitative research.

BACKGROUND: High rates of mental distress, mental illness, and the associated physical effects of psychological injury experienced by ambulance personnel has been widely reported in quantitative research. However, there is limited understanding of how the nature of ambulance work contributes to this problem, the significant large toll that emergency medical response takes on the individual, and particularly about late and cumulative development of work-related distress among this first responder workforce. METHODS: This study examined peer-reviewed qualitative research published from 2000 to 2018 to outline the effect of emergency medical response work on the psychological, psychosocial, and physical health of paramedics, ambulance officers, ambulance volunteers, and call-takers. Databases searched included: Ovid Medline, CINAHL, Ovid EMcare, PsychInfo and Scopus. The systematic review was organised around five key areas: impact of the work on psychological wellbeing; impact of psychological stress on physical wellbeing; how work-related well-being needs were articulated; effects of workflow and the nature of the work on well-being; and, effects of organisational structures on psychological and physical well-being. RESULTS: Thirty-nine articles met the eligibility criteria. Several factors present in the day-to-day work of ambulance personnel, and in how organisational management acknowledge and respond, were identified as being significant and contributing to mental health and well-being, or increasing the risk for developing conditions such as PTSD, depression, and anxiety. Ambulance personnel articulated their well-being needs across four key areas: organisational support; informal support; use of humour; and individual mechanisms to cope such as detachment and external supports. CONCLUSIONS: Interactions between critical incidents and workplace culture and demands have an overwhelming impact on the psychological, physical and social well-being of ambulance personnel. These include day-to-day managerial actions and responses, the impact of shift work, poorly-managed rosters, and long hours of work with little time between for recovery. Mental health issues result from exposure to traumatic events, and the way managers and peers respond to worker distress. Ambulance personnel suffering from work-related stress feel abandoned by peers, management, and the service, during illness, in return-to-work, and post-retirement. Policy, programmes and interventions, and education need to occur at an individual, peer, organisational, and government level.

Pain Self-Management: Easier Said than Done? Factors Associated with Early Dropout from Pain Self-Management in a Rural Primary Care Population.

OBJECTIVE: To explore whether psychosocial or demographic factors are associated with early dropout from pain self-management in a rural, low-socioeconomic status population. DESIGN: Secondary analysis of retrospective data. SETTING: Multidisciplinary pain clinic located in an outer regional area of Australia. SUBJECTS: One hundred eighty-six people attending a public community health center with chronic noncancer pain (mean age 54.9 years; 58.1% women; 81.7% in receipt of government benefit as their primary source of income). METHODS: Bivariate analysis and logistic regression, with early dropout as the dependent variable and a range of demographic and psychological independent variables. RESULTS: Following bivariate analysis, early dropout was significantly associated (P < 0.05) with male gender, younger age, history of substance use, being a past victim of assault/abuse, receiving unemployment or disability benefit, having literacy difficulties, higher pain catastrophizing score, higher daily opioid dose, and not holding a multifactorial belief about the cause of pain. Logistic regression analysis resulted in three significant predictors of dropout: substance use history (P = 0.002), past victim of assault or abuse (P = 0.029), high pain catastrophising score (P = 0.048); and one of engagement: holding a multifactorial belief about pain cause (P = 0.005). CONCLUSIONS: In a rural, low-socioeconomic status population, addressing social stressors related to lifetime adversity may be important to increasing engagement in pain self-management. Lack of attention to these factors may increase health inequity among those most disabled by chronic pain. Further research into dropout and engagement, especially among disadvantaged populations, is recommended.

Outcomes of telephone-delivered low-intensity cognitive behaviour therapy (LiCBT) to community dwelling Australians with a recent hospital admission due to depression or anxiety: MindStep™.

BACKGROUND: In 2006, the British government launched 'Improving Access to Psychological Therapies' (IAPT), a low intensity cognitive behaviour therapy intervention (LiCBT) designed to manage people with symptoms of anxiety and depression in the community. The evidence of the effectiveness of IAPT has been demonstrated in multiple studies from the UK, USA, Australia and other countries. MindStep™ is the first adaptation of IAPT in Australia, delivered completely by telephone, targeting people with a recent history of a hospital admission for mental illnesses within the private health system. This paper reports on the outcome of the first 17 months of MindStep™ implemented across Australia from March 2016. METHODS: This prospective observational study investigated the MindStep™ program in a cohort of clients with a recent hospitalisation for mental illnesses. The study used quantitative methods to compare pre-post treatment clinical measures (N = 680) using Patient Health Questionnaire (PHQ-9) and the Generalised Anxiety Disorder (GAD-7). This study also included in-depth interviews with participants (N = 14) and coaches (N = 4) to determine the feasibility and acceptability of the program. RESULTS: Of the 867 clients referred to MindStep™, 757 had initial assessments by phone making an enrolment rate of 87.3%. Following assessment, 680 commenced treatment and of them, 427 (62.7%) completed treatment. According to 'per-protocol' analysis (N = 427), there was a large effect size for post-treatment PHQ-9 (d = 1.03) and GAD-7 (d = 0.99) scores; reliable recovery rate was 62% (95% CI: 57-68%). For intent-to-treat analysis using multiple imputation (N = 680), effect sizes were also large for pre-post treatment change: PHQ-9 (d = 0.78) and GAD-7 (d = 0.76). The reliable recovery rate was 49% (95% CI: 45-54%). Qualitative findings supported these claims where participants were positive about MindStep™ and found the telephone delivery and use of mental health coaches highly acceptable. CONCLUSIONS: MindStep™ has demonstrated encouraging outcomes that suggest LiCBT can be successfully delivered to people with a history of hospital admissions for anxiety and depressive disorders and achieve target recovery rates of > 50%. Other promising evaluation findings indicate the MindStep™ option is acceptable, feasible and safe within the stepped models of mental health care delivery in Australia.