Predicting mental health and well-being in adulthood.

Although previous research focused on identifying risk factors for mental disorders (or ill-being), recent research has demonstrated a shift towards factors predicting mental well-being. A series of variables from a longitudinal study was used to compare 2 interpretations of mental well-being, namely mental health, defined as lack of DSM caseness, and dispositional optimism. Using logistic and linear regression analyses, the significant predictors of mental health were fewer adverse life events, higher self-esteem, greater perceived social support, and less anticipated depressogenic effects when goals were not met, while optimism was predicted by fewer adverse life events, higher self-esteem, lower neuroticism, and higher femininity scores. After discussion of the implications of both definitions, it is proposed that both can potentially be used as proxies for mental health when more direct well-being measures are unavailable. This article reinforces the need for precise conception(s) of mental well-being, allowing objective measures to guide future research.

Temperament, substance use and psychopathology in a prisoner population: implications for treatment.

OBJECTIVE: The association between temperament and drug use or temperament and psychopathology has previously been restricted to community clinical or non-clinical samples. The aim of the present study was therefore to examine these associations in a large cohort of Australian offenders using Cloninger's Temperament and Character Inventory (TCI). METHODS: A total of 1322 prisoners from New South Wales (NSW) who completed all dimensions of the TCI and were screened for mental illness using the Australian National Survey of Mental Health and Wellbeing were included in the study. RESULTS: A total of 15% of the sample fulfilled the criteria for a diagnosis for depression, 36% for anxiety disorders and 54% for a substance abuse disorder. Using logistic regression analysis, the TCI dimensions of harm-avoidance and low self-direction predicted depression. Being female, a poly-substance user and having high harm-avoidance, persistence, self-direction and self-transcendence predicted anxiety disorders. Significant stepped trends across age, gender, and type of drug use were found for all TCI dimensions. CONCLUSIONS: The TCI is useful in identifying prisoners with a history of psychopathology and substance misuse. This tool also provides clinically relevant information about at-risk individuals and has the potential to guide the development of intervention programmes for inmates.

Smoking cessation and depression: current knowledge and future directions.

This paper reviews the literature on comorbid smoking and depression. Current models used to explain this co-occurrence are examined, as are treatment options (both psychological and pharmacological). This paper surmises that treatment planning should consider factors that potentially confound treatment efficacy, including the nature of the depressive illness and the patient's smoking profile. Although there is limited research examining the benefits of a stepped-care framework, a tiered treatment format appears to work well, assisting those who require minimal treatment, as well as those who prolonged difficulties. Further research examining a stepped-care framework for smokers at risk of depression is required, as is appropriate training for health practitioners using this model. Further directions for research and practice are also discussed.

Expressive writing for high-risk drug dependent patients in a primary care clinic: a pilot study.

BACKGROUND: Previous research has shown that expressive writing is beneficial in terms of both physical and emotional health outcomes. This study aimed to investigate the effectiveness and acceptability of a brief expressive writing intervention for high-risk drug dependent patients in a primary care clinic, and to determine the relationship between linguistic features of writing and health outcomes. METHODS: Participants completed four 15-minute expressive writing tasks over a week, in which they described their thoughts and feelings about a recent stressful event. Self-report measures of physical (SF-12) and psychological health (DASS-21) were administered at baseline and at a two-week follow-up. Fifty-three participants were recruited and 14 (26%) completed all measures. RESULTS: No statistically significant benefits in physical or psychological health were found, although all outcomes changed in the direction of improvement. The intervention was well-received and was rated as beneficial by participants. The use of more positive emotion words in writing was associated with improvements in depression and stress, and flexibility in first person pronoun use was associated with improvements in anxiety. Increasing use of cognitive process words was associated with worsening depressive mood. CONCLUSION: Although no significant benefits in physical and psychological health were found, improvements in psychological wellbeing were associated with certain writing styles and expressive writing was deemed acceptable by high-risk drug dependent patients. Given the difficulties in implementing psychosocial interventions in this population, further research using a larger sample is warranted.

Great expectations: factors influencing patient expectations and doctors recommendations at a Mood Disorders Unit.

BACKGROUND: Literature about expectations and management of depression within community samples reflects attitudes of people who have generally not received treatment. We examined the factors influencing treatment expectations and psychiatrists' treatment recommendations for patients referred to a mood disorders unit with identified episodes of major depression. METHODS: Prior to attending a mood disorders unit, 182 men and women who met DSM-III-R or DSM-IV criteria for current major depression provided data on sociodemographic details, history of medical and psychiatric illness and expectations of treatment. Psychiatrists' treatment recommendations to the referring clinician were assessed to determine whether the patients' initial expectations were met. RESULTS: Data analyses revealed three factors relating to patients' expectations: "enhanced coping", "providing fresh ideas for the referring doctor" and "providing fresh ideas to self". Patients' expectations were influenced by sociodemographic and illness-related characteristics. In particular, young female patients typically expected to receive strategies to enhance coping, while those with lifetime anxiety expected less active involvement on their part. Some clinicians' recommendations were dependent upon depression type and patient factors. Women and those with a history of anxiety disorders received more education and recommendations for relationship counselling and support groups. LIMITATIONS: The study design did not allow determination of the impact of patients' expectations on the psychiatrists' recommendations. CONCLUSIONS: Individual and illness characteristics are important predictors of treatment expectations prior to specialist care. It appears that doctors take these factors into account with implications for patients' satisfaction with the type of care recommended.

Emotional flooding and hostile discipline in the families of toddlers with disruptive behavior problems.

This study examined the relationship between negative parenting practices and dysfunction in parents' cognitive processing of child affect cues in families of toddlers with disruptive behavior problems. This dysfunction comprised a bias toward the misclassification of child affect as anger (affect appraisal bias) and parents' proneness to emotional flooding (Gottman, 1991, 1993). Participants were families of toddlers (n = 82; 53% male; aged 18-48 months) referred to a tertiary-level health service for the treatment of disruptive behavior problems. Affect appraisal bias was indexed in terms of the discrepancy between rates of child anger coded from video recordings of parent-child interactions and rates of child anger estimated by parents immediately after these interactions. Parenting practices and emotional flooding were assessed using the Parenting Scale and the Parental Flooding Scale. Both hostile and overreactive discipline were positively associated with severity of disruptive behavior problems, however only hostile discipline was associated with the biased appraisal of child affect and emotional flooding. Emotional flooding was found to be a unique predictor of hostile discipline, independent of covariates including the severity of disruptive behavior problems. Variance in hostile discipline was further explained by the interaction between emotional flooding and affect appraisal bias. Emotional flooding appears to be particularly proximal to hostile discipline in the families of toddlers with disruptive behavior problems, consistent with evidence previously reported for nonclinical families.

Women and depression: a 30 year learning curve.

This paper reviews 30 years of longitudinal research, initially undertaken to examine gender differences in rates of major depression and psychosocial risk factors for depression. The research focus has broadened to include the impact of anxiety on depression onset, coping styles for stress and depression, genetic and environmental influences on depression onset, and more recently, a shift towards examining positive mental health. The original cohort consisted of a socially homogenous group of postgraduate teacher trainees and does not attempt to represent the normal variability in an adult population. However, the issues raised by this research provide many insights about real and artefactual factors that contribute to the rate and experience of depression. The study findings are supplemented by data from other studies undertaken by this research team that are pertinent to the topic and add weight to some of the observations from the Teachers' Study.

Life events, first depression onset and the serotonin transporter gene.

BACKGROUND: A relationship between the serotonin transporter gene, adverse events and onset of major depression has been reported. AIMS: To replicate a gene x environment interaction in a cohort with longitudinal data for life events, experience of depression, parental bonding and neuroticism. METHOD: At the 25-year follow-up, genomic DNA was obtained from 127 cohort members (mean age 48 years) to determine the genotype of the serotonin transporter gene-linked promoter region (5-HTTLPR). Associations were investigated between the 5-HTTLPR genotype, positive and adverse life events and the gene x environment interaction, and also between the 5-HTTLPR genotype and risk factors for depression. RESULTS: No relationship was found between 5-HTTLPR genotype and either risk factors for depression or positive life events. Adverse life events had a significantly greater impact on the onset of depression for individuals with the s/s genotype. CONCLUSIONS: The 5-HTTLPR genotype is a significant predictor of onset of major depression following multiple adverse events. This is one of the more robust findings concerning specific biological risk factors for depression.