Child Maltreatment and Long-Term Physical and Mental Health Outcomes: An Exploration of Biopsychosocial Determinants and Implications for Prevention.

Child maltreatment rates remain unacceptably high and rates are likely to escalate as COVID-related economic problems continue. A comprehensive and evidence-building approach is needed to prevent, detect and intervene where child maltreatment occurs. This review identifies key challenges in definitions, overviews the latest data on prevalence rates, reviews risk and protective factors, and examines common long-term mental health outcomes for children who experience maltreatment. The review takes a systems approach to child maltreatment outcomes through its focus on the overall burden of disease, gene-environment interactions, neurobiological mechanisms and social ecologies linking maltreatment to mental ill-health. Five recommendations relating to the accurate measurement of trends, research on brain structures and processes, improving the reach and impact of teleservices for detecting, preventing and treating child maladjustment, community-based approaches, and building population-focused multidisciplinary alliances and think tanks are presented.

The mental health and wellbeing survey of Australian optometrists.

PURPOSE: To investigate the prevalence of mental health conditions and burnout among practising optometrists in Australia. METHODS: A cross-sectional survey of registered practising Australian optometrists was undertaken over a three-week period from mid-November 2019. The survey comprised three well-established mental health scales (Kessler Psychological Distress Scale [K10], Depression Anxiety Stress Scales [DASS-21] and Maslach Burnout Inventory [MBI]) and an open-ended question inviting comments. RESULTS: Five hundred and five respondents completed the K10, representing 8.8% of registered optometrists in Australia; 466 completed all three scales. Prevalence of moderate to severe psychological distress (K10 ≥ 25) was 30.7% (95% CI 26.7%-34.7%), with similar findings for depression and anxiety (DASS-21). Prevalence of high burnout, as indicated by MBI-GS exhaustion was 56.1% (95% CI 51.7%-60.4%), cynicism 57.1% (95% CI 52.7%-61.5%) and professional efficacy 23.1% (95% CI 19.4%-26.8%). Optometrists aged ≤ 30 years were 3.5 times more likely to report moderate to severe psychological distress compared to optometrists aged >30 years (OR = 3.54, P < 0.001, 95% CI 2.38-5.25). The most frequently mentioned work-related issues concerned retail pressures, workload and career dissatisfaction. CONCLUSIONS: The rates of mental health conditions and burnout reported by practising Australian optometrists were high compared with the general population and other health professionals. Younger age and burnout were significant risk factors for psychological distress. Interventions are required to address these issues, particularly for younger optometrists, and could include workplace modifications and building resilience to improve personal mental wellbeing and ensure patient safety.

Understanding eating and drinking behaviours in Pakistani university students: A conceptual model through qualitative enquiry.

Excess weight in Pakistan's university students is on the rise and is driven by their maladaptive eating behaviours. Practitioners in Pakistan have adopted Western conceptual models to understand obesogenic eating behaviours. However, these models provide incomplete explanations as they miss important culturally specific determinants for such eating behaviours. The goals of this study were two-fold: first, to explore Pakistani university students' perception of their obesity-related eating behaviours and attitudes; second, to develop a culturally sensitive model of obesogenic eating behaviours in university students from Pakistan. Semi-structured interviews were used with twenty-four Pakistani university students who were categorised as obese using the Body Mass Index according to Asia-Specific cut-offs. Interviews were transcribed, translated, and then analysed through a Grounded Theory methodology. Six major categories emerged from interviews: (1) Obesogenic Eating Habits (Social Eating, Emotional Eating, and Eating Whatever and Whenever You Want); (2) Beliefs about Food in the Culture; (3) Neither Too Fat nor Too Thin body belief (4) Student Life Attitudes; (5) Student Stressors; (6) Inconsistent Weight-Control Strategies. A model was developed with cultural beliefs about food, attitudes towards student-life, and stressors as important determinants of students' obesogenic eating habits, while inconsistent weight-control strategies contributed to further weight gain. The findings highlight the importance of identifying culturally specific determinants of eating behaviours among university students in Pakistan. This emerging model can be used to guide the development of future quantitative and also longitudinal studies aimed at identifying targets for therapeutic interventions to manage obesogenic eating behaviours in Pakistani university students.

Postnatal depressive symptoms amongst women in Central Vietnam: a cross-sectional study investigating prevalence and associations with social, cultural and infant factors.

BACKGROUND: This study investigated the prevalence and socio-cultural correlates of postnatal mood disturbance amongst women 18-45 years old in Central Vietnam. Son preference and traditional confinement practices were explored as well as factors such as poverty, parity, family and intimate partner relationships and infant health. METHODS: A cross-sectional study was conducted in twelve randomly selected Commune Health Centres from urban and rural districts of Thua Thien Hue Province, Vietnam. Mother-infant dyads one to six months postpartum were invited to participate. Questionnaires from 431 mothers (urban n = 216; rural n = 215) assessed demographic and family characteristics, traditional confinement practices, son preference, infant health and social capital. The Edinburgh Postnatal Depression Scale (EPDS) and WHO5 Wellbeing Index indicated depressive symptoms and emotional wellbeing. Data were analysed using general linear models. RESULTS: Using an EPDS cut-off of 12/13, 18.1% (n = 78, 95% CI 14.6-22.1) of women had depressive symptoms (20.4% urban; 15.8% rural). Contrary to predictions, infant gender and traditional confinement were unrelated to depressive symptoms. Poverty, food insecurity, being frightened of family members, and intimate partner violence increased both depressive symptoms and lowered wellbeing. The first model accounted for 30.2% of the variance in EPDS score and found being frightened of one's husband, husband's unemployment, breastfeeding difficulties, infant diarrhoea, and cognitive social capital were associated with higher EPDS scores. The second model had accounted for 22% of the variance in WHO5 score. Living in Hue city, low education, poor maternal competence and a negative family response to the baby lowered maternal wellbeing. CONCLUSIONS: Traditional confinement practices and son preference were not linked to depressive symptoms among mothers, but were correlates of family relationships and wellbeing. Poverty, food insecurity, violence, infant ill health, and discordant intimate and family relationships were linked with depressive symptoms in Central Vietnam.

A Qualitative Study of Adolescents from Refugee Backgrounds Living in Australia: Identity and Resettlement.

Identity formation among young people from refugee backgrounds is complex, as it occurs while they are both integrating into a novel cultural landscape and navigating the intricacies of adolescence. The present study explored sense of identity and experiences among refugee youth in the context of resettlement. Nineteen young people (15-18 years) from refugee backgrounds, settled in Brisbane, Australia, took part in the study. An individual semi-structured interview, drawing upon the Tree of Life method, was used. The thematic analysis (TA) methodology was adopted, and several themes emerged: experiencing changes in family roles; experience of belonging; experience of bonds with lost loved ones; dealing with emotions in a new context; experience of self in the context of change. There was one emergent overarching theme of meaning-making in the context of change. These themes were explicated within the framework of social identity and sociocultural theories, which emphasises the dynamic co-construction of identity through the interplay of belonging and meaning-making within specific contextual settings. This study highlights the fundamental role of social context, particularly the fostering of school belonging, in the multifaceted process of identity construction. The findings identify the importance of integrating multiple identities and experiences to develop a comprehensive and resilient sense of personal cohesion and selfhood.

An Indonesian model of well-being: The integration of universal and cultural factors.

The current study examined a predictive model of both universal factors (socioeconomic, neuroticism, and extraversion) and culturally specific factors (sense of community, trust, and self-construal) towards the well-being of Indonesians. A nationally representative sample (N = 929) was recruited across the nation to complete a survey in either online or offline format. The survey contained a measure of well-being as well as demographic, psychosocial, and cultural variables. Analysis via hierarchical multiple regression showed that both universal and cultural factors were associated with well-being in this Indonesian sample. In particular, once the cultural factors were added to the model, there were changes in universal factor effects to well-being. The finding of this study recognized the multidimensional model of well-being and supports the importance of evaluating well-being at the dimensional level to allow for an exploration of the nuanced relationship between distinct indicators and facets of well-being. The theoretical implications of these results and future directions were also discussed in this study.

Identifying the Links Between Trauma and Social Adjustment: Implications for More Effective Psychotherapy With Traumatized Youth.

Background: Past research has highlighted the role of trauma in social adjustment problems, but little is known about the underlying process. This is a barrier to developing effective interventions for social adjustment of traumatized individuals. The present study addressed this research gap through a cognitive model. Methods: A total of 604 young adults (aged 18-24; living in Australia) from different backgrounds (refugee, non-refugee immigrant, and Australian) were assessed through self-report questionnaires. The data were analyzed through path analysis and multivariate analysis of variance. Two path analyses were conducted separately for migrant (including non-refugee and refugee immigrants) and Australian groups. Results: Analyses indicated that cognitive avoidance and social problem solving can significantly mediate the relation between trauma and social adjustment (p < 0.05). The model explaining this process statistically fit the data (e.g., NFI, TLI, CFI > 0.95). According to the model, reacting to trauma by cognitive avoidance (i.e., chronic thought suppression and over-general autobiographical memory) can disturb the cognitive capacities that are required for social problem solving. Consequently, a lack of effective social problem solving significantly hinders social adjustment. There were no significant differences among the Australian, non-refugee immigrant and refugee participants on the dependent variables. Moreover, the hypothesized links between the variables was confirmed similarly for both migrant (including refugee and non-refugee immigrants) and Australian groups. Conclusion: The findings have important implications for interventions targeting the social adjustment of young individuals. We assert that overlooking the processes identified in this study, can hinder the improvement of social adjustment in young adults with a history of trauma. Recommendations for future research and practice are discussed.

How much can our universities do in the development of cultural intelligence? A cross-sectional study among health care students.

BACKGROUND: Cultural intelligence reflects the competence to adapt to new cultural settings. Universities offer students various opportunities to gain cultural learning and develop cultural intelligence. However, there has been little empirical research to compare the effects of cultural learning and other related psycho-social factors in this process. OBJECTIVE: This study explores the importance of cultural learning and identifies the unique contribution of cultural education in universities to health care students' cultural intelligence. DESIGN: Cross-sectional survey study. METHODS: 271 health care students completed a survey measuring social desirability, demographics, personality, prior cultural exposure, previous cultural learning and cultural intelligence. RESULTS: Hierarchical regressions showed that cultural learning could affect cultural intelligence and its three components (i.e., metacognition, cognition, motivation, and behaviour) under the control for related psycho-social factors. However, its effect on the behavioral component was not significant. Considering the different types of cultural learning, overseas study experiences were more related to cultural intelligence, compared to in-class cultural learning. CONCLUSION: Cultural learning, especially overseas study experiences, plays a significant role in the development of health care students' cultural intelligence.

Improvement in the Cognitive Aspects of Cultural Competence after Short-Term Overseas Study Programs.

Universities are providing short-term overseas study programs for healthcare students to increase their cultural competence (i.e., capacity to work effectively in cross-cultural situations). However, there is limited empirical research evaluating the effects of these programs using well-controlled research designs. In the present research study, undergraduate healthcare students in an Australian university were selected as participants. Group 1 (n = 32) participated in a short-term overseas study program in Asia (i.e., China, Vietnam, Singapore, and Taiwan), whereas Group 2 (n = 46) stayed in Australia to continue their university education as usual. All participants completed a self-developed demographic questionnaire, Cultural Intelligence Scale, and Multicultural Personality Questionnaire. Cultural competence was surveyed pre- and post-short-term overseas programs. After controlling for prior overseas experiences and the open-mindedness trait, an ANCOVA indicated that Group 1 had a significantly higher scores than Group 2 in cultural knowledge (p < 0.05), but not in cultural awareness, attitude, or skills. It is suggested that short-term overseas study programs may increase healthcare students' cultural knowledge, a component of competence, and that more needs to be accomplished to improve other areas of cultural competence.

Difficulties and coping strategies of Sudanese refugees: a qualitative approach.

A qualitative approach was used to interview 23 Sudanese refugees residing in Brisbane, Australia. Semi-structured interviews were conducted to examine the participants' pre-migration, transit and post-migration experiences. Refugees reported traumatic and life-threatening experiences during the pre-migration and transit phases, and difficulties with resettlement during the post-migration phase. Nevertheless, participants reported using a number of coping strategies across all phases, including: reliance on religious beliefs, cognitive strategies such as reframing the situation, relying on their inner resources, and focusing on future wishes and aspirations. Social support also emerged as a salient coping strategy. The findings are useful for mental health professionals as they highlight the difficulties experienced by refugees across phases of migration as well as strategies they use to manage these traumas and stresses.

The development and psychometric investigation of the university student depression inventory.

BACKGROUND: Depression is prevalent among university students. It is debilitating and affects the academic performance of students. One of the most common reasons why students consult counselling centres is depression. Therefore it is important to assess the university students' depression by valid measures designed particularly for this purpose. METHOD: The present study developed the "University Student Depression Inventory" (USDI) to measure the depressive symptoms of university students. RESULT: Items based on a broad range of depression symptoms were subjected to factor analysis, resulting in a 30 item scale with three subscales: Lethargy; Cognitive/Emotional; and Academic Motivation. Psychometric investigation revealed satisfactory reliability and divergent and convergent validity. CONCLUSION: It is expected that multidimensional USDI would be a useful tool for university counselling services to assess the depression of the students.

The Thoughts Questionnaire (TQ) for family caregivers of people with dementia.

OBJECTIVES: To develop a new measure of dysfunctional thoughts for family caregivers of people living with dementia. These thoughts can contribute to negative outcomes, but they may be modifiable. METHOD: A stepwise process was used to develop the Thoughts Questionnaire, commencing with item generation, concept mapping, and pilot testing in a sample of professional and nonprofessional caregivers of people with dementia (n = 18). Next, an independent sample of 35 family caregivers of people with dementia (30 female; Mage = 64.30, standard deviation = 10.65) completed: (a) the Thoughts Questionnaire; (b) an existing measure of dysfunctional thoughts, the Dementia Thoughts Caregivers Questionnaire; and (c) separate validated measures of depressive symptoms, caregiver stress, and coping, respectively. RESULTS: The level of agreement with dysfunctional thought statements from the Dementia Thoughts Caregivers Questionnaire and Thoughts Questionnaire was low. However, a small number of Thoughts Questionnaire statements were strongly endorsed by over 85% of the sample. Both dysfunctional thought measures had adequate reliability, but total scores were not significantly intercorrelated (r = .287, p = .095). Only the Thoughts Questionnaire was significantly, positively correlated with most caregiver stress measures. Thoughts Questionnaire items required a much lower reading level than the Dementia Thoughts Caregivers Questionnaire items. DISCUSSION: This study provides preliminary data on a tool for assessing the negative role-related thoughts that family caregivers of people with dementia may experience. Given that these thoughts are implicated in depression but they may be modified, the capacity to identify dysfunctional thoughts may prove useful in caregiver support programs.

Depression among Indian university students and its association with perceived university academic environment, living arrangements and personal issues.

The aim of the study is to ascertain the level of depression among university students across gender, academic stream, semesters, perception of family environment and relationship with parents, academic performance, and family income. In addition, the study examines the association between students' perceived university academic environment, living arrangements, personal issues, and depression. Seven hypotheses were formulated for verification. A total of 717 students were recruited following the multistage cluster sampling method, and data were collected by a specially designed structured questionnaire, academic achievement record and a standardized University Students Depression Inventory. Findings disclosed that 37.7%, 13.1%, and 2.4% of the students were suffering from moderate, severe, and extremely severe depression. A significant difference was found across semester, that is, semester II students reported a higher level of depression than semester III students. So far as academic stream is concerned, students from humanities and social science were found to be suffering from more depression compared to students from science and management streams. The study further disclosed that the students who reported positive views about the university academic environment and living arrangements had lower level of depression compared to their counterparts. Personal resilience's such as being able to sharing personal problems with others and doing regular exercise were found to be associated with positive mental health. The findings of the study emphasize the need for immediate mental health support services for about 15.6% of the students who were either suffering from severe or extremely severe depression at the University.

Anxious Thoughts and Tendencies Scale: an investigation of factor structure and the psychometric properties on the basis of an Australian sample.

BACKGROUND: The factor structure and psychometric properties of the revised Anxious Thoughts and Tendencies Scale (AT&T) is investigated. METHODS: An Australian sample of 215 students and 33 patients diagnosed with an anxiety disorder completed a battery of anxiety-related questionnaires. RESULTS: Factor analysis indicated one factor, which accounted for 38% of the variance and had high internal consistency and reliability. Significant relationships were found with measures of anxiety, anxiety sensitivity, catastrophic cognitions, fear and depression. The AT&T discriminated between students and patients, and between students with high or low levels of anxiety and fear. LIMITATIONS: The size of the clinical sample was very small and the study needs to be replicated with a large and carefully recruited clinical sample. CONCLUSIONS: These results support the AT&T as a valuable and psychometrically sound measure of the cognitive aspects of anxiety.

University student depression inventory (USDI): confirmatory factor analysis and review of psychometric properties.

BACKGROUND: The 30-item USDI is a self-report measure that assesses depressive symptoms among university students. It consists of three correlated three factors: lethargy, cognitive-emotional and academic motivation. The current research used confirmatory factor analysis to asses construct validity and determine whether the original factor structure would be replicated in a different sample. Psychometric properties were also examined. METHOD: Participants were 1148 students (mean age 22.84 years, SD=6.85) across all faculties from a large Australian metropolitan university. Students completed a questionnaire comprising of the USDI, the depression anxiety stress scale (DASS) and Life Satisfaction Scale (LSS). RESULTS: The three correlated factor model was shown to be an acceptable fit to the data, indicating sound construct validity. Internal consistency of the scale was also demonstrated to be sound, with high Cronbach alpha values. Temporal stability of the scale was also shown to be strong through test-retest analysis. Finally, concurrent and discriminant validity was examined with correlations between the USDI and DASS subscales as well as the LSS, with sound results further supporting the construct validity of the scale. Cut-off points were also developed to aid total score interpretation. LIMITATIONS: Response rates are unclear. In addition, the representativeness of the sample could be improved potentially through targeted recruitment (i.e. reviewing the online sample statistics during data collection, examining the representativeness trends and addressing particular faculties within the university that were underrepresented). CONCLUSIONS: The USDI provides a valid and reliable method of assessing depressive symptoms found among university students.