Development and evaluation of an aged care specific Advance Care Plan.

OBJECTIVES: To report on the quality of advance care planning (ACP) documents in use in residential aged care facilities (RACF) in areas of Victoria Australia prior to a systematic intervention; to report on the development and performance of an aged care specific Advance Care Plan template used during the intervention. DESIGN: An audit of the quality of pre-existing documentation used to record resident treatment preferences and end-of-life wishes at participating RACFs; development and pilot of an aged care specific Advance Care Plan template; an audit of the completeness and quality of Advance Care Plans completed on the new template during a systematic ACP intervention. PARTICIPANTS AND SETTING: 19 selected RACFs (managed by 12 aged care organisations) in metropolitan and regional areas of Victoria. RESULTS: Documentation in use at facilities prior to the ACP intervention most commonly recorded preferences regarding hospital transfer, life prolonging treatment and personal/cultural/religious wishes. However, 7 of 12 document sets failed to adequately and clearly specify the resident's preferences as regards life prolonging medical treatment. The newly developed aged care specific Advance Care Plan template was met with approval by participating RACFs. Of 203 Advance Care Plans completed on the template throughout the project period, 49% included the appointment of a Medical Enduring Power of Attorney. Requests concerning medical treatment were specified in almost all completed documents (97%), with 73% nominating the option of refusal of life-prolonging treatment. Over 90% of plans included information concerning residents' values and beliefs, and future health situations that the resident would find to be unacceptable were specified in 78% of completed plans. CONCLUSIONS: Standardised procedures and documentation are needed to improve the quality of processes, documents and outcomes of ACP in the residential aged care sector.

Quality of advance care planning policy and practice in residential aged care facilities in Australia.

OBJECTIVES: To assess existing advance care planning (ACP) practices in residential aged care facilities (RACFs) in Victoria, Australia before a systematic intervention; to assess RACF staff experience, understanding of and attitudes towards ACP. DESIGN: Surveys of participating organisations concerning ACP-related policies and procedures, review of existing ACP-related documentation, and pre-intervention survey of RACF staff covering their role, experiences and attitudes towards ACP-related procedures. SETTING: 19 selected RACFs in Victoria. PARTICIPANTS: 12 aged care organisations (representing 19 RACFs) who provided existing ACP-related documentation for review, 12 RACFs who completed an organisational survey and 45 staff (from 19 RACFs) who completed a pre-intervention survey of knowledge, attitudes and behaviour. RESULTS: Findings suggested that some ACP-related practices were already occurring in RACFs; however, these activities were inconsistent and variable in quality. Six of the 12 responding RACFs had written policies and procedures for ACP; however, none of the ACP-related documents submitted covered all information required to meet ACP best practice. Surveyed staff had limited experience of ACP, and discrepancies between self reported comfort, and levels of knowledge and confidence to undertake ACP-related activities, indicated a need for training and ongoing organisational support. CONCLUSIONS: Surveyed organisations â policies and procedures related to ACP were limited and the quality of existing documentation was poor. RACF staff had relatively limited experience in developing advance care plans with facility residents, although attitudes were positive. A systematic approach to the implementation of ACP in residential aged care settings is required to ensure best practice is implemented and sustained.

Successful aging: development and testing of a multidimensional model using data from a large sample of older australians.

OBJECTIVES: To develop a multidimensional statistical model that could assess the contribution of, and interrelationships between, measures likely to contribute to an individual's successful aging, defined as aging well across a number of dimensions. DESIGN: Cross-sectional. SETTING: Data collected from 8,841 Australians aged 16 to 85 during the 2007 National Survey of Mental Health and Well-Being conducted by the Australian Bureau of Statistics. PARTICIPANTS: Two thousand two hundred eighty-six survey participants aged 61 to 85. MEASUREMENTS: Self-assessed physical and mental health, quality of life, and cognition constitute the outcome factor: successful aging. Attributes measuring past and current mental and physical health, social measures, and health behaviors were considered for inclusion as predictor measures. Results of the final model allowed calculation of individual weighted successful aging scores. RESULTS: The final model closely fitted responses from participants and men and women separately. Factors measuring mental and physical health and social support contributed significantly and independently to successful aging. Health behaviors, measuring extent of physical exercise and not smoking, contributed to successful aging in addition to their association with physical health. On average, those scoring in the highest decile of the successful aging measure reported having two chronic health conditions, indicating that such conditions do not necessarily preclude high levels of well-being in older individuals. CONCLUSION: This model developed from a large sample of older individuals identified factors worth targeting in future social and health policy initiatives for this age group. It also indicates that chronic illness is not necessarily a barrier to successful aging.

The general practitioner's role in providing mental health services to Australians, 1997 and 2007: findings from the national surveys of mental health and wellbeing.

OBJECTIVES: To compare the findings of the 1997 and 2007 Australian national surveys of mental health and wellbeing (NSMHWBs) with respect to the role of general practitioners in providing mental health services. DESIGN, SETTING AND PARTICIPANTS: There were 10,641 participants Australia-wide in the 1997 survey and 8841 in the 2007 survey. Data were gathered through face-to-face interviews using a written questionnaire. MAIN OUTCOME MEASURES: Rates of use of GPs and other health care providers for treatment of mental health problems; levels of met and unmet need for mental health services reported by those accessing GP services. RESULTS: Between 1997 and 2007, the proportion of people accessing any mental health care service within the previous 12 months increased significantly, from 12.4% to 21.4% (P < 0.01), although the proportion accessing GP care for mental health problems did not increase. In both surveys, nearly 60% of individuals with self-assessed mental health problems sought no professional help for their problems, although about 80% of these non-users had seen GPs about other matters. The proportions of participants who reported receiving sufficient information, medication and/or therapy for their mental health problem increased significantly over the 10-year period. However, unmet need for information also increased. In both surveys, over 90% of participants aged 60 years or over with self-assessed mental health problems reported obtaining no help for their mental health problem despite seeing a GP for other reasons. CONCLUSION: Despite a significant rise in the use of mental health services, the role of GPs in providing such services has not increased.

Differences in older people's responses to CIDI's depression screening and diagnostic questions may point to age-related bias.

BACKGROUND: Psychiatric surveys based on the Composite International Diagnostic Interview (CIDI) report very low rates of affective disorder in older people, perhaps because CIDI's long, convoluted screening questions present a special challenge to aged respondents. We have shown previously that inconsistencies in responses to CIDI's two screening questions about dysphoria and anhedonia rose in frequency with age. By contrast, responses to the short, simple K-10 and GHQ-12 mental health scales showed much less change over the lifespan. As a check on age-related bias, we now compare responses to CIDI's depression screening questions with responses to subsequent, simpler questions about other depressive symptoms. METHODS: Secondary analysis of an Australian national survey in which CIDI was administered to 10,641 adults by trained lay interviewers. RESULTS: Rates of positive responses to both CIDI screening questions fell from 11% in age-group 18-34 years to 3% in respondents aged > or = 65 years. Responses to simpler CIDI items about other depressive symptoms and help-seeking behaviour showed much less change with age. CONCLUSION: Older respondents may deny symptoms when subjected to complex batteries of questions concerning severity, time frame, attribution and consequences. CIDI diagnoses need to be validated across the full age spectrum. LIMITATIONS: Residents of aged care facilities and those with low cognitive scores were excluded.

Mental health scales and psychiatric diagnoses: responses to GHQ-12, K-10 and CIDI across the lifespan.

BACKGROUND: Surveys based on complex interviews like CIDI report very low rates of affective disorder in older people, perhaps because the lengthy, convoluted questions present a special challenge to aged respondents. By contrast, mental health scales like the GHQ-12 and K-10 show much less change in score with age. Before concluding that scales present a fairer picture of aged mental health, it is important to check if scores are inflated by items that might reflect normal involutional changes in cognition, energy and social role. METHODS: Secondary analysis of an Australian national survey of 10,641 adults. RESULTS: GHQ-12 and K-10 scores declined with age to a relatively minor degree. When scores were bisected, the proportion of respondents scoring above the cutpoints fell with age but to a lesser degree than with ICD-10 diagnoses. Scores on GHQ-12 and K-10 items relating to cognition, energy and social role rose with age but, on factor analysis, these items loaded similarly in a two-factor model. CONCLUSION: No evidence emerged of age-related bias in either GHQ-12 or K-10. Items concerning cognition, energy and social role were associated with affect in older people, just as they were in younger ones. It seems unlikely therefore that the different trajectories over the lifespan of CIDI diagnoses and scores on GHQ-12 and K-10 are due to limitations within the scales. The possibility that CIDI minimizes affective disorder in older age-groups cannot be discounted. LIMITATIONS: Residents of aged care facilities and those with low cognitive scores were excluded.

Pretrauma and posttrauma neurocognitive functioning and PTSD symptoms in a community sample of young adults.

OBJECTIVE: The authors sought to assess whether neurocognitive deficits in people with the posttraumatic stress disorder (PTSD) symptoms of reexperiencing and arousal are a consequence of these symptoms or represent a preexisting vulnerability factor for developing these symptoms after exposure to a traumatic event. METHOD: A random sample of 2,097 young adults who participated in a longitudinal epidemiological study in 1999 and 2000 were reinterviewed in 2003 and 2004 after a major natural disaster (a widespread fire) had occurred in the region. At both interviews, participants completed a number of neurocognitive tests covering immediate and delayed word recall, digit span, coding speed, and vocabulary. Five pre- and posttrauma neurocognitive measures for 1,599 participants who were exposed to the fire were examined to assess the extent to which development of the PTSD symptoms of reexperiencing and arousal was associated with change in neurocognitive skills. Analyses adjusted for a number of potential confounding factors. RESULTS: Higher levels of fire-related reexperiencing and arousal symptoms were associated with less improvement in word recall ability at the second interview. However, levels of these symptoms were more consistently associated with having poorer pretrauma scores on all five neurocognitive measures available for this study. CONCLUSIONS: The presence of the PTSD symptoms of reexperiencing and arousal may result in a relative decline in some measures of verbal memory over time. The more robust finding from this study is that poorer performance on some neurocognitive tests may be a vulnerability factor for developing symptoms of PTSD, not only an outcome of PTSD symptoms.

The brain reserve hypothesis, brain atrophy and aging.

BACKGROUND: Researchers have used the concept of brain reserve to explain the dissociation between pathological brain damage and cognitive and functional performance. A variety of brain reserve hypotheses exist, and different empirical strategies have been employed to investigate these variants. OBJECTIVE: The study investigates (i) the relationship between measures of brain burden (atrophy, white matter hyperintensities (WMH)) and measures of reserve (education, creativity, and intelligence); (ii) the relationship between cognitive decline and reserve; (iii) whether measures of reserve mediate the effect of atrophy on estimated cognitive change, and (iv) the association between brain risk factors, education and atrophy. METHODS: A cross-sectional study of a sample of 446 individuals 60-64 years of age who underwent MRI scans as part of a large epidemiological study. Measures were taken of education, intelligence, creativity, cognitive speed, brain volume, WMH, estimated cognitive decline from earlier in life and brain atrophy. RESULTS: No association was found between estimated cognitive decline and brain burden (atrophy, WMH). Risk factors for brain insult were not associated with greater brain atrophy in the less well educated. Neither education, nor any other measure including intelligence or creativity, provided a buffer for cognitive decline in individuals with high levels of brain atrophy. CONCLUSION: Little support was found for the brain reserve hypothesis.

Effectiveness of complementary and self-help treatments for depression in children and adolescents.

OBJECTIVE: To review the evidence for the effectiveness of complementary and self-help treatments for depression in children and adolescents. DATA SOURCES: Systematic literature search using PubMed, PsycINFO and the Cochrane Library for 131 treatments up to February 2006. STUDY SELECTION: There were 13 treatments that had been evaluated in intervention studies. DATA EXTRACTION: Studies on each treatment were reviewed by one author and checked by a second. A consensus was reached for level of evidence. DATA SYNTHESIS: Relevant evidence was available for glutamine, S-adenosylmethionine, St John's wort, vitamin C, omega-3 fatty acids, light therapy, massage, art therapy, bibliotherapy, distraction techniques, exercise, relaxation therapy and sleep deprivation. However, the evidence was limited and generally of poor quality. The only treatment with reasonable supporting evidence was light therapy for winter depression. CONCLUSIONS: Given that antidepressant medication is not recommended as a first line treatment for children and adolescents with mild to moderate depression, and that the effects of psychological treatments are modest, there is a pressing need to extend the range of treatments available for this age group.

Belief in dealing with depression alone: results from community surveys of adolescents and adults.

BACKGROUND: Community surveys have found that some people believe that it is better to deal with depression alone rather than seek help. However, there has been little research into the characteristics of this group. METHODS: Data were drawn from three Australian surveys: (1) a national survey of 1001 adults aged 18+ years; (2) a school survey of 552 students aged 14-16 years from two regions; (3) a survey of 577 young people aged 12-17 years from the Melbourne region. In all three surveys, participants who believed it would be helpful to deal with depression alone were contrasted with those who believed it would be harmful in terms of sociodemographic characteristics, recognition of depression in a vignette, contact with people who experienced depression, beliefs about treatments, beliefs about using substances, beliefs about long-term outcomes, and beliefs about causes. RESULTS: In both adolescents and adults, belief in dealing with depression alone was associated with male gender, less favourable views about mental health professionals, more favourable views about using substances to deal with depression, and a more positive expectation about the outcome if treatment is not sought. Adolescents believing in dealing with depression alone had more favourable views about some potential helpers, such as church workers and pharmacists. In adults, but not adolescents, there was an association with the belief that depression is caused by personal weakness. LIMITATIONS: The surveys did not directly ask about reasons for believing that dealing with depression alone would be helpful and did not assess actual help-seeking. CONCLUSIONS: Factors encouraging dealing with depression alone are a belief that it is a self-limiting disorder, that substances are an effective way to deal with it and, in adults, that depression is due to personal weakness. Consistent with previous research, males are an important target group for encouraging seeking help to deal with depression.

Tobacco use after experiencing a major natural disaster: analysis of a longitudinal study of 2063 young adults.

AIM: To identify the extent to which tobacco use is affected by experience of a natural disaster and resulting symptoms of post-traumatic stress disorder (PTSD). DESIGN: Longitudinal community survey. SETTING: Canberra, the national capital of Australia. PARTICIPATION: A random selection of 2063 young adults participating in this project lived in a region affected by a major bushfire in 2003. They were first interviewed in 1999-2000 and re-interviewed in 2003-4 after the bushfire had occurred. MEASUREMENTS: Changes in participants' level of consumption of tobacco over a 4-year period were calculated. When interviewed after the disaster, participants answered questions concerning their experience of traumatic events, their immediate emotional response during the disaster and their fire-related PTSD symptoms of re-experiencing and hyperarousal. FINDINGS: Experience of traumatic events experienced during the disaster was associated with an increase in consumption of tobacco (OR: 1.12, 95% CI: 1.03-1.21). PTSD symptoms did not contribute independently to increased tobacco use after controlling for trauma experiences. CONCLUSIONS: These findings indicate that trauma experiences can trigger increased tobacco use in young adults regardless of whether such experiences result in PTSD symptoms. Public health information provided to communities and health-care providers should note that increases in this preventable health risk may occur as a result of individuals experiencing trauma.

The warpy thoughts scale: a new 20-item instrument to measure dysfunctional attitudes.

Cognitive theories of psychopathology propose that specific negative cognitive schema held by individuals can increase their likelihood of experiencing depressive episodes. While it has been argued that such dysfunctional attitudes are state measures that occur primarily during periods of depression, a range of research has supported the view that holding dysfunctional attitudes is ongoing, persisting prior to and following depressive episodes. To date, the need for a parsimonious measure of dysfunctional attitudes has not been well addressed. Using data provided by 4545 participants in a free on-line cognitive behavioural therapy program, MoodGYM, we have developed the Warpy Thoughts Scale (WTS), a 20-item instrument measuring dysfunctional attitudes. This scale provides 3 first order factors (Relationships, Achievements and Entitlements) and a higher order factor, Warpy Thoughts, from which a Warpy Thoughts score can be obtained. Confirmatory factor analyses on this model indicated that it provides robust results for men and women and for individuals in a wide range of ages. WTS scores were moderately correlated with levels of depressive and anxiety symptoms (0.39 and 0.40, respectively) and explained up to one-fifth of the variance of these mental health measures. Further validation of the WTS against other measures of dysfunctional thoughts is required.

An instrument to measure engagement in life: factor analysis and associations with sociodemographic, health and cognition measures.

BACKGROUND: It has been proposed that active engagement with life may protect against cognitive decline. However, existing instruments for measuring life engagement have covered limited domains. OBJECTIVE: To present a new instrument to measure engagement with life; the RIASEC Activities List draws on activities categorised according to interest categories previously developed by Holland: Realistic, Investigative, Artistic, Social, Enterprising and Conventional (RIASEC). METHODS: Participants in a longitudinal, community-based survey were drawn from 3 age groups: 2,404 participants aged 20-24; 2,530 aged 40-44, and 2,551 aged 60-64 years. They provided information on which of 54 selected activities they had performed in the 6 months prior to their survey interview. Other information obtained from participants included measures of sociodemographic characteristics, personality attributes and mental and physical health. Two measures of cognition were also examined. Analyses were conducted separately for men and women in each of the 3 age groups. RESULTS: Confirmatory factor analyses identified six scales of activity types corresponding to Holland's six interest categories. The number of activities of any type undertaken in the past 6 months was significantly associated with cognitive measures, better physical health, and better mental health although these findings varied for men and women across the 3 age groups. Further, for both men and women in all age groups, performing activities of any type was associated with having higher extraversion and mastery scores, and lower levels of neuroticism. Associations were also found between performing specific types of activities and cognitive measures. CONCLUSIONS: This instrument has the potential to identify more clearly types of activities that may offer cognitive benefits and warrants further testing in longitudinal studies.

Depression in mild cognitive impairment in a community sample of individuals 60-64 years old.

OBJECTIVE: This cross-sectional study examined the prevalence and characteristics of depression in subjects with mild cognitive impairment (MCI). The data presented here are from the first wave of the longitudinal Personality and Total Health Through Life 60+ (PATH 60+) Project. METHOD: A total of 2551 community-dwelling individuals in the age range 60-64 years were recruited randomly through the electoral roll. They were screened using a short cognitive battery and those who screened positive underwent detailed medical and neuropsychological assessments. There were 29 subjects who fulfilled the Mayo Clinic criteria for MCI and these were compared to 520 controls. Subjects were evaluated for depression symptoms and DSM-IV major and minor depression syndromes. RESULTS: Subjects with MCI had more minor depression and higher scores on a symptom scale. However, a multivariate examination of specific symptoms showed that the differences were confined to only two motivation-related symptoms ("felt slowed up" and "little interest or pleasure"). CONCLUSION: Motivation-related depressive symptoms are more relevant in subjects with MCI than mood-related symptoms.

Clinical and neuroimaging correlates of mild cognitive impairment in a middle-aged community sample: the personality and total health through life 60+ study.

This cross-sectional study aimed at determining the clinical and structural brain magnetic resonance imaging correlates of mild cognitive impairment (MCI). The data presented here are from the first wave of the longitudinal Personality and Total Health through Life 60+ project. 2,551 community-dwelling individuals in the age range of 60-64 years were recruited randomly through the electoral roll. They were screened using Mini-Mental State Examination and a short cognitive battery. Those who screened positive underwent detailed medical and neuropsychological assessments. Of the 224 subjects who screened positive, 117 underwent a detailed assessment. Twenty-nine subjects fulfilled the Mayo Clinic criteria for MCI. Magnetic resonance imaging scans were analyzed for 26 subjects with MCI as well as normal controls. Subjects were clinically evaluated for depressive symptoms and major and minor depression syndromes. Logistic regression analysis was performed predicting MCI from anterior and mid-ventricular brain ratios, cortical atrophy measures, hippocampal volumes, volumes of amygdala and white matter hyperintensities after adjusting for age, gender, years of education, depression and physical disability. None of the neuroanatomical substrates appeared as predictors of MCI. The only predictors were higher depression scores and fewer years of education. Structural neuroimaging may not have an added advantage in the detection of MCI in middle-aged community-dwelling subjects. It may be that this age group is too young for such brain changes to be identified.

Associations of pre-trauma attributes and trauma exposure with screening positive for PTSD: analysis of a community-based study of 2,085 young adults.

BACKGROUND: While pre-trauma personality and mental health measures are risk factors for post-traumatic stress disorder (PTSD), such information is usually obtained following the trauma and can be influenced by post-trauma distress. We used data collected from a community-based survey of young adults before and after a major natural disaster to examine the extent to which participants' traumatic experiences, demographic and pre-trauma risk factors were associated with their screening positive for PTSD when re-interviewed. METHOD: A representative selection of 2,085 young adults from the Australian Capital Territory and environs, interviewed in 1999 as part of a longitudinal community-based survey, were re-interviewed 3-18 months after a major bushfire had occurred in the region. When re-interviewed, they were asked about their experiences of trauma threat, uncontrollable and controllable traumatic experiences and their reaction to the fire. They were also screened for symptoms of fire-related PTSD experienced in the week prior to interview. RESULTS: Four-fifths of participants were exposed to the trauma with around 50% reporting having experienced uncontrollable traumatic events. Reporting PTSD symptoms was associated with being female, having less education, poorer mental health and higher levels of neuroticism prior to the trauma. Particular fire experiences, including being evacuated and feeling very distressed during the disaster, were more strongly associated with PTSD symptoms compared with pre-trauma measures. CONCLUSIONS: While demographic and pre-trauma mental health increased the likelihood of reporting PTSD symptoms, exposure to trauma threat and reaction to the trauma made greater contributions in explaining such symptoms as a result of this disaster.

Within-occasion intraindividual variability and preclinical diagnostic status: is intraindividual variability an indicator of mild cognitive impairment?

Intraindividual variability in cognitive test performance has the potential to be a good marker of preclinical Alzheimer's disease status (S. C. Li & U. Lindenberger, 1999). Using cross-sectional community data from 2,317 individuals aged 60-64 years, the authors of this study found that variability was greater in individuals who met criteria for mild cognitive impairment or aging-associated cognitive decline but not for age-associated memory impairment. Higher variability was associated with lower education and a non-English-speaking background. In contrast to previous findings, variability in this study did not contribute uniquely to meeting criteria for mild cognitive impairment. The reasons for the differences may reside in the authors' method of estimating mean independent variability, the use of an occasion-specific measure, or the relatively younger age of the participants. Follow-up of the cohort in 4 years will yield data on the prospective validity of variability as a risk factor for impairment.

Relationship of homocysteine, folic acid and vitamin B12 with depression in a middle-aged community sample.

BACKGROUND: Case control studies have supported a relationship between low folic acid and vitamin B112 and high homocysteine levels as possible predictors of depression. The results from epidemiological studies are mixed and largely from elderly populations. METHOD: A random subsample of 412 persons aged 60-64 years from a larger community sample underwent psychiatric and physical assessments, and brain MRI scans. Subjects were assessed using the PRIME-MD Patient Health Questionnaire for syndromal depression and severity of depressive symptoms. Blood measures included serum folic acid, vitamin B12, homocysteine and creatinine levels, and total antioxidant capacity. MRI scans were quantified for brain atrophy, subcortical atrophy, and periventricular and deep white-matter hyperintensity on T2-weighted imaging. RESULTS: Being in the lowest quartile of homocysteine was associated with fewer depressive symptoms, after adjusting for sex, physical health, smoking, creatinine, folic acid and B12 levels. Being in the lowest quartile of folic acid was associated with increased depressive symptoms, after adjusting for confounding factors, but adjustment for homocysteine reduced the incidence rate ratio for folic acid to a marginal level. Vitamin B12 levels did not have a significant association with depressive symptoms. While white-matter hyperintensities had significant correlations with both homocysteine and depressive symptoms, the brain measures and total antioxidant capacity did not emerge as significant mediating variables. CONCLUSIONS: Low folic acid and high homocysteine, but not low vitamin B12 levels, are correlates of depressive symptoms in community-dwelling middle-aged individuals. The effects of folic acid and homocysteine are overlapping but distinct.

Mental health first aid responses of the public: results from an Australian national survey.

BACKGROUND: The prevalence of mental disorders is so high that members of the public will commonly have contact with someone affected. How they respond to that person (the mental health first aid response) may affect outcomes. However, there is no information on what members of the public might do in such circumstances. METHODS: In a national survey of 3998 Australian adults, respondents were presented with one of four case vignettes and asked what they would do if that person was someone they had known for a long time and cared about. There were four types of vignette: depression, depression with suicidal thoughts, early schizophrenia, and chronic schizophrenia. Verbatim responses to the open-ended question were coded into categories. RESULTS: The most common responses to all vignettes were to encourage professional help-seeking and to listen to and support the person. However, a significant minority did not give these responses. Much less common responses were to assess the problem or risk of harm, to give or seek information, to encourage self-help, or to support the family. Few respondents mentioned contacting a professional on the person's behalf or accompanying them to a professional. First aid responses were generally more appropriate in women, those with less stigmatizing attitudes, and those who correctly identified the disorder in the vignette. CONCLUSIONS: There is room for improving the range of mental health first aid responses in the community. Lack of knowledge of mental disorders and stigmatizing attitudes are important barriers to effective first aid.

Pet ownership and health in older adults: findings from a survey of 2,551 community-based Australians aged 60-64.

BACKGROUND: It is commonly assumed that owning a pet provides older residents in the community with health benefits including improved physical health and psychological well-being. It has also been reported that pet owners are lower on neuroticism and higher on extraversion compared with those without pets. However, findings of research on this topic have been mixed with a number of researchers reporting that, for older people, there is little or no health benefit associated with pet ownership. OBJECTIVE: To identify health benefits associated with pet ownership and pet caring responsibilities in a large sample of older community-based residents. METHODS: Using survey information provided by 2,551 individuals aged between 60 and 64 years, we compared the sociodemographic attributes, mental and physical health measures, and personality traits of pet owners and non-owners. For 78.8% of these participants, we were also able to compare the health services used, based on information obtained from the national insurer on the number of general practitioner (GP) visits they made over a 12-month period. RESULTS: Compared with non-owners, those with pets reported more depressive symptoms while female pet owners who were married also had poorer physical health. We found that caring for a pet was associated with negative health outcomes including more symptoms of depression, poorer physical health and higher rates of use of pain relief medication. No relationship was found between pet ownership and use of GP services. When we examined the personality traits of pet owners and carers, we found that men who cared for pets had higher extraversion scores. Our principal and unexpected finding, however, was that pet owners and carers reported higher levels of psychoticism as measured by the Revised Eysenck Personality Questionnaire. CONCLUSIONS: We conclude that pet ownership confers no health benefits for this age group. Instead, those with pets have poorer mental and physical health and use more pain relief medication. Further, our study suggests that those with pets are less conforming to social norms as indicated by their higher levels of psychoticism.