Developing the Occupational Communion Scale: Belonging-Based Social Connections Are Vital for Work Engagement, Self-Efficacy, and Positive Affect in Aged Care Workforces.

BACKGROUND AND OBJECTIVES: A multifaceted construct called occupational communion (OC), defined as a sense of belonging based on social interaction at work, has been proposed to understand why care workers were positively engaged in their jobs over time, even though they were very demanding. Rich qualitative data on the multiple aspects of OC in care work exist, but a valid measure does not. RESEARCH DESIGN AND METHODS: We applied a mixed-method systematic scale development process to measure OC. Aged and dementia care workers in Australia (76%) and other countries participated in a focus group and online surveys (N = 2,451). We also used interview data from our prior study. The study involved 3 components: (1) scale development and design; (2) pilot test validation with exploratory factor analysis; and (3) confirmatory validation via confirmatory factor analysis. The third component assessed convergent and discriminant validity using measures of communion, self-efficacy, work engagement, job and life satisfaction, intention to leave, positive and negative affect, and mood. RESULTS: We developed a 28-item Occupational Communion Scale (OCS) with good internal consistency (composite reliability = 0.75-0.91) across 6 factors: (1) "natural" carer, (2) psychological need to care, (3) connection with clients, (4) connection with coworkers, (5) desire for more connection, and (6) blurred boundaries. All validity measures correlated with OC and work engagement, self-efficacy, and positive affect showed the strongest association. DISCUSSION AND IMPLICATIONS: The OCS can be used to design and evaluate interventions addressing aged care workforce engagement, social connections and well-being, and care outcomes.

Care-home Nurses' responses to the COVID-19 pandemic: Managing ethical conundrums at personal cost: A qualitative study.

INTRODUCTION: The COVID-19 pandemic had an unprecedented effect on those living and working in care-homes for older people, as residents were particularly vulnerable to contracting the SARS-CoV-2 virus, associated with high morbidity and mortality. Often undervalued, care-home nurses (RNs) are leaders, managing complex care while working in isolation from their professional peers. The pandemic made this more apparent, when care and treatments for COVID-19 were initially unknown, isolation increased due to withdrawal of many professional health services, accompanied by staff shortages. OBJECTIVE: To explore RNs' experiences of working in older people's care-homes during the COVID-19 pandemic. DESIGN: Qualitative interview study. SETTING: Care-homes for older people in England and Scotland, UK. METHODS: Recruitment via direct contact with care-homes, social media, and links provided by national partners, then purposive sampling for age, gender, type of care-home, and location. Data collected through one-to-one online interviews using topic guide developed collaboratively with care-home nurses, focusing on how COVID-19 impacted on nurses' resilience and mental wellbeing. Data analyzed thematically using Tronto's ethics of care framework to guide development of interpretative themes. RESULTS: Eighteen nurses (16 female; 16 adult, and two mental health nurses) were interviewed March-June 2021; majority aged 46-55 years; mean time registered with Nursing and Midwifery Council: 19 years; 17 had nursed residents with COVID-19. RNs' experiences resonated with Tronto's five tenets of ethical care: attentiveness, responsibility, competence, responsiveness, and solidarity. All nurses described being attentive to needs of others, but were less attentive to their own needs, which came at personal cost. RNs were aware of their professional and leadership responsibilities, being as responsive as they could be to resident needs, processing and sharing rapidly changing guidance and implementing appropriate infection control measures, but felt that relatives and regulatory bodies were not always appreciative. RNs developed enhanced clinical skills, increasing their professional standing, but reported having to compromise care, leading to moral distress. Broadly, participants reported a sense of solidarity across care-home staff and working together to cope with the crisis. CONCLUSION: Care-home nurses felt unprepared for managing the COVID-19 pandemic, many experienced moral distress. Supporting care-home nurses to recover from the pandemic is essential to maintain a healthy, stable workforce and needs to be specific to care-home RNs, recognizing their unique pandemic experiences. Support for RNs will likely benefit other care-home workers either directly through wider roll-out, or indirectly through improved wellbeing of nurse leaders. CLINICAL RELEVANCE: The COVID-19 pandemic, an international public health emergency, created many challenges for Registered Nurses (RNs) working in long-term care facilities for older people, as residents were particularly vulnerable to the impact of the SARS-CoV-2 virus. Care-home RNs faced challenges distinct from their hospital-based nursing peers and non-nursing social care colleagues due to their isolation, leadership roles, professional legal obligations, and ethical responsibilities, leading to psychological distress on the one hand, but also a newly found confidence in their existing and newly developed skills, and increased recognition by the wider health community of their specialisms.

The precarious resilience of aged care employees enrolled in an Australian online dementia course: A cross-sectional study of occupational health and well-being.

OBJECTIVE: Australian aged care workforce surveys offer limited information about those who engage in online dementia education regarding their occupational health and well-being. A salutogenic approach was applied to an aged care context to quantitatively assess both positive and negative aspects of health at work to inform the development of workplace interventions tailored to those interested in self-development. METHODS: Physical, psychological and occupational health were measured in an online cross-sectional survey of general health, chronic conditions, psychological distress, positive and negative affect, job satisfaction, access to workplace amenities and turnover intentions of aged care workers undertaking an online dementia course in October 2014. RESULTS: Participants (N = 662) rated their general physical health as good and a minority experienced chronic conditions such as obesity. Overall, workers had average levels of positive and negative affect and low distress. However, 25% were likely to have a mental health condition. While most were employed on a permanent basis (80%) and reported moderate job satisfaction, 18% were likely to leave their job. There were some gaps in workplace amenities to support health and well-being: for example, 13% reported no access to lunch break areas. CONCLUSIONS: Results suggest precarious resilience in aged care workers enrolled in an Australian online dementia course. Workplace interventions that focus on preventative health strategies are required to address the health risks associated with higher than national averages of obesity and mental health, and reduce exposure of workers to physical and psychological harms.

The experiences and perceptions of wellbeing provision among English ambulance services staff: a multi-method qualitative study.

BACKGROUND: NHS ambulance service staff are at risk of poor physical and mental wellbeing because of the likelihood of encountering stressful and traumatic incidents. While reducing sickness absence and improving wellbeing support to ambulance staff is a key NHS priority, few studies have empirically documented a national picture to inform policy and service re-design. The study aimed to understand how ambulance service trusts in England deal with staff health and wellbeing, as well as how the staff perceive and use wellbeing services. METHODS: To achieve our aim, we undertook semi-structured telephone interviews with health and wellbeing leads and patient-facing ambulance staff, as well as undertaking documentary analysis of ambulance trust policies on wellbeing. The study was conducted both before and during the UK first COVID-19 pandemic wave. The University of Lincoln ethics committee and the Health Research Authority (HRA) granted ethical approval. Overall, we analysed 57 staff wellbeing policy documents across all Trusts. Additionally, we interviewed a Health and Wellbeing Lead in eight Trusts as well as 25 ambulance and control room staff across three Trusts. RESULTS: The study highlighted clear variations between organisational and individual actions to support wellbeing across Trust policies. Wellbeing leads acknowledged real 'tensions' between individual and organisational responsibility for wellbeing. Behaviour changes around diet and exercise were perceived to have a positive effect on the overall mental health of their workforce. Wellbeing leads generally agreed that mental health was given primacy over other wellbeing initiatives. Variable experiences of health and wellbeing support were partly contingent on the levels of management support, impacted by organisational culture and service delivery challenges for staff. CONCLUSION: Ambulance service work can impact upon physical and mental health, which necessitates effective support for staff mental health and wellbeing. Increasing the knowledge of line managers around the availability of services could improve engagement.

Why do ambulance employees (not) seek organisational help for mental health support? A mixed-methods systematic review protocol of organisational support available and barriers/facilitators to uptake.

INTRODUCTION: The COVID-19 pandemic is exacerbating a wide range of symptoms of poor mental health among emergency medical service (EMS) ambulance populations. Evidence suggests that using organisational support can improve employee outcomes and in turn, patient outcomes. Understanding why EMS staff do and do not use support services is therefore critical to improving uptake, ensuring equitable access, and potentially influencing workforce well-being, organisational sustainability and patient care delivery. This systematic review aims to identify what support is available and any perceived barriers and facilitators to accessing and utilising organisational support. METHODS AND ANALYSIS: Searches performed between 18 February 2022 and 23 February 2022 will be used to identify studies that report barriers and facilitators to EMS employee support among all government/state commissioned EMS ambulance systems. Electronic databases, AMED, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, EMBASE, EMCARE, HMIC, Medline and PsycINFO will be searched. All relevant English-language studies of adult employees of government/state commissioned EMS ambulance organisations published since December 2004 will be screened and relevant data extracted by two independent reviewers. A third reviewer will resolve any disagreements.The primary outcome is the identification of perceived barriers or facilitators to EMS staff using organisational support for mental health. The secondary outcome is the identification of supportive interventions offered through or by ambulance trusts. Study selection will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological quality of included studies will be appraised by administering rating checklists. A narrative synthesis will be conducted to report qualitative and quantitative data and will include population characteristics, methodological approach and information about barriers and facilitators. ETHICS AND DISSEMINATION: Ethical approval is not required because only available published data will be analysed. Findings will be disseminated through peer-reviewed publication and conference presentation. PROSPERO REGISTRATION NUMBER: CRD42022299650.

Effects of a Mindfulness App on Employee Stress in an Australian Public Sector Workforce: Randomized Controlled Trial.

BACKGROUND: Workplace-based mindfulness programs have good evidence for improving employee stress and mental health outcomes, but less is known about their effects on productivity and citizenship behaviors. Most of the available evidence is derived from studies of mindfulness programs that use class-based approaches. Mindfulness apps can increase access to training, but whether self-directed app use is sufficient to realize benefits equivalent to class-based mindfulness programs is unknown. OBJECTIVE: We assessed the effectiveness of a mindfulness app, both with and without supporting classes, for reducing employees' perceived stress. Changes in mindfulness, mental health, quality of life, perceptions of job demand, control and support, productivity indicators, organizational citizenship, and mindful behaviors at work were also investigated. METHODS: Tasmanian State Service employees were invited by the Tasmanian Training Consortium to a 3-arm randomized controlled trial investigating the effects of a mindfulness app on stress. The app used in the Smiling Mind Workplace Program formed the basis of the intervention. The app includes lessons, activities, and guided meditations, and is supported by 4 instructional emails delivered over 8 weeks. Engagement with the app for 10-20 minutes, 5 days a week, was recommended. Reported data were collected at baseline (time point 0), 3 months from baseline (time point 1 [T1]), and at 6-month follow-up (time point 2). At time point 0, participants could nominate a work-based observer to answer surveys about participants' behaviors. Eligible participants (n=211) were randomly assigned to self-guided app use plus four 1-hour classes (app+classes: 70/211, 33.2%), self-guided app use (app-only: 71/211, 33.6%), or waitlist control (WLC; 70/211, 33.2%). Linear mixed effects models were used to assess changes in the active groups compared with the WLC at T1 and for a head-to-head comparison of the app+classes and app-only groups at follow-up. RESULTS: App use time was considerably lower than recommended (app+classes: 120/343 minutes; app-only: 45/343 minutes). Compared with the WLC at T1, no significant change in perceived stress was observed in either active group. However, the app+classes group reported lower psychological distress (ß=-1.77, SE 0.75; P=.02; Cohen d=-0.21) and higher mindfulness (ß=.31, SE 0.12; P=.01; Cohen d=0.19). These effects were retained in the app+classes group at 6 months. No significant changes were observed for the app-only group or for other outcomes. There were no significant changes in observer measures at T1, but by time point 2, the app+classes participants were more noticeably mindful and altruistic at work than app-only participants. CONCLUSIONS: Including classes in the training protocol appears to have motivated engagement and led to benefits, whereas self-guided app use did not realize any significant results. Effect sizes were smaller and less consistent than meta-estimates for class-based mindfulness training. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Register ACTRN12617001386325; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372942&isReview.

Health-related quality of life in people with psychotic disorders: The role of loneliness and its contributors.

BACKGROUND: Perception of loneliness has been identified as the strongest predictor of health-related quality of life assessed with the Assessment of Quality of Life-4D in people with psychotic disorders. We aimed to establish contributors to perceived loneliness, and ascertain the mediating role of loneliness in the relationship between identified contributors to loneliness and other known predictors of health-related quality of life with health-related quality of life. METHODS: Data for 1642 people collected as part of the 2010 Australian National Survey of Psychosis were analysed. Health-related quality of life was assessed using the Assessment of Quality of Life-4D, and loneliness through a single-item five-level categorical variable. To identify independent contributors to loneliness, a statistical model was constructed with reference to a theoretical model comprising 23 variables. A predictive model with health-related quality of life as the dependent variable was then developed and tested to assess the mediating role of loneliness. RESULTS: Nine contributors to loneliness were found (social dysfunction, experienced stigma, contact with friends, diagnosis, depressive symptoms, anxiety, mental health service utilisation, arthritis and traumatic events in childhood), with social dysfunction the strongest. In the prediction of health-related quality of life, all contributors to loneliness were partially mediated through loneliness (except service utilisation) as were negative symptoms and use of psychotropic/anticholinergic medications. CONCLUSION: Assuming a plausible causal model of mediation, loneliness was found to have direct and indirect effects on health-related quality of life in people with psychotic disorders. Findings add impetus to efforts to develop and trial strategies aimed at reducing loneliness in this population, and, in turn, improving their health-related quality of life.

Trends, variations and prediction of staff sickness absence rates among NHS ambulance services in England: a time series study.

OBJECTIVES: Our aim was to measure ambulance sickness absence rates over time, comparing ambulance services and investigate the predictability of rates for future forecasting. SETTING: All English ambulance services, UK. DESIGN: We used a time series design analysing published monthly National Health Service staff sickness rates by gender, age, job role and region, comparing the 10 regional ambulance services in England between 2009 and 2018. Autoregressive Integrated Moving Average (ARIMA) and Seasonal ARIMA (SARIMA) models were developed using Stata V.14.2 and trends displayed graphically. PARTICIPANTS: Individual participant data were not available. The total number of full-time equivalent (FTE) days lost due to sickness absence (including non-working days) and total number of days available for work for each staff group and level were available. In line with The Data Protection Act, if the organisation had less than 330 FTE days available during the study period it was censored for analysis. RESULTS: A total of 1117 months of sickness absence rate data for all English ambulance services were included in the analysis. We found considerable variation in annual sickness absence rates between ambulance services and over the 10-year duration of the study in England. Across all the ambulance services the median days available were 1 336 888 with IQR of 548 796 and 73 346 median days lost due to sickness absence, with IQR of 30 551 days. Among clinical staff sickness absence varied seasonally with peaks in winter and falls over summer. The winter increases in sickness absence were largely predictable using seasonally adjusted (SARIMA) time series models. CONCLUSION: Sickness rates for clinical staff were found to vary considerably over time and by ambulance trust. Statistical models had sufficient predictive capability to help forecast sickness absence, enabling services to plan human resources more effectively at times of increased demand.

The impact of providing end-of-life care during a pandemic on the mental health and wellbeing of health and social care staff: Systematic review and meta-synthesis.

BACKGROUND: Disease outbreaks and disasters can result in excess deaths and severe disruption of usual end-of-life care processes. We aimed to: i) synthesise evidence describing the experiences of health and social care staff providing end-of-life care during a disease outbreak or humanitarian disaster, ii) understand the impact on their mental health and wellbeing and, iii) identify means of support. METHODS: A systematic review with meta-synthesis was conducted including studies of health and social care staff providing end-of-life care during disease outbreaks (Ebola, COVID-19, SARs, MERs) or humanitarian disasters (2001-2020). MEDLINE (Ovid), Embase, PsycInfo, Web of Science, and grey literature databases were searched systematically, with forward and backward citation searching of included studies. Any research study designs, in any care settings, were included. Study quality was assessed using an appraisal tool relevant to each study design. Qualitative meta-synthesis was used to analyse the findings, which were then reported narratively. PROSPERO registration: CRD42020181444. RESULTS: Nineteen studies were included, including 10 Ebola studies and two COVID-19 studies. The analysis generated two superordinate themes: individual experience and organisational responsibilities. Individual experience comprised four themes: dignity in death, positive experiences, negative experience and support for staff. Organisational responsibilities comprised four themes: preparation, adaption, resources, and Personal Protective Equipment (PPE). DISCUSSION: No studies quantitively measured the impact of providing end-of-life care on staff mental health and wellbeing, however qualitative studies described experiences in varied settings. Serious disease outbreaks and disasters can expose care staff to abnormally high levels of mortality and suffering. Health and social care systems need to proactively prepare for future events and enable peer support mechanisms that may help mitigate experiences of psychological distress in humanitarian crises.

Mental health, well-being and support interventions for UK ambulance services staff: an evidence map, 2000 to 2020.

BACKGROUND: Prior to COVID-19 there had been a renewed policy focus in the National Health Service on the health and well-being of the healthcare workforce, with the ambulance sector identified as a priority area. This focus is more important than ever as the sector deals with the acute and longer-term consequences of a pandemic. AIM: To systematically identify, summarise and map the evidence regarding mental health, well-being and support interventions for United Kingdom ambulance services staff and to identify evidence gaps. METHOD: Evidence mapping methodology of published and grey original research published in English from 1 January 2000 to 23 May 2020 describing the health risk, mental health and/or well-being of UK ambulance services staff including retired staff, volunteers and students. MEDLINE, EMBASE, PsychINFO, CINAHL and AMED databases, plus EThOS, Zetoc, OpenGrey and Google, were searched, alongside hand-searching of grey literature and bibliographies. Information was extracted on study aims, sample, design and methodology, funding source, country and key findings. Included studies were categorised into seven a priori theme areas. RESULTS: Of 1862 identified articles, 45 peer-reviewed studies are included as well as 24 grey literature documents. Peer-reviewed research was largely observational and focused on prevalence studies, post-traumatic stress disorder or organisational and individual social factors related to health and well-being. Most grey literature reported the development and testing of interventions. Across all study types, underpinning theory was often not cited. CONCLUSION: To date, intervention research has largely been funded by charities and published in the grey literature. Few studies were identified on self-harm, bullying, sleep and fatigue or alcohol and substance use. Theoretically informed intervention development and testing, including adaptation of innovations from other countries and 24-hour workforces, is needed. This evidence map provides important context for planning of staff well-being provision and research as the sector responds to and recovers from the pandemic. PROSPERO REGISTRATION NUMBER: CRD42018104659.

Proposing a causal pathway for health-related quality of life in people with psychotic disorders.

This study aimed to establish independent predictors for health-related quality of life (HRQoL) in people with psychotic disorders, and the mediating role of global functioning in those relationships. Data for 1642 people collected as part of the second Australian National Survey of Psychosis were analyzed. The Assessment of Quality of Life (AQoL)-4D and the Personal and Social Performance scale were used for assessing HRQoL and global functioning respectively. The study commenced with a theoretical model comprised of 26 sociodemographic and clinical variables. A predictive model for HRQoL was built up using a purposeful selection strategy to arrive at a set of clinically meaningful, independent predictors. The mediating effect of global functioning was then assessed. Seven variables were found to have an independent effect on HRQoL: perception of loneliness, number of negative symptoms, use of psychotropic and anticholinergic medications, course of disorder, lifetime histories of chronic pain and cardiovascular disease and living arrangements at the time of the interview. All variables except perceived loneliness and chronic pain were partially mediated through global functioning. This final model explained 46% of the variance in HRQoL, with loneliness and number of negative symptoms the strongest predictors. Evidence in support of a credible causal pathway for HRQoL in people with psychotic disorders, mediated by global functioning was presented. The importance of the quality of social relationships was highlighted, and potential targets for improving the HRQoL of this population identified.

Protecting the Mental Health of Small-to-Medium Enterprise Owners: A Randomized Control Trial Evaluating a Self-Administered Versus Telephone Supported Intervention.

OBJECTIVE: Small-medium enterprises (SMEs) are under-represented in occupational health research. Owner/managers face mental ill-health risks/exacerbating factors including financial stress and long working hours. This study assessed the effectiveness of a workplace mental health and wellbeing intervention specifically for SME owner/managers. METHODS: Two hundred ninety seven owner/managers of SMEs were recruited and invited to complete a baseline survey assessing their mental health and wellbeing and were then randomly allocated to one of three intervention groups: (1) self-administered, (2) self-administered plus telephone, or (3) an active control condition. After a four-month intervention period they were followed up with a second survey. RESULTS: Intention to treat analyses showed a significant decrease in psychological distress for both the active control and the telephone facilitated intervention groups, with the telephone group demonstrating a greater ratio of change. CONCLUSION: The provision of telephone support for self-administered interventions in this context appears warranted.

Trend of emergency department presentations with a mental health diagnosis in Australia by diagnostic group, 2004-05 to 2016-17.

OBJECTIVE: To examine trends of ED presentations with a mental health (MH) diagnosis in Australia and its jurisdictions by diagnostic group between 2004-05 and 2016-17. METHODS: Data comprised ED presentations with a principal diagnosis of ICD-10-AM F00-F99 (MHdx ) captured within the National Non-Admitted Patient Emergency Department Care Database. Trends in absolute number and rates of MHdx presentations per 10 000 population were assessed as differences (x-fold) and annual growth rates (average and compound). RESULTS: Increased presentation rates were observed for most diagnostic groups, except for mental retardation (F70-F79) and mood disorders (F30-F39). The greatest absolute increase was for psychoactive substance use-related disorders (F10-F19), and relative increase, unspecified mental disorder (F99). There was differentiation across jurisdictions regarding rates of and growth in presentations. In 2016-17, rates at least twice the national average were observed for psychoactive substance-use (F10-F19), schizophrenia and psychotic disorders (F20-F29) and childhood and adolescence onset disorders (F90-F98) in the Northern Territory, F90-F98 in South Australia, personality disorders (F60-F69) in Tasmania and unspecified mental disorder (F99) in New South Wales. The most marked growth was observed for F99 in New South Wales. CONCLUSION: Between 2004-05 and 2016-17, rates of ED presentations increased across most MH diagnostic groups, but particularly psychoactive substance use-related disorders. To reduce the need for MH crisis care in Australian EDs, strategies are required to reduce psychoactive substance use in the community, and policies may be needed to strengthen the capability of community MH services and primary care professionals to recognise, diagnose and treat earlier in the course of illness.

Emergency department presentations with a mental health diagnosis in Australia, by jurisdiction and by sex, 2004-05 to 2016-17.

OBJECTIVES: To examine trends in ED presentations with a mental health diagnosis (MHdx ) in Australia by jurisdiction and by sex, between 2004-05 and 2016-17. METHODS: Data were captured in the National Non-Admitted Patient Emergency Department Care Database. Outcomes were the proportion of ED presentations with a principal diagnosis of ICD-10-AM F00-F99 (MHdx ), and the rate of all ED and MHdx presentations per 10 000 population. RESULTS: Between 2004-05 and 2016-17, MHdx presentations experienced compounding annual growth of 5.9% nationally, and increased from 3.3% to 3.7% of all ED presentations with a diagnosis. Most growth occurred between 2010-11 and 2015-16. Northern Territory (NT) had the highest level of MHdx presentations per 10 000 population, more than double the Australian average. The proportion of MHdx presentations was highest in South Australia (SA) in most years, and the average annual proportion of MHdx presentations was statistically significantly higher than the national average in SA, Queensland (QLD) and Western Australia (WA). The proportion of MHdx presentations increased in each jurisdiction, with significant increases for Victoria, QLD, WA, Australian Capital Territory and NT. Males experienced greater numbers and rates of all ED and MHdx presentations, while the proportion of MHdx presentations was 8% higher for females. CONCLUSIONS: The proportion of ED presentations for MH conditions, narrowly defined, has increased in all Australian jurisdictions between 2004-05 and 2016-17, but particularly since 2010-11. Differences between jurisdictions indicate jurisdictional specific issues. However, significant or upward trend of MHdx presentations across all jurisdictions indicates generic issues necessitating concern and policy development at a national level.

Association between depression, anxiety and weight change in young adults.

BACKGROUND: To investigate whether there are bi-directional associations between anxiety and mood disorders and body mass index (BMI) in a cohort of young adults. METHODS: We analysed data from the 2004-2006 (baseline) and 2009-2011 (follow-up) waves of the Childhood Determinants of Adult Health study. Lifetime DSM-IV anxiety and mood disorders were retrospectively diagnosed with the Composite International Diagnostic Interview. Potential mediators were individually added to the base models to assess their potential role as a mediator of the associations. RESULTS: In males, presence of mood disorder history at baseline was positively associated with BMI gain (ß = 0.77, 95% CI: 0.14-1.40), but baseline BMI was not associated with subsequent risk of mood disorder. Further adjustment for covariates, including dietary pattern, physical activity, and smoking reduced the coefficient (ß) to 0.70 (95% CI: 0.01-1.39), suggesting that the increase in BMI was partly mediated by these factors. In females, presence of mood disorder history at baseline was not associated with subsequent weight gain, however, BMI at baseline was associated with higher risk of episode of mood disorder (RR per kg/m2: 1.04, 95% CI: 1.01-1.08), which was strengthened (RR per kg/m2 = 1.07, 95% CI: 1.00-1.15) after additional adjustment in the full model. There was no significant association between anxiety and change in BMI and vice-versa. CONCLUSION: The results do not suggest bidirectional associations between anxiety and mood disorders, and change in BMI. Interventions promoting healthy lifestyle could contribute to reducing increase in BMI associated with mood disorder in males, and excess risk of mood disorder associated with BMI in females.

Trends of emergency department presentations with a mental health diagnosis by age, Australia, 2004-05 to 2016-17: A secondary data analysis.

OBJECTIVES: The present study aims to explore for Australia: (i) the trends of ED presentations with a mental health (MH) diagnosis by age group; and (ii) whether those trends differ from all ED presentations. METHODS: ED presentations to Australian public hospitals, 2004-05 to 2016-17 were captured in the National Non-Admitted Patient Emergency Department Care Database. We assessed total change and annual rate of change in the number and rates of presentations per 10 000 population for all presentations and those with a MH principal diagnosis (ICD-10-AM F00 to F99, MHdx ). Multivariable regression was used to assess the trend of the proportion of MHdx presentations. RESULTS: Between 2004-05 and 2016-17, children (0-14 years), followed by older persons (≥65 years) had the highest ED utilisation; while youth (15-24 years) and younger adults (25-34 years) predominated for MHdx presentations. As a proportion of all presentations, MHdx presentations were lowest in children, and highest in people 35-44 years (13.2-times higher than for children). The rate of increase in MHdx presentations was higher than for all presentations in all age groups, reaching almost four times higher for children. CONCLUSION: The Australian Institute of Health and Welfare should consider expanding the breadth of MH diagnoses they report to better identify the impact of MH on ED presentations. Between 2004-05 and 2016-17, high ED utilisation by children and older persons, and the increasing burden of MHdx presentations for youth, younger adults and children suggest that healthcare planning strategies for urgent and emergency care cannot afford to overlook the growing impact of these sub-groups.

Chronic pain, pain severity and analgesia use in Australian women of reproductive age.

BACKGROUND: The increasing prevalence and adverse outcomes associated with opioid analgesia use in women of reproductive age have become a significant public health issue internationally, with use during pregnancy potentially affecting maternal and infant health outcomes. OBJECTIVE: This study aims to provide national estimates of chronic pain, pain severity and analgesia use in Australian women of reproductive age by pregnancy status. METHOD: Data were obtained from the Australian Bureau of Statistics 2011-12 National Health Survey (n=20,426). Weighting was applied to sample data to obtain population estimates. For this study data were analysed for pregnant (n=166, N=192,617) and non-pregnant women (n=4710, N=5,256,154) of reproductive age (15-49 years). RESULTS: Chronic or reoccurring pain was reported in 5.1% of pregnant women and 9.7% of non-pregnant women, and 0.7% and 2.6% of pregnant and non-pregnant women reported recent opioid analgesia use respectively. Moderate-to-very severe pain was more common in pregnant than non-pregnant women taking opioid analgesics, and no pain and very mild-to-mild pain in non-pregnant women. CONCLUSION: Approximately 1 in 20 pregnant Australian women have chronic or reoccurring pain. Opioid analgesia was used by around 1% of Australian pregnant women during a two-week period, with use associated with moderate-to-very severe pain. Given that the safety of many analgesic medications in pregnancy remains unknown, pregnant women and health professionals require accurate, up-to-date information on the risks and benefits of analgesic use during pregnancy. Further evidence on the decision-making processes of pregnant women with pain should assist health professionals maximise outcomes for mothers and infants.

A systematic review and meta-analysis of workplace mindfulness training randomized controlled trials.

This meta-analytic review responds to promises in the research literature and public domain about the benefits of workplace mindfulness training. It synthesizes randomized controlled trial evidence from workplace-delivered training for changes in mindfulness, stress, mental health, well-being, and work performance outcomes. Going beyond extant reviews, this article explores the influence of variability in workforce and intervention characteristics for reducing perceived stress. Meta-effect estimates (Hedge's g) were computed using data from 23 studies. Results indicate beneficial effects following training for mindfulness (g = 0.45, p < .001) and stress (g = 0.56, p < .001), anxiety (g = 0.62, p < .001) and psychological distress (g = 0.69, p < .001), and for well-being (g = 0.46, p = .002) and sleep (g = 0.26, p = .003). No conclusions could be drawn from pooled data for burnout due to ambivalence in results, for depression due to publication bias, or for work performance due to insufficient data. The potential for integrating the construct of mindfulness within job demands-resources, coping, and prevention theories of work stress is considered in relation to the results. Limitations to study designs and reporting are addressed, and recommendations to advance research in this field are made. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Association between childhood health, socioeconomic and school-related factors and effort-reward imbalance at work: a 25-year follow-up study.

OBJECTIVES: Stress pathways can have origins in childhood, but few early predictors have been explored in relation to adult job stress. This study examined whether childhood school, health or socioeconomic factors were associated with adult job stress. METHODS: Data came from the Childhood Determinants of Adult Health study that began in 1985 with children aged 7-15 years who reported effortreward imbalance (ERI) scales at ages 31-41 years. Linear regression assessed the association between childhood factors and adult ERI adjusted for age and socioeconomic position (SEP) in childhood and adulthood. RESULTS: There were between 999 and 1390 participants in each analysis. Lower adulthood ERI, indicating less job stress, was predicted by several school-related factors in men. For example, each higher category of learner self-concept was associated with a 19% (95% CI - 32% to 6%) reduction in adult ERI, and each unit increase in academic attainment was associated with a 15% (95% CI -28% to 3%) reduction in adult ERI. Childhood health was associated with adult ERI. For example, in women, overweight children had 14% (95% CI 5% to 22%) higher adult ERI scores compared with healthy weight children, and each unit of negative affect was associated with 2% (95% CI 1% to 4%) increase in adult ERI. Adult SEP had no effect on these associations for men but explained some of the effect in women. Childhood SEP had inconsistent associations with adult ERI. CONCLUSION: Our findings suggest that a range of childhood socioeconomic, school- and health-related factors might contribute to the development of job stress in adulthood.