The Health4Life e-health intervention for modifying lifestyle risk behaviours of adolescents: secondary outcomes of a cluster randomised controlled trial.

OBJECTIVES: To investigate the effectiveness of a school-based multiple health behaviour change e-health intervention for modifying risk factors for chronic disease (secondary outcomes). STUDY DESIGN: Cluster randomised controlled trial. SETTING, PARTICIPANTS: Students (at baseline [2019]: year 7, 11-14 years old) at 71 Australian public, independent, and Catholic schools. INTERVENTION: Health4Life: an e-health school-based multiple health behaviour change intervention for reducing increases in the six major behavioural risk factors for chronic disease: physical inactivity, poor diet, excessive recreational screen time, poor sleep, and use of alcohol and tobacco. It comprises six online video modules during health education class and a smartphone app. MAIN OUTCOME MEASURES: Comparison of Health4Life and usual health education with respect to their impact on changes in twelve secondary outcomes related to the six behavioural risk factors, assessed in surveys at baseline, immediately after the intervention, and 12 and 24 months after the intervention: binge drinking, discretionary food consumption risk, inadequate fruit and vegetable intake, difficulty falling asleep, and light physical activity frequency (categorical); tobacco smoking frequency, alcohol drinking frequency, alcohol-related harm, daytime sleepiness, and time spent watching television and using electronic devices (continuous). RESULTS: A total of 6640 year 7 students completed the baseline survey (Health4Life: 3610; control: 3030); 6454 (97.2%) completed at least one follow-up survey, 5698 (85.8%) two or more follow-up surveys. Health4Life was not statistically more effective than usual school health education for influencing changes in any of the twelve outcomes over 24 months; for example: fruit intake inadequate: odds ratio [OR], 1.08 (95% confidence interval [CI], 0.57-2.05); vegetable intake inadequate: OR, 0.97 (95% CI, 0.64-1.47); increased light physical activity: OR, 1.00 (95% CI, 0.72-1.38); tobacco use frequency: relative difference, 0.03 (95% CI, -0.58 to 0.64) days per 30 days; alcohol use frequency: relative difference, -0.34 (95% CI, -1.16 to 0.49) days per 30 days; device use time: relative difference, -0.07 (95% CI, -0.29 to 0.16) hours per day. CONCLUSIONS: Health4Life was not more effective than usual school year 7 health education for modifying adolescent risk factors for chronic disease. Future e-health multiple health behaviour change intervention research should examine the timing and length of the intervention, as well as increasing the number of engagement strategies (eg, goal setting) during the intervention. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12619000431123 (prospective).

The lived experience of caring for someone with bipolar disorder: A qualitative study.

Being a close family or friend of someone with bipolar disorder (BD) can lead to experiences of increased stress, anxiety and depressive symptoms related to the burden of caring. However, the lived experience of being a carer for a person with BD has not received significant research attention. This study aimed to gain further insight into the experiences of individuals in an informal caring role for someone with BD and determine what additional information and support these people need to take care of both themselves and the person they are caring for. Fifteen qualitative interviews were carried out with carers discussing their lived experiences with utilising coping strategies and supporting someone with BD. Following the interviews, thematic analysis was used to identify five key themes. These themes were: Separation of the person and the disorder, carer health and coping strategies, unpredictability and variability of symptoms, carer disillusionment and silencing, and story sharing and support needs. Overall, the findings highlighted the need for increased in-person and online support specifically tailored for carers with loved ones experiencing BD.

Health behavior interventions for university students measuring mental health outcomes: A scoping review.

Introduction: Many university students have poor mental health, and co-occurring health risk behaviors. Targeting health behavior change in this population may improve mental health outcomes. This scoping review describes the extent and range of randomized controlled trials (RCT) evaluating interventions targeting health risk behaviors and measuring a mental health outcome, among university students. Methods: Six electronic databases were searched for RCTs published until the 18th May 2021. Eligible RCTs included university students, evaluated interventions that promoted health behavior change (i.e., dietary intake, physical activity, sedentary behavior, alcohol and drug use, smoking, and sleep), and measured a mental health-related outcome. Results: Fifty-nine RCTs met the inclusion criteria that were published from 2000 to 2021, and over half (n = 33) were conducted in the United States. Interventions evaluated within the RCTs (n = 92) predominantly targeted changes to dietary intake (n = 41 interventions), physical activity (n = 39), or alcohol intake (n = 35). Most interventions targeted one (n = 51) or two (n = 27) health behaviors only. Included RCTs considered mental ill health outcomes (n = 24), psychological wellbeing outcomes (n = 20), or both (n = 15). Discussion: This scoping review identified a moderate volume of experimental research investigating the impact of health behavior interventions on university students' mental health. There is scope for further research examining health behavior interventions targeting university students, particularly interventions taking a multi-behavioral approach.

Effectiveness of the Hunter Way Back Support Service: An historical controlled trial of a brief non-clinical after-care program for hospital-treated deliberate self-poisoning.

INTRODUCTION: Active contact and follow-up interventions have been shown to be effective in reducing repetition of hospital-treated self-harm. The Way Back Support Service (WBSS) is a new service funded by the Australian government to provide three months of non-clinical after-care following a hospital-treated suicide attempt. The aim of this study was to investigate the effectiveness of WBSS in reducing deliberate self-poisoning (DSP) and psychiatric hospital admissions over a 12-month follow-up period for a population of DSP patients within the Hunter (Australia) region. METHODS: A non-randomized, historical controlled (two periods) trial design with intention-to-treat analyses. Outcome data were drawn from hospital records. RESULTS: There were a total of 2770 participants across study periods. There were no significant differences between cohorts for proportion with any, or number of, re-admissions for DSP in the follow-up period. For psychiatric admissions, the intervention cohort had a non-significantly greater proportion with any psychiatric admission and significantly more admissions compared to one of the control cohorts. CONCLUSION: The WBSS model of care should be modified to strengthen treatment engagement and retention and to include established, clinical, evidence-based treatments shown to reduce DSP repetition. Any modified WBSS model should be subject to further evaluation.

Randomised controlled trial of a healthy lifestyle intervention among smokers with psychotic disorders: Outcomes to 36 months.

OBJECTIVE: People living with psychotic disorders (schizophrenia spectrum and bipolar disorders) have high rates of cardiovascular disease risk behaviours, including smoking, physical inactivity and poor diet. We report cardiovascular disease risk, smoking cessation and other risk behaviour outcomes over 36 months following recruitment into a two-arm randomised controlled trial among smokers with psychotic disorders. METHODS: Participants ( N = 235) drawn from three sites were randomised to receive nicotine replacement therapy plus (1) a Healthy Lifestyles intervention delivered over approximately 9 months or (2) a largely telephone-delivered intervention (designed to control for nicotine replacement therapy provision, session frequency and other monitoring). The primary outcome variables were 10-year cardiovascular disease risk and smoking status, while the secondary outcomes included weekly physical activity, unhealthy eating, waist circumference, psychiatric symptomatology, depression and global functioning. RESULTS: Significant reductions in cardiovascular disease risk and smoking were detected across the 36-month follow-up period in both intervention conditions, with no significant differences between conditions. One-quarter (25.5%) of participants reported reducing cigarettes per day by 50% or more at multiple post-treatment assessments; however, few (8.9%) managed to sustain this across the majority of time points. Changes in other health behaviours or lifestyle factors were modest; however, significant improvements in depression and global functioning were detected over time in both conditions. Participants experiencing worse 'social discomfort' at baseline (e.g. anxiety, mania, poor self-esteem and social disability) had on average significantly worse global functioning, lower scores on the 12-Item Short Form Health Survey physical scale and significantly greater waist circumference. CONCLUSION: Although the telephone-delivered intervention was designed as a comparison condition, it achieved excellent retention and comparable outcomes. Telephone-delivered smoking cessation support may potentially help to reduce smoking rates among people with psychotic disorders. Discomfort in social situations may also be a useful target for future health interventions, addressing confidence and social skills, and promoting social networks that reduce inactivity.

Specific features of current and emerging mobile health apps: user views among people with and without mental health problems.

BACKGROUND: Despite widespread development of mobile health apps, there is a paucity of research investigating user views of apps and their features, particularly among people with mental health problems. This study aimed to gain an understanding of the acceptability of specific features of current and emerging mobile health apps among people with and without mental health problems. METHODS: Adults living in Australia were recruited to complete a self-report questionnaire regarding demographic characteristics, mental health, technology use, and attitudes regarding specific features of mobile health apps. RESULTS: A total of 284 participants were recruited, including 53% with a history of mental illness. Few concerns were reported with mobile app features (mean =1.8 features; SD =2.19) and statistical analyses found that age, gender, income, rurality, mental health status and technology use did not affect the expression of these concerns. Key issues identified included privacy and security of personal information, apps acting automatically, sharing personal information and the invasive nature of some features. CONCLUSIONS: These results suggest that mental illness may not be a barrier to widespread use of mobile technologies for health purposes. It is hoped that this research will assist developers and clinicians to develop and integrate mobile health apps into everyday care more effectively.

Therapeutic Alliance, Client Need for Approval, and Perfectionism as Differential Moderators of Response to eHealth and Traditionally Delivered Treatments for Comorbid Depression and Substance Use Problems.

PURPOSE: This study sought to undertake an exploratory analysis of the impact of therapeutic alliance and dysfunctional attitudes (perfectionism and need for approval) on outcomes for participants receiving therapist-delivered and eHealth interventions for comorbid depression and alcohol/cannabis use problems. These factors have been shown in previous research to moderate response to psychological treatment for depression and related disorders. METHOD: Participants (N = 274) with concurrent depression and alcohol/cannabis misuse were randomized to 10 sessions of therapist-delivered cognitive behavior therapy/motivational interviewing (CBT/MI), computer-delivered CBT/MI with brief therapist assistance (SHADE CBT/MI), or supportive counseling (PCT). Follow-up occurred at 3, 6, and 12 months post-baseline. Exploratory moderator analyses examined changes in depression, alcohol use, and cannabis use over the 3-12-month follow-up timepoints, adjusting for baseline, as a function of treatment allocation, and the hypothesized moderators of therapeutic alliance, perfectionism, and need for approval. RESULTS: The sample size and number of comparisons in the analysis mean that the results are considered preliminary and need replication in larger trials. The analysis revealed that "client initiative," a subscale of therapeutic alliance, moderated change in depression scores between 3- and 12-month follow-up for the PCT group, with higher scores associated with decreases in depression over time. Higher therapeutic "bond" early in treatment for SHADE CBT/MI participants was associated with reduced cannabis use over time. Participants with higher "perfectionism" scores at baseline who received therapist CBT/MI reported increases in depression over the follow-up period, but reductions in depression if they received SHADE CBT/MI. Therapist CBT/MI participants high on "need for approval" at baseline reported better alcohol use outcomes over time. CONCLUSION: The preliminary nature of these results do not justify firm conclusions. However, the specific variables of perfectionism, need for approval, and client initiative show promise as moderators of treatment efficacy for comorbid depression and alcohol/cannabis use problems. Further research is justified to determine whether these factors can assist in tailoring the modality and strategies offered in the delivery of psychotherapy to this population.

The association between cannabis use and motivation and intentions to quit tobacco within a sample of Australian socioeconomically disadvantaged smokers.

This study aimed to (i) describe concurrent and simultaneous tobacco and cannabis use and (ii) investigate the association between cannabis use and motivation and intentions to quit tobacco in a sample of socioeconomically disadvantaged smokers. A cross-sectional survey was conducted in 2013 and 2014 with current tobacco smokers receiving aid from two community service organizations in New South Wales, Australia. At least weekly cannabis use for the month prior to survey, motivation to quit tobacco and intentions to quit tobacco were measured in 369 participants (77% consent rate). Regressions were carried out to investigate associations between weekly cannabis use and motivation and intentions to quit tobacco.Concurrent tobacco and cannabis use was reported by 19% (n = 71) of the sample and of these users, 100% reported simultaneous use. Although regular cannabis use was significantly associated with lower motivation to quit tobacco, it was not significantly associated with intentions to quit tobacco in the next 30 days. Concurrent cannabis use is common in disadvantaged smokers and may play a role in decreased motivation to quit tobacco; however, it does not appear to be associated with intentions to quit in a sample of disadvantaged smokers.

Early Therapeutic Alliance, Treatment Retention, and 12-Month Outcomes in a Healthy Lifestyles Intervention for People with Psychotic Disorders.

Engaging and retaining individuals with psychotic disorders in psychosocial treatments is difficult. Early therapeutic alliance, treatment retention, and 12-month outcomes were examined in a subsample of smokers with a psychotic disorder (N = 178) participating in a healthy lifestyles study comparing a telephone versus face-to-face delivered intervention. Therapeutic alliance was assessed using the Agnew Relationship Measure; primary outcomes were treatment retention and changes in symptoms and health behaviors. Contrary to expectations, early alliance did not predict treatment retention. However, elements of both client- and therapist-rated alliance predicted some clinical outcomes (e.g., higher confidence in the therapeutic alliance at session 1 predicted improvements in 12-month depression). Some modest interactions between early alliance and intervention condition were also identified (e.g., clients initially with lower self-perceived initiative, or higher therapist-perceived bonding benefited preferentially from the telephone-delivered intervention), highlighting the need to further examine the interplay between therapeutic alliance and treatment modality.

Reducing smoking reduces suicidality among individuals with psychosis: Complementary outcomes from a Healthy Lifestyles intervention study.

This study sought to explore the impact of smoking reduction on suicidality (suicide ideation and behaviour) among people with a psychotic disorder (n=235) who participated in a randomized trial of a healthy lifestyle intervention trial. Suicidality, measured by item -4 of the Brief Psychiatric Rating Scale (BPRS) was the main variable of interest. Measures were collected by research assistants blind to treatment allocation at baseline, at 15 weeks (mid-intervention) and 12 months after baseline. Mediation analysis, adjusted for confounders, was used to determine the relationship between smoking reduction and suicidality and to explore whether this was mediated through depression. At 12 months, smoking reduction was found to be significantly associated with suicidality change; an association was also seen between smoking reduction and depression and depression and suicidality. After adjusting for depression, the association between smoking reduction and suicidality was attenuated but remained statistically significant; the proportion of the total effect that was mediated through depression was 30%. There was no significant association between suicidality and treatment group (vs. controls) over time. Our study suggests that smoking interventions may have benefits over and above those for improved physical health, by reducing suicidal ideation in people with psychosis.

Study protocol for a systematic review of evidence for lifestyle interventions targeting smoking, sleep, alcohol/other drug use, physical activity, and healthy diet in people with bipolar disorder.

BACKGROUND: People with bipolar disorder (BD) have a mortality gap of up to 20 years compared to the general population. Physical conditions, such as cardiovascular disease (CVD) and cancer, cause the majority of excess deaths in psychiatric populations and are the leading causes of mortality in people with BD. However, comparatively little attention has been paid to reducing the risk of physical conditions in psychiatric populations. Unhealthy lifestyle behaviors are among the potentially modifiable risk factors for a range of commonly comorbid chronic medical conditions, including CVD, diabetes, and obesity. This systematic review will identify and evaluate the available evidence for effective interventions to reduce risk and promote healthy lifestyle behaviors in BD. METHODS/DESIGN: We will search MEDLINE, Embase, PsychINFO, Cochrane Database of Systematic Reviews, and CINAHL for published research studies (with at least an abstract published in English) that evaluate behavioral or psychosocial interventions to address the following lifestyle factors in people with BD: tobacco use, physical inactivity, unhealthy diet, overweight or obesity, sleep-wake disturbance, and alcohol/other drug use. Primary outcomes for the review will be changes in tobacco use, level of physical activity, diet quality, sleep quality, alcohol use, and illicit drug use. Data on each primary outcome will be synthesized across available studies in that lifestyle area (e.g., tobacco abstinence, cigarettes smoked per day), and panel of research and clinical experts in each of the target lifestyle behaviors and those experienced with clinical and research with individuals with BD will determine how best to represent data related to that primary outcome. Seven members of the systematic review team will extract data, synthesize the evidence, and rate it for quality. Evidence will be synthesized via a narrative description of the behavioral interventions and their effectiveness in improving the healthy lifestyle behaviors in people with BD. DISCUSSION: The planned review will synthesize and evaluate the available evidence regarding the behavioral or psychosocial treatment of lifestyle-related behaviors in people with BD. From this review, we will identify gaps in our existing knowledge and research evidence about the management of unhealthy lifestyle behaviors in people with BD. We will also identify potential opportunities to address lifestyle behaviors in BD, with a view to reducing the burden of physical ill-health in this population. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015019993.

Associations between personality disorder characteristics and treatment outcomes in people with co-occurring alcohol misuse and depression.

BACKGROUND: Personality disorders are highly comorbid with alcohol misuse and depressive symptomatology; however, few studies have investigated treatment outcomes in this population. The aim of this study was to examine relationships between baseline personality disorder cluster profiles and overall and treatment-related changes for those with co-occurring alcohol misuse and depression. METHODS: Secondary analysis was conducted using a subset of data (N = 290) from two randomised controlled trials of psychological interventions for co-occurring alcohol misuse and depression, which did not specifically target personality disorders. Baseline dimensional personality disorder cluster scores were derived from the International Personality Disorder Examination Questionnaire (IPDEQ). Four treatment conditions were compared: a brief integrated intervention, followed by no further treatment, or nine further sessions of integrated-, alcohol-, or depression-focused treatment. Associations between IPDEQ scores and changes in alcohol use, depressive symptoms and functioning from baseline to the 6- and the 12-month follow-ups were of primary interest. RESULTS: Personality disorder cluster scores moderately negatively impacted on overall change (primarily Cluster C), as well as treatment-related outcomes (primarily Cluster A), particularly changes in depressive symptoms and psychosocial functioning. Longer interventions appeared to be more effective in the longer-term (e.g., at 12-month follow-up), with integrated interventions relatively more effective than single-focused ones for individuals with higher personality disorder cluster scores. CONCLUSIONS: Greater attention needs to be paid to particular personality disorder clusters during the assessment and treatment of individuals with co-occurring alcohol misuse and depression. Integrated interventions, incorporating motivational interviewing and cognitive behaviour therapy, may provide a useful therapeutic framework. Integrated interventions also provide opportunities for adjunctive components focussing on other issues and coping strategies (e.g., to offset negative affective states), potentially tailored to the characteristics and needs of individual participants.

Investigation of a Suicide Ideation Risk Profile in People With Co-occurring Depression and Substance Use Disorder.

Disengagement from services is common before suicide, hence identifying factors at treatment presentation that predict future suicidality is important. This article explores risk profiles for suicidal ideation among treatment seekers with depression and substance misuse. Participants completed assessments at baseline and 6 months. Baseline demographics, psychiatric history, and current symptoms were entered into a decision tree to predict suicidal ideation at follow-up. Sixty-three percent of participants at baseline and 43.5% at follow-up reported suicidal ideation. Baseline ideation most salient when psychiatric illness began before adulthood, increasing the rate of follow-up ideation by 16%. Among those without baseline ideation, dysfunctional attitudes were the most important risk factor, increasing rates of suicidal ideation by 35%. These findings provide evidence of factors beyond initial diagnoses that increase the likelihood of suicidal ideation and are worthy of clinical attention. In particular, providing suicide prevention resources to those with high dysfunctional attitudes may be beneficial.

Recruiting for addiction research via Facebook.

INTRODUCTION AND AIMS: This study aimed to examine the feasibility of recruiting participants to addiction research via Facebook. DESIGN AND METHODS: Participants were recruited via an advertisement on Facebook, a local research register and university psychology courses. Participants completed a self-report survey regarding substance use, history of mental health issues and current psychological distress. RESULTS: The 524 participants recruited via Facebook cost $1.86 per participant; and 418 participants were recruited via more traditional methods. There were significantly fewer women in the Facebook sample compared with the non-Facebook sample (χ(2) = 196.61, P < 0.001), but no differences on age. Significantly more Facebook participants reported current use of tobacco (women: Facebook = 57%, non-Facebook = 21%, χ(2) = 39.71, P < 0.001; men: Facebook = 62%, non-Facebook = 21%, χ(2) = 32.429, P < 0.001) and cannabis (women: Facebook = 26%, non-Facebook = 7%, χ(2) = 14.364, P < 0.001; men: Facebook = 46%, non-Facebook = 24%, χ(2) = 6.765, P < 0.01). They also reported significantly more harmful use of tobacco [women: F degrees of freedom (d.f.) = 6.07, P < 0.05; men: F(d.f.) = 9.03, P < 0.01] and cannabis [women: F(d.f.) = 11.00, P < 0.01; men: F(d.f.) = 6.40, P < 0.05]. The Facebook sample contained a higher percentage of high-severity cannabis users (women: Facebook = 24%, non-Facebook = 4%, χ(2) = 18.12, P < 0.001; men: Facebook = 43%, non-Facebook = 16%, χ(2) = 10.00, P < 0.01) and reported significantly more severe depressive symptoms [women: F(d.f.) = 26.38, P < 0.001; men: F(d.f.) = 7.44, P < 0.05]. DISCUSSION AND CONCLUSIONS: Through Facebook, we were able to capture a greater proportion of people with high-severity substance use and mental health issues and were able to capture a greater and more severe range of substance use behaviours. This suggests social networking sites are efficient, cost-effective ways to recruit large numbers of participants, with relevant behaviours and conditions, to addiction research. [Thornton LK, Harris K, Baker AL, Johnson M, Kay-Lambkin FJ. Recruiting for addiction research via Facebook. Drug Alcohol Rev 2016;35:494-502].

Systematic review of neurocognition in people with co-occurring alcohol misuse and depression.

BACKGROUND: Alcohol misuse and depression represent two major social and health problems globally. These conditions commonly co-occur and both are associated with significant cognitive impairment. Despite this, few studies have examined the impact on cognitive functioning of co-occurring alcohol misuse and depression. This study aims to critically review findings from peer-reviewed published articles examining neuropsychological test performance among samples of people with co-occurring alcohol misuse and depression. METHOD: A comprehensive literature search was conducted, yielding six studies reporting neuropsychological profiles of people with co-occurring alcohol misuse and depression. Results comparing cognitive functioning of people with this comorbidity to those with alcohol misuse alone, depression alone, healthy controls and published norms were examined as well as those describing the correlation between depressive symptoms and cognitive functioning in people with alcohol use disorders. RESULTS: In the majority of instances, the comorbid groups did not differ significantly from those with depression only or alcohol misuse only, nor from healthy controls or published norms. In the cases where a difference in neuropsychological test scores between groups was found, it was not consistently identified across studies. However, visual memory was identified in two studies as being impaired in comorbid samples and is worthy of inclusion in future studies. LIMITATIONS: Due to the small number of included studies and the large variation in inclusion criteria as well as differing assessment tools and methodologies between studies, the review did not include a quantitative synthesis. CONCLUSIONS: Research into cognitive deficits among people with singly occurring versus co-occurring alcohol misuse and depression is accumulating. Evidence suggests that the neuropsychological performance among samples with this comorbidity is generally not severely impaired and is unlikely to preclude benefit from treatment.

Randomized Controlled Trial of a Healthy Lifestyle Intervention Among Smokers With Psychotic Disorders.

INTRODUCTION: People with severe mental disorders typically experience a range of health problems; consequently, interventions addressing multiple health behaviors may provide an efficient way to tackle this major public health issue. This two-arm randomized controlled trial among people with psychotic disorders examined the efficacy of nicotine replacement therapy (NRT) plus either a face-to-face or predominantly telephone delivered intervention for smoking cessation and cardiovascular disease (CVD) risk reduction. METHODS: Following baseline assessment and completion of a common, individually delivered 90-minute face-to-face intervention, participants (n = 235) were randomized to receive NRT plus: (1) a "Healthy Lifestyles" intervention for smoking cessation and CVD risk behaviors or (2) a predominantly telephone-based intervention (designed to control for NRT provision, session frequency, and other monitoring activities). Research assistants blind to treatment allocation performed assessments at 15 weeks (mid-intervention) and 12 months after baseline. RESULTS: There were no significant differences between intervention conditions in CVD risk or smoking outcomes at 15 weeks or 12 months, with improvements in both conditions (eg, 12 months: 6.4% confirmed point prevalence abstinence rate; 17% experiencing a 50% or greater smoking reduction; mean reduction of 8.6 cigarettes per day; mean improvement in functioning of 9.8 points). CONCLUSIONS: The health disparity experienced by people with psychotic disorders is high. Face-to-face Healthy Lifestyle interventions appear to be feasible and somewhat effective. However, given the accessibility of telephone delivered interventions, potentially combined with lower cost, further studies are needed to evaluate telephone delivered smoking cessation and lifestyle interventions for people with psychotic disorders.

Women's perceptions of information about alcohol use during pregnancy: a qualitative study.

BACKGROUND: A number of alcohol guidelines worldwide suggest that pregnant women should abstain from alcohol. However, high prevalence rates of alcohol consumption during pregnancy still exist. It is unknown whether there are problems with the dissemination of guideline information that is potentially contributing to such consumption. This qualitative study aimed to explore women's perceptions of information they received about alcohol use during pregnancy after the introduction of abstinence guidelines. METHODS: Nineteen women from the Australian Longitudinal Study on Women's Health (ALSWH) 1973-78 cohort that reported a pregnancy in 2009 were recruited for semi-structured telephone interviews. The interviews were conducted until data saturation was reached. Interviews were transcribed, then thematically analysed. ALSWH survey data was used to augment the findings. The main outcome measure was women's perceptions of information received about alcohol use during pregnancy after the introduction of the 2009 Australian guidelines promoting abstinence during pregnancy. RESULTS: Women reported a number of problems with the information about alcohol use during pregnancy and with its dissemination. There were inconsistencies in the information about alcohol use during pregnancy and in the advice provided. Mixed messages and confusion about identifying a safe level of consumption had implications on women's decisions to drink or abstain during pregnancy. Women expressed a need for a clear, consistent message to be provided to women as early as possible. They preferred that the message come from healthcare professionals or another reputable source. CONCLUSIONS: To make an informed decision about alcohol use during pregnancy, women must first be provided with the latest evidence-based information. As this study found a number of limitations with information provision, it is suggested that a systematic approach be adopted by healthcare professionals, in line with best-practice guidelines, to ensure all women are made aware of the alcohol recommendations for pregnancy.

Treatments for co-occurring depression and substance use in young people: a systematic review.

BACKGROUND: Depression and problematic substance use represent two of the major social and health problems facing young people internationally. Frequently, these conditions co-occur and this co-occurrence is associated with greater functional impact, poorer treatment outcomes, and increased costs to both society and the individual. OBJECTIVE: This review aims to identify peer-reviewed published trials of interventions for co-occurring substance use and depression delivered to young people, describe these interventions, and critique the methodological quality of the studies. METHOD: Eleven electronic databases were searched. The reference lists of relevant review papers were searched manually for additional studies not identified by the electronic database search. RESULTS: Initially, 1,976 studies were identified, of which 22 were classified as trial studies of youth-based treatment interventions for co-occurring substance use and depression. Ten of these studies met criteria for review. The majority (60%) utilized a pharmacotherapy component, but found it to be generally no better than placebo when both groups received adjunct counselling. METHODological quality of studies varied. CONCLUSIONS: There is a dearth of trials of interventions for co-occurring depression and substance use disorders in young people. The limited data available is promising regarding the overall effectiveness of a psychological counselling approach. Given the importance of early intervention, and the difficulties faced when engaging youth in treatment, there is a need for further focused effort amongst this group. This may require more innovative techniques in intervention design and implementation. Recent advances in Internet- and mobile phone-based therapies present a potential avenue for further research.