Care navigation addresses issues of tele-mental health acceptability and uptake in rural and remote Australian communities.

INTRODUCTION: People living in rural and remote areas face substantial barriers to accessing timely and appropriate mental health services. In the Bowen Basin region of Queensland, Australia, barriers include: limited local providers, long waiting lists, unreliable telecommunication, and reluctance to trial telehealth. Isaac Navicare is a new, community co-designed care navigation service which addresses these barriers by coupling care navigation with supported telehealth, and referrals to mental health providers and other supports. We aimed to understand the reach and effectiveness of Isaac Navicare in improving access to mental health services and address an evidence gap on strategies for improving telehealth acceptability. METHODS: This mixed-methods implementation science evaluation used the RE-AIM Framework. It involved a client database review, survey and semi-structured interviews with service users during the 12-month pilot from November 2021. RESULTS: 197 clients (128 adults, 69 minors) were referred to Navicare during the pilot. Half of adult clients were unemployed, meaning referral options were limited to low-cost or bulk-billed services. Participants described Navicare as supportive and effective in helping to access timely and appropriate mental health supports. Most clients who expressed a treatment modality preference selected face-to-face (n = 111, 85.4%), however most referrals were for telehealth (n = 103, 66.0%) due to a lack of suitable alternatives. The rapport and trust developed with the care navigator was critical for increasing willingness to trial telehealth. Barriers to telehealth included privacy issues, technical difficulties, unreliable internet/phone, and perceived difficulties developing therapeutic rapport. The supported telehealth site was under-utilised. The majority (88.3%, n = 182) of referrals to Navicare were from local health or community service providers or schools. DISCUSSION: Coupling supportive, individualised care navigation with tele-mental health provider options resulted in increased uptake and acceptance of telehealth. Many barriers could be addressed through better preparation of clients and improving promotion and uptake of the supported telehealth site. CONCLUSION: Attitudes towards telehealth have changed during the COVID-19 pandemic, however although the need exists, barriers remain to uptake. Telehealth alone is not enough. Coupling telehealth with other supports such as care navigation improves acceptance and uptake.

Factor structure of the Edinburgh Postnatal Depression Scale in a large population-based sample of fathers.

BACKGROUND: Paternal perinatal distress is receiving increasing attention. The Edinburgh Postnatal Depression Scale (EPDS) is the predominant screening tool for paternal perinatal distress. Research using the large Avon Longitudinal Study of Parents and Children (ALSPAC) cohort demonstrated that a three-factor EPDS structure is appropriate among mothers, with anhedonia, anxiety and depression factors emerging consistently across perinatal timepoints. METHOD: We employed confirmatory factor (CFA; n = 6170 to 9848) analysis to determine if this structure was appropriate for ALSPAC fathers, and the extent of invariance between mother and father groups. RESULTS: At 18-weeks gestation, and 8-weeks, 8-months and 21-months postpartum, the three-factor model had consistently superior fit to other proposed models. Consistent with interpretation of a total distress score, factors were highly correlated. The model exhibited configural invariance in both the first (8-months) and second (21-months) post-partum years. Metric and scalar invariance were not supported, however, non-invariance was largely attributable to item 9 canvassing "crying". LIMITATIONS: While the study employs a large cohort, the data collection in 1991 to 1992 in the United Kingdom may not account for the diverse gender roles, family structures and societal changes seen since that time. CONCLUSIONS: Interpretation of the EPDS as representing perinatal distress, reflecting anhedonia, anxiety and depression aspects, is appropriate for mothers and fathers. The experience of distress has nuanced gender-based differences. Implications for EPDS interpretation and cut-off scores among fathers are discussed.

Prescribing behavior of antidepressants for depressive disorders: A systematic review.

Objective: Guidelines for the prescription of antidepressants for Depressive Disorders (DD) have been in place for a long time. However, there is a lack of systematic information on the prescribing behavior of antidepressants in evidence-based clinical practice in psychopharmacotherapy of depressive disorders. This may suggest a lack of implementation of clinical guidelines by clinicians. Existing literature mainly focuses on specific issues or medications. To provide general information on the prescribing behavior of antidepressants for depressive disorders, a systematic review of available studies since 2013 was conducted. Methods and materials: To ensure a structured and systematic approach for the literature search and subsequent review process, the PRISMA guidelines for systematic reviews were followed. Major medical and health and psychological databases were used for the literature search. These included Ebsco Host, OVID, PubMed, Science Direct, Scopus, and Web of Science. The online application "Covidence" was employed to manage the titles collected and the full articles retrieved from the initial literature search. Upon finalizing the list of selected studies, data extraction was then conducted using a build-in function of the Covidence platform with the required information pre-set on a template for data extraction. The extracted information was tabulated and summarized in a table. Results: Forty-one studies were identified after an extensive search of the literature following the PRISMA guidelines. Of these, 37 quantitative studies providing useful information were systematically reviewed and information extracted. There was a high level of heterogeneity among these studies with different foci or characteristics. Most studies were conducted in or utilized data obtained from hospital and primary healthcare settings. SSRIs were the most commonly prescribed type of antidepressant in the past decade, particularly among younger patients. Among these studies, antidepressants were mainly prescribed by psychiatrists with some by other physicians and general practitioners. This might reflect differences in legislation regarding professional requirements for prescribers or clinical practices. Conclusions: A few themes that would be considered important in terms of the effect of prescription behavior on depression, specifically children/adolescents, special target populations, and off-label prescription. The results highlighted the need for more studies on a community-based approach and the role of GPs in the treatment of DD.

Validation of the Behavioral Anger Response Questionnaire for Children (BARQ-C) in a large community sample of Vietnamese middle adolescents in Hanoi.

BACKGROUND: Depression and other forms of psychological distress are common among Vietnamese adolescents and increase the risk of mental health problems in adulthood. As anger coping is a robust predictor of adolescent mental health difficulties, and there appear to be cultural variations in anger coping, a measure of adolescent anger coping styles that has been validated using a non-Western adolescent sample is required to inform and support early intervention to prevent or treat mental health difficulties in Vietnamese adolescents. This study examined the construct validity (structural and external) of the Behavioral Anger Response Questionnaire for Children in Vietnam (BARQC-V). METHODS: Baseline data sourced from a recent randomised control trial conducted with Grade 10 Vietnamese adolescents aged 14 to 16 (N = 1084) were used to examine multiple aspects of construct validity: factorial structure (evaluated using factor analysis); internal consistency (tested using Cronbach's alpha coefficient); and external aspect (assessed using Pearson's correlation coefficients between the BARQC-V and Vietnamese translations of the Coping Self-Efficacy Scale, Centre for Epidemiologic Studies Depression Scale Revised, Mental Health Continuum Short Form, and the Depression Anxiety and Stress Scale). RESULTS: Evaluating factorial structure using confirmatory factor analysis failed to converge on a solution. Exploratory factor analysis yielded a 5-factor structure model that explained 49.32% of the BARQC-V's total variance and was deemed to be a good fit by the final confirmatory factor analysis. Cronbach's alpha coefficients of the 5 factors demonstrated acceptable internal reliability for the BARQC-V's sub-scales. Concerning concurrent validity, three sub-scales predicted well-being and mental health difficulties: the maladaptive anger coping styles Rumination and Direct Anger-out were positively associated with depression and distress, and negatively associated with coping self-efficacy and mental well-being; and the adaptive anger coping style Assertion was positively associated with coping self-efficacy and mental well-being, and negatively associated with depression. CONCLUSIONS: The BARQC-V provides a validated measure of three anger coping strategies used by adolescents in Vietnam (Rumination, Direct Anger-out, and Assertion) that can be used to improve detection and treatment of mental health difficulties in this population, and as a starting point by future research to develop a much-needed gold standard measure of anger coping for adults, adolescents and children world-wide.

The effect of acculturation and harm beliefs on medication adherence on Middle Eastern hypertensive refugees and migrants in Australia.

Background Different populations have different levels of acculturation, and beliefs about medications. Little is known about the differences between refugees and migrants regarding these various beliefs. Adherence to medications is influenced by many factors, including individuals' characteristics, acculturation, and their perceptions about medications. Having a thorough understanding of these beliefs contributes to understanding medication adherence in refugee and migrant populations. Objectives To evaluate the differences between Middle Eastern refugees and migrants in Australia regarding acculturation, beliefs about medications, and medication adherence, and to evaluate the association of acculturation and beliefs about medications and natural remedies with medication adherence. Setting Participants were recruited from various community groups and English language learning centres in Australia. Arabic Facebook community groups were also used to recruit participants for this study. Method A total of 320 Middle Eastern refugees and migrants with hypertension completed Arabic or English versions of the general Beliefs about Medicine Questionnaire (BMQ)-harm scale, a question about beliefs in natural remedies, six items about acculturation and the Medication Adherence Questionnaire. Two models of multiple mediation were applied. The first model examined the role of acculturation, length of residency, beliefs about natural remedies, and harm beliefs as mediators between migration status and medication adherence. The second model identified the role of acculturation, and beliefs about natural remedies as mediators between migration status and medication harm beliefs. Main outcome measure Medication adherence, harm beliefs about medication, acculturation, and beliefs about natural remedies. In addition, the differences between refugees and migrants regarding these beliefs and medication adherence. Results Differences were found between refugees and migrants for medication adherence and medication beliefs. Refugees were likely to have more harm beliefs towards medicine and were less acculturated than migrants (p = 0.0001). They were also less likely to adhere to medications (p = 0.0001), and perceived natural remedies to be safer than Western medications (p = 0.0001). Perceiving medications as harmful substances, and beliefs in natural remedies were mediators in the relationship between migration status and medication adherence. Beliefs in natural remedies and acculturation were mediators in the relationship between migration status and harm beliefs. Conclusion Beliefs about medications and natural remedies, and acculturation in refugees and migrants need to be better understood to enhance medication adherence and potentially overall health outcomes.

A short form of the Recovery Assessment Scale-Domains and Stages: Development and validation among adults with anxiety disorders.

The Recovery Assessment Scale-Domains and Stages (RAS-DS) is a 38-item self-report instrument measuring recovery from serious mental illness. We explored the suitability of the RAS-DS for individuals with anxiety disorders. A parsimonious short form of the scale was developed. Participants with anxiety disorder symptoms (N = 295) completed the RAS-DS, DASS-21 and GAD-7. Confirmatory factor analysis supported the expected four-factor structure. Associations with related scales exhibited the expected pattern supporting construct validity in this population. The Recovery Assessment Scale-Short Form (RAS-SF) was derived by inspection of factor loadings and modification indices, yielding a 20-item scale with five items per subscale. Strong correlations between subscales confirmed the total score represented a valid overarching measure of recovery. The present study indicates that recovery is pertinent to individuals with anxiety disorders. Development of the short-form RAS-SF affords opportunity for routine measurement of recovery in populations with anxiety and other high prevalence conditions.

The Role of Medication Beliefs on Medication Adherence in Middle Eastern Refugees and Migrants Diagnosed with Hypertension in Australia.

PURPOSE: The study assessed the association between medication beliefs and adherence in Middle Eastern refugees and migrants in Australia, and also examined differences between the two groups regarding beliefs and adherence to medication. PATIENTS AND METHODS: A total of 319 Middle Eastern refugees and migrants with hypertension were approached via various social groups in Australia and asked to complete Arabic versions of the Beliefs about Medicine Questionnaire (BMQ) and the Medication Adherence Questionnaire. BMQ scores (necessity and concerns scales) were classified as "accepting", "indifferent", "ambivalent" or "skeptical". Multiple mediation modelling was applied to examine the role of necessity and concerns scales as mediators between migration status and medication adherence. RESULTS: There were significant associations between medication adherence and medication beliefs scores (necessity and concerns scales) (p=0.0001). Necessity and concern were mediators in the relationship between migration status and medication adherence. Significant differences were found between refugees and migrants for medication adherence and medication beliefs. Refugees were likely to have less necessity, and more concern beliefs than migrants, and were also less likely to adhere to medications. Almost 30% of refugees could be classified as skeptical and 40% as ambivalent. In contrast, 50% of migrants had accepting beliefs, and around 35% held ambivalent beliefs. Refugees and migrants with "accepting" beliefs reported the highest adherence to medication and those holding "skeptical" beliefs reported the lowest adherence. CONCLUSION: Medication beliefs are potentially modifiable and are reasonable targets for clinical interventions designed to improve medication adherence. Understanding these beliefs and the likely differences between refugees and migrants is crucial to provide specific and targeted advice to each group independently in order to improve medication adherence and overall health.

Emotion Regulation as a Risk Factor for Suicide Ideation among Adolescents and Young Adults: The Mediating Role of Belongingness.

Thwarted belongingness is an established predictor of suicide ideation. Emerging theory suggests belongingness may be a crucial pathway through which risk factors such as dysfunctional emotion regulation influence suicide ideation. This study examined whether belongingness mediated the relationship between emotion regulation and suicide ideation in young people (16-25 years). Participants (n = 1699; 63.6% females, M = 20.24 years, SD = 2.45 years) completed measures of these constructs, including the emotion regulation domains of internal-functional, internal-dysfunctional, external-functional, and external-dysfunctional. Belongingness mediated over half of the association between three emotion regulation domains and suicide ideation (internal-functional: 55.6%, internal-dysfunctional: 54.1%, and external-functional: 64.8%). Consistent with current etiological suicidality models, results suggest low belongingness is an important precursor to suicide ideation in young people, and that there is an inter-relationship between emotional regulation styles and belongingness.

Social support and self-care outcomes in adults with diabetes: The mediating effects of self-efficacy and diabetes distress. Results of the second diabetes MILES - Australia (MILES-2) study.

AIMS: Diabetes self-care outcomes are positively impacted by social support. Understanding the mechanisms involved can inform more effective interventions. This study tested potential cross-sectional mediation of social support through self-efficacy and diabetes distress for self-care and clinical outcomes (diet, physical activity, blood glucose monitoring, HbA1c). METHOD: We analysed a sub-sample of the Australian Diabetes MILES-2 cross-sectional online survey (N = 1727). Measures were: Diabetes Social Support Scale, Confidence in Diabetes Self-care Scale, Problem Areas In Diabetes scale, diet and physical activity subscales of the Summary of Diabetes Self-Care Activities, and self-reported HbA1c. Separate mediation path models were tested for each of the four self-care/clinical outcomes in groups with type 1 and type 2 (insulin- and non-insulin-treated) diabetes. RESULTS: Social support was associated with more optimal self-care and self-reported HbA1c outcomes. When diabetes-specific self-efficacy and distress were included as mediators, the direct path from social support became non-significant. Conversely, the indirect effects of social support through diabetes-specific self-efficacy and distress were significant across all diabetes groups and outcomes. CONCLUSION: Diabetes-specific self-efficacy and distress may be important mechanisms linking social support with diabetes self-care and clinical outcomes. Social support interventions could explore whether improving diabetes self-efficacy and decreasing diabetes distress could help improve self-care.

The role of refugee and migrant migration status on medication adherence: Mediation through illness perceptions.

BACKGROUND: Illness perceptions may vary between different populations. This raises the question as to whether refugees and migrants of the same ethnic background have different perceptions. Understanding differences may have a significant impact on enhancing medication adherence in these groups. OBJECTIVE: The study examined the associations and differences between illness perceptions, and medication adherence in hypertensive Middle Eastern migrants and refugees. METHODS: Middle Eastern refugees and migrants (≥30 years old), with hypertension were recruited from Arabic community groups in Australia and asked to complete a cross-sectional survey. The survey consisted of basic socio-demographic and clinical profile, self-reported illness perceptions, and self-reported medication adherence. The outcome measure was the Medication Adherence Questionnaire. Simple mediation modelling was applied to examine the role of illness perceptions as a mediator between different migration statuses, and medication adherence. RESULTS: A total of 320 participants were recruited; 168 refugees, and 152 migrants. Educational level was found to be positively significantly associated with medication adherence in refugees, p = 0.003, while employed migrants were more likely to report higher adherence to hypertensive medication, p = 0.005. In both groups, there was a significant association between illness perceptions and medication adherence p = 0.0001. Significant differences were found between both groups regarding adherence and illness perceptions variables. Refugees had more negative illness perceptions and were less adherent than migrants. Illness perception was a mediator in the relationship between migration status and medication adherence; the unstandardized indirect effect was 0.24, and the 95% confidence interval ranged from (0.21-0.36). CONCLUSIONS: To achieve better adherence to medications in vulnerable populations such as refugees, illness perceptions need to be understood, and differentiated from other populations, such as migrants from similar backgrounds. Patients' education about illnesses and medications should be specific and targeted to each population. Interventional studies are recommended to modify refugees' and migrants' illness perceptions, to enhance medication adherence and wellbeing.

Associations between prenatal maternal mental health indices and mother-infant relationship quality 6 to 18 months' postpartum: A systematic review.

Maternal mental disorders can significantly impact on children's psychosocial and psychological development, incurring substantial ongoing economic and personal costs. A key mediating mechanism is mother-infant relationship quality (MIRQ). Research studies and perinatal mental health screening initiatives have predominantly focused on depressive symptoms and perinatal depression as predictors of MIRQ. While maternal depression is associated with suboptimal MIRQ, the findings have not been consistent. Personality characteristics are associated with parenting and proneness to depression, presenting a potential addition to prenatal mental health assessment. We conducted a systematic review of studies that have examined the link between prenatal depressive symptoms and/or personality characteristics with postnatal MIRQ. Our findings suggest that both maternal personality traits and depressive symptoms measured in early pregnancy are associated with postnatal MIRQ. A measure of personality characteristics may enhance prenatal mental health assessment, affording opportunities for targeted intervention commencing in pregnancy to improve MIRQ, parenting, maternal mental health outcomes, and infant psychosocial and psychological development, and thereby contributing to the reduction of human and economic cost burdens.

Los trastornos mentales maternos pueden impactar significativamente el desarrollo sicosocial y sicológico de los niños lo cual conlleva considerables continuos costos económicos y personales. Un mecanismo mediador clave es la calidad de la relación madre-infante (MIRQ). Los estudios investigativos y las iniciativas de exámenes de salud mental perinatales predominantemente se enfocan en los síntomas depresivos y la depresión perinatal como factores de predicción de MIRQ. Mientras que la depresión materna se asocia con una MIRQ inferior al nivel óptimo, los resultados no son consistentes. Las características de la personalidad se asocian con la crianza y la tendencia a la depresión, lo cual presenta un posible punto adicional a la evaluación de salud mental prenatal. Llevamos a cabo una revisión sistemática de estudios que examinaron la conexión entre síntomas depresivos prenatales y/o características de la personalidad con MIRQ postnatal. Nuestros resultados sugieren que tanto las características maternas de la personalidad como los síntomas depresivos medidos durante el temprano embarazo se asocian con MIRQ postnatal. Una medición de las características de la personalidad pudiera mejorar la evaluación de salud mental prenatal lo cual permitiría oportunidades para la intervención enfocada a partir del embarazo con miras a mejorar MIRQ, la crianza, los resultados de salud mental maternos, así como el desarrollo sicosocial y sicológico del infante, contribuyendo así a reducir la carga humana y económica.

Les troubles mentaux maternels peuvent avoir un impact important sur le développement psychosocial et psychologique des enfants menant à des coûts personnels et économiques continus et importants. Un mécanisme de médiation clé est la qualité de la relation mère-nourrisson (ici abrégé en français QRMN). Les études de recherché et les initiatives de dépistage en santé mentale périnatale ont surtout porté sur les symptômes dépressifs et la dépression périnatale en tant que prédicteurs de la QRMN. Mais alors que la dépression maternelle est liée à une QRMN sous-optimale, les résultats ne sont pas uniformes et constants. Les caractéristiques de personnalité sont liées au parentage et à la propension à la dépression, présentant un ajout potentiel à l'évaluation de santé mentale prénatale. Nous avons passé en revue systématiquement toutes les études ayant examiné le lien entre les symptômes dépressifs périnataux et / ou les caractéristiques de personnalité avec une QRMN postnatale. Nos recherches suggèrent que les traits de personnalité maternelle et les symptômes dépressifs mesurés durant le début de la grossesse sont à la fois liés à la QRMN postnatale. Une mesure de caractéristiques de personnalité pourrait améliorer l'évaluation de la santé mentale prénatale et offrir des possibilités d'intervention ciblée commençant durant la grossesse, afin d'améliorer la QRMN, le parentage et les résultats de santé mentale maternelle, ainsi que le développement psychosocial et psychologique du nourrisson, contribuant donc à la réduction de la charge du coût humain et économique.

Prenatal maternal personality as an early predictor of vulnerable parenting style.

Perinatal mental health problems, particularly depression, are prevalent and have been a central focus of prevention initiatives. The greater proportion of ongoing annual perinatal mental health economic cost burdens relate to children. A key linking mechanism is mother-infant relationship quality. Perinatal depression symptoms are typically transient. However, personality style, including interpersonal sensitivity, is a more stable construct and predicts proneness to depression and common mental disorders. Building on our previous work, the objective of the present study is to examine the association between specific dimensions of prenatal interpersonal sensitivity and postpartum mother-infant relationship quality in the context of prenatal depression symptoms. We analysed data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Interpersonal sensitivity and depression symptoms were measured at 18 weeks gestation. In a randomly selected 10% subsample of the ALSPAC cohort, mother-infant interaction was measured through standard observation at 12 months postpartum. For the subsample that had complete data at all time points (n = 812), multiple regression models examined prenatal interpersonal sensitivity dimensions predicting postpartum mother-infant relationship quality, accounting for depression symptoms. Two dimensions of maternal interpersonal sensitivity modestly predicted mother-infant relationship quality at 12 months postpartum and remained robust when we controlled for depression symptoms. The interpersonal sensitivity subscales were significantly associated with prenatal depression symptoms but more consistently and robustly predicted postnatal mother-infant interaction quality. The inclusion of personality measures may strengthen prenatal mental health assessment to identify vulnerability to suboptimal mother-infant relationship quality.

Efficacy and Outcomes of a Music-Based Emotion Regulation Mobile App in Distressed Young People: Randomized Controlled Trial.

BACKGROUND: Emotion dysregulation increases the risk of depression, anxiety, and substance use disorders. Music can help regulate emotions, and mobile phones provide constant access to it. The Music eScape mobile app teaches young people how to identify and manage emotions using music. OBJECTIVE: This study aimed to examine the effects of using Music eScape on emotion regulation, distress, and well-being at 1, 2, 3, and 6 months. Moderators of outcomes and user ratings of app quality were also examined. METHODS: A randomized controlled trial compared immediate versus 1-month delayed access to Music eScape in 169 young people (aged 16 to 25 years) with at least mild levels of mental distress (Kessler 10 score>17). RESULTS: No significant differences between immediate and delayed groups on emotion regulation, distress, or well-being were found at 1 month. Both groups achieved significant improvements in 5 of the 6 emotion regulation skills, mental distress, and well-being at 2, 3, and 6 months. Unhealthy music use moderated improvements on 3 emotion regulation skills. Users gave the app a high mean quality rating (mean 3.8 [SD 0.6]) out of 5. CONCLUSIONS: Music eScape has the potential to provide a highly accessible way of improving young people's emotion regulation skills, but further testing is required to determine its efficacy. Targeting unhealthy music use in distressed young people may improve their emotion regulation skills. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12615000051549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365974.

Efficacy and outcomes of a mobile app targeting alcohol use in young people.

Mobile apps provide a highly accessible way of reducing alcohol use in young people. This paper determines the 1-month efficacy and 2, 3 and 6month outcomes of the Ray's Night Out app, which aims to increase alcohol knowledge and reduce alcohol use in young people. User-experience design and agile development processes, informed by the Information-Motivation-Behavioral skills model and evidence-based motivational interviewing treatment approaches guided app development. A randomized controlled trial comparing immediate versus 1-month delayed access to the app was conducted in 197 young people (16 to 25years) who drank alcohol in the previous month. Participants were assessed at baseline, 1, 2, 3 and 6months. Alcohol knowledge, alcohol use and related harms and the severity of problematic drinking were assessed. App quality was evaluated after 1-month of app use. Participants in the immediate access group achieved a significantly greater increase in alcohol knowledge than the delayed access group at 1-month, but no differences in alcohol use or related problems were found. Both groups achieved significant reductions in the typical number of drinks on a drinking occasion over time. A reduction in maximum drinks consumed was also found at 1month. These reductions were most likely to occur in males and problem drinkers. Reductions in alcohol-related harm were also found. The app received a high mean quality (M=3.82/5, SD=0.51). The Ray app provides a youth-friendly and easily-accessible way of increasing young people's alcohol knowledge but further testing is required to determine its impact on alcohol use and related problems.

Development and validation of the cannabis experiences questionnaire - Intoxication effects checklist (CEQ-I) short form.

OBJECTIVE: To develop and validate a short form of the Cannabis Experiences Questionnaire - Intoxication Effects (CEQ-I), a 42-item scale which measures the euphoric and paranoid-dysphoric effects of cannabis intoxication. METHOD: Exploratory and confirmatory factor analyses were conducted among 604 past-month cannabis users to develop the short form. The factor structure was replicated in a second sample of 146 past-month cannabis users. The concurrent validity of the scale was also examined. RESULTS: Consistent with previous research, two factors were identified (paranoid-dysphoric; euphoric), and were replicated with confirmatory factor analyses. The most parsimonious scale consisted of 13 items. Correlations of short-form subscales with corresponding original subscales were high. The paranoid-dysphoric subscale was also moderately positively correlated with measures of psychotic-like experiences (PLEs) and psychological distress. CONCLUSIONS: The revised and validated CEQ-I short form can be used to explore the euphoric and paranoid-dysphoric effects of cannabis intoxication in young cannabis users, and whether these experiences increase their risk of developing cannabis use and psychotic disorders. The CEQ-I short form has the potential to aid in the identification of young cannabis users at risk of the paranoid-dysphoric effects of cannabis intoxication and may assist in the development of early intervention strategies targeting cannabis users with PLEs.

Antenatal interpersonal sensitivity is more strongly associated than perinatal depressive symptoms with postnatal mother-infant interaction quality.

Maternal mental health has enduring effects on children's life chances and is a substantial cost driver for child health, education and social services. A key linking mechanism is the quality of mother-infant interaction. A body of work associates maternal depressive symptoms across the antenatal and postnatal (perinatal) period with less-than-optimal mother-infant interaction. Our study aims to build on previous research in the field through exploring the association of a maternal personality trait, interpersonal sensitivity, measured in early pregnancy, with subsequent mother-infant interaction quality. We analysed data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to examine the association between antenatal interpersonal sensitivity and postnatal mother-infant interaction quality in the context of perinatal depressive symptoms. Interpersonal sensitivity was measured during early pregnancy and depressive symptoms in the antenatal year and across the first 21 months of the postnatal period. In a subsample of the ALSPAC, mother-infant interaction was measured at 12 months postnatal through a standard observation. For the subsample that had complete data at all time points (n = 706), hierarchical regression examined the contribution of interpersonal sensitivity to variance in mother-infant interaction quality. Perinatal depressive symptoms predicted little variance in mother-infant interaction. Antenatal interpersonal sensitivity explained a greater proportion of variance in mother-infant interaction quality. The personality trait, interpersonal sensitivity, measured in early pregnancy, is a more robust indicator of subsequent mother-infant-interaction quality than perinatal depressive symptoms, thus affording enhanced opportunity to identify vulnerable mother-infant relationships for targeted early intervention.

Young Love: Romantic Concerns and Associated Mental Health Issues among Adolescent Help-Seekers.

Over 50% of young people have dated by age 15. While romantic relationship concerns are a major reason for adolescent help-seeking from counselling services, we have a limited understanding of what types of relationship issues are most strongly related to mental health issues and suicide risk. This paper used records of 4019 counselling sessions with adolescents (10-18 years) seeking help from a national youth counselling service for a romantic relationship concern to: (i) explore what types and stage (pre, during, post) of romantic concerns adolescents seek help for; (ii) how they are associated with mental health problems, self-harm and suicide risk; and (iii) whether these associations differ by age and gender. In line with developmental-contextual theory, results suggest that concerns about the initiation of relationships are common in early adolescence, while concerns about maintaining and repairing relationships increase with age. Relationship breakups were the most common concern for both male and female adolescents and for all age groups (early, mid, late adolescence). Data relating to a range of mental health issues were available for approximately half of the sample. Post-relationship concerns (including breakups) were also more likely than pre- or during-relationship concerns to be associated with concurrent mental health issues (36.8%), self-harm (22.6%) and suicide (9.9%). Results draw on a staged developmental theory of adolescent romantic relationships to provide a comprehensive assessment of relationship stressors, highlighting post-relationship as a particularly vulnerable time for all stages of adolescence. These findings contribute to the development of targeted intervention and support programs.

Is the mental wellbeing of young Australians best represented by a single, multidimensional or bifactor model?

Internationally there is a growing interest in the mental wellbeing of young people. However, it is unclear whether mental wellbeing is best conceptualized as a general wellbeing factor or a multidimensional construct. This paper investigated whether mental wellbeing, measured by the Mental Health Continuum-Short Form (MHC-SF), is best represented by: (1) a single-factor general model; (2) a three-factor multidimensional model or (3) a combination of both (bifactor model). 2220 young Australians aged between 16 and 25 years completed an online survey including the MHC-SF and a range of other wellbeing and mental ill-health measures. Exploratory factor analysis supported a bifactor solution, comprised of a general wellbeing factor, and specific group factors of psychological, social and emotional wellbeing. Confirmatory factor analysis indicated that the bifactor model had a better fit than competing single and three-factor models. The MHC-SF total score was more strongly associated with other wellbeing and mental ill-health measures than the social, emotional or psychological subscale scores. Findings indicate that the mental wellbeing of young people is best conceptualized as an overarching latent construct (general wellbeing) to which emotional, social and psychological domains contribute. The MHC-SF total score is a valid and reliable measure of this general wellbeing factor.

Understanding the determinants of Australian hospital nurses' hand hygiene decisions following the implementation of a national hand hygiene initiative.

Hand hygiene is the primary measure in hospitals to reduce the spread of infections, with nurses experiencing the greatest frequency of patient contact. The '5 critical moments' of hand hygiene initiative has been implemented in hospitals across Australia, accompanied by awareness-raising, staff training and auditing. The aim of this study was to understand the determinants of nurses' hand hygiene decisions, using an extension of a common health decision-making model, the theory of planned behaviour (TPB), to inform future health education strategies to increase compliance. Nurses from 50 Australian hospitals (n = 2378) completed standard TPB measures (attitude, subjective norm, perceived behavioural control [PBC], intention) and the extended variables of group norm, risk perceptions (susceptibility, severity) and knowledge (subjective, objective) at Time 1, while a sub-sample (n = 797) reported their hand hygiene behaviour 2 weeks later. Regression analyses identified subjective norm, PBC, group norm, subjective knowledge and risk susceptibility as the significant predictors of nurses' hand hygiene intentions, with intention and PBC predicting their compliance behaviour. Rather than targeting attitudes which are already very favourable among nurses, health education strategies should focus on normative influences and perceptions of control and risk in efforts to encourage hand hygiene adherence.

Differences in parent regulation beliefs and maternal postnatal depressive symptoms in early weeks.

Postnatal depression is consistently associated with couple relationship qualities. Substantial infant care requirements in early weeks may highlight differences in parenting beliefs between mother and father. We calculated difference scores in parenting beliefs (disparity) in a community sample of 209 parent dyads. Contrary to previous research regarding 'disagreement' which could be interpreted as discord, independently measured disparity was not associated with maternal depressive symptoms. Coparenting interventions should promote respectful negotiation rather than resolution of differences.