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1.
Health Place ; 60: 102231, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31629193

RESUMO

There has been limited exploration of social capital at the contextual level in relation to maternal health, and in particular with the "obstetric transition" and associated mental health problems. In the North Central Province of Sri Lanka, with socio-culturally diverse communities, and a recent history of major conflict, the leading cause of maternal death is suicide. The objective of this study was to identify contextual patterns of social capital constructs that lead to poor maternal mental wellbeing, using a novel bubble visualisation technique, to demonstrate the use of data derived from qualitative approaches. We conducted a qualitative study of pregnant women based on diary entries (n = 41) and interviews (n = 38) in eight different communities of the Anuradhapura district of Sri Lanka. Bubble diagrams were constructed to visualize each context using the frequency and weight of responses given in diaries. Marital, family and neighbourhood cohesion were not homogenous in the district and the bubble diagrams displayed clear microgeographical patterns in which women living in specific communities had poorer mental wellbeing. Such techniques can be used to convey complex social capital implications in digestible way for policy makers and planners to enact locally specific strategies addressing health inequalities.

2.
J Sci Med Sport ; 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31615727

RESUMO

OBJECTIVES: Supporting healthy ageing is a key priority worldwide. Physical activity, diet quality and sleep are all associated with health outcomes, but few studies have explored their independent associations with all-cause mortality in an older population in the same model. The study aim was to examine associations between step-count, self-reported diet quality, restless sleep, and all-cause mortality in adults aged 55-85 years. DESIGN: A prospective cohort study of adults in Newcastle, New South Wales, Australia. METHOD: Data were from 1697 participants (49.3% women; baseline mean age 65.4 ±â€¯7.1 years). Daily steps (measured by pedometer), diet quality (from a modified Australian Recommended Food Score), and frequency of restless sleep (by self-report) were assessed in relation to all-cause mortality using Cox proportional hazard regression with adjustment for sex, age, household income and smoking. Baseline data were collected between January 2005 and April 2008, and last follow-up was in March 2017 (median follow-up 9.6 years). RESULTS: Higher step count (HR: 0.93, 95%CI: 0.88-0.98 per 1000-step increment) and higher diet quality (HR: 0.86, 95%CI: 0.74-0.99 per 8-point increment in diet quality score) were associated with reduced mortality risk. Restless sleep for ≥3 nights/week was not associated with mortality risk (HR: 1.03, 95%CI: 0.78-1.39). Sensitivity analyses, adjusting for chronic disease and excluding deaths <1 year after baseline, did not change these estimates. CONCLUSIONS: Increased daily steps and consumption of a greater variety of nutrient-dense foods every week would result in substantial health benefits for older people. Future research should include a greater variety of sleep measures.

3.
Occup Environ Med ; 76(9): 595-602, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31413183

RESUMO

OBJECTIVES: Making decisions about disclosing a mental illness in the workplace is complicated. Decision aid tools are designed to help an individual make a specific choice. We developed a web-based decision aid to help inform decisions about disclosure for employees. This study aimed to examine the efficacy of this tool. METHOD: We conducted a randomised controlled trial with recruitment, randomisation and data collection all online. Participants had access to the intervention for 2 weeks. Assessments occurred at baseline, postintervention and 6 weeks' follow-up. The primary outcome was decisional conflict. Secondary outcomes were stage and satisfaction of decision-making and mental health symptoms. RESULTS: 107 adult employees were randomised to READY (n=53) or the control (n=54). The sample was predominantly female (83.2%). Participants using READY showed greater reduction in decisional conflict at postintervention (F(1,104)=16.8, p<0.001) (d=0.49, 95% CI 0.1 to 0.9) and follow-up (F(1,104)=23.6, p<0.001) (d=0.61, 95% CI 0.1 to 0.9). At postintervention the READY group were at a later stage of decision-making (F(1,104)=6.9, p=0.010) which was sustained, and showed a greater reduction in depressive symptoms (F(1,104)=6.5, p=0.013). Twenty-eight per cent of READY users disclosed, and reported a greater improvement in mental health than those who did not disclose. CONCLUSIONS: READY provides a confidential, flexible and effective tool to enhance employee's decision-making about disclosure. Its use led to a comparative improvement in depressive symptoms compared with the current information provided by a leading mental health non-governmental organisation, without apparent harm. READY seems worth evaluating in other settings and, if these results are replicated, scaling for wider use. TRIAL REGISTRATION NUMBER: ACTRN12618000229279.

4.
J Occup Environ Med ; 61(7): 545-551, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31045851

RESUMO

OBJECTIVE: Mental ill-health is now the leading cause of sickness absence and occupational incapacity in high-income countries. This study evaluated HeadCoach online manager training, designed to improve confidence, and managerial behaviors that create mentally healthy workplaces. METHODS: A cluster randomized controlled trial was conducted comparing managers who received HeadCoach (N = 87) to waitlist control (N = 123). Managers' confidence and behavior were investigated at baseline, postintervention, and follow-up. Psychological distress of direct reports was evaluated. RESULTS: Confidence significantly increased postintervention only; however, per-protocol analyses indicated a significant improvement for program completers compared with control at both time points. Responsive and preventive behaviors significantly improved. Psychological distress of direct reports remained unchanged. CONCLUSIONS: HeadCoach online mental health training is an effective and scalable way to improve managers' confidence and workplace practices around mental health. The impact on direct reports remains unknown.

5.
Australas Psychiatry ; 27(4): 374-377, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31107103

RESUMO

OBJECTIVES: There is emerging interest in models of care that focus on assessment and brief inpatient treatment (two to three days) including psychiatric emergency care centre units and short-stay units in Australia. We present the development of a functionally integrated Missenden Assessment Unit and six-bed short-stay unit in the new Professor Marie Bashir Centre at Royal Prince Alfred Hospital in inner-city Sydney. The focus was on collaboration between emergency, drug and alcohol and mental-health services in developing the short-stay unit and Missenden Assessment Unit with joint admission and resource use. We outline the models of care and findings from the 2016 evaluation following the initial two years of operation and consider ongoing challenges. CONCLUSION: The Missenden Assessment Unit provides an alternative point of presentation for mental-health drug and alcohol patients. The short-stay unit provides coordinated, therapeutic interventions. The Missenden Assessment Unit/short-stay unit reduced the burden of presentations to the emergency department while providing the opportunity for training and collaboration. Further refinement of the models of care should occur with policy development and via research.

6.
BMJ Open ; 8(10): e026179, 2018 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-30381313

RESUMO

INTRODUCTION: Traditional behavioural weight loss trials targeting improvements in physical activity and diet are modestly effective. It has been suggested that sleep may have a role in weight loss and maintenance. Improving sleep health in combination with physical activity and dietary behaviours may be one strategy to enhance traditional behavioural weight loss trials. Yet the efficacy of a weight loss intervention concurrently targeting improvements in physical activity, dietary and sleep behaviours remains to be tested. METHODS AND ANALYSIS: The primary aim of this three-arm randomised controlled trial is to examine the efficacy of a multicomponent m-Health behaviour change weight loss intervention relative to a waitlist control group. The secondary aims are to compare the relative efficacy of a physical activity, dietary behaviour and sleep intervention (enhanced intervention), compared with a physical activity and dietary behaviour only intervention (traditional intervention), on the primary outcome of weight loss and secondary outcomes of waist circumference, glycated haemoglobin, physical activity, diet quality and intake, sleep health, eating behaviours, depression, anxiety and stress and quality of life. Assessments will be conducted at baseline, 6 months (primary endpoint) and 12 months (follow-up). The multicomponent m-Health intervention will be delivered using a smartphone/tablet 'app', supplemented with email and SMS and individualised in-person dietary counselling. Participants will receive a Fitbit, body weight scales to facilitate self-monitoring, and use the app to access educational material, set goals, self-monitor and receive feedback about behaviours. Generalised linear models using an analysis of covariance (baseline adjusted) approach will be used to identify between-group differences in primary and secondary outcomes, following an intention-to-treat principle. ETHICS AND DISSEMINATION: The Human Research Ethics Committee of The University of Newcastle Australia provided approval: H-2017-0039. Findings will be disseminated via publication in peer-reviewed journals, conference presentations, community presentations and student theses. TRIAL REGISTRATION NUMBER: ACTRN12617000735358; UTN1111-1219-2050.

7.
Aust N Z J Psychiatry ; : 4867418808899, 2018 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-30375881

RESUMO

OBJECTIVE:: Shark bites are rare, with intense media exposure. There are no known studies of the psychological impacts of this specific type of traumatic event. This is the first study that describes those directly and indirectly affected, and evaluates the prevalence of post-traumatic stress disorder (PTSD) and related risk factors. METHODS:: In total, 124 members of an Australian shark-bite peer-support group were invited to complete an online survey assessing demographic, event, media and psychological factors. Response rate was 48% ( n = 60, 63% male, 44 ± 14 years). Retrospective and current measures of PTSD (PTSD Checklist for DSM-5 [PCL-5]) and suicidality (Suicidal Ideation Attributes Scale [SIDAS-5]) were used. RESULTS:: Post-event PTSD was prevalent in this sample ( n = 16/59, 27.1%, 95% confidence interval [CI] = [15.4, 38.8]), but less so currently ( n = 2/55, 3.6%, 95% CI = [0.0, 8.7]). In addition, nine ( n = 9/59, 15.3%, 95% CI = [5.8, 24.7]) had subthreshold, but highly symptomatic, syndromes post event. There was no association of PTSD with direct/indirect bite involvement, gender, or prior trauma. Two respondents were at risk of suicidal behaviour. PTSD was commonly reported by those without a partner (odds ratio [OR] = 5.91, 95% CI = [1.52, 22.99], p = 0.01) or with two friends or fewer to rely on (OR = 5.83, 95% CI = [1.62, 21.01], p = 0.01). PTSD was more likely in those with a negative media experience ( n = 34/52, 65.4%, OR = 11.90, 95% CI = [1.42, 100.04], p = 0.02) and 61.5% ( n = 32/52) of respondents reported media coverage lasting months or years. In multivariate modelling, negative media impact, relationship status and friendships were independently associated with PTSD and explained much of the variance in PTSD ( F4,41 = 10.94, p < 0.0001, r2 = 0.52). CONCLUSION:: Nearly one-third of members of an Australian shark-bite peer-support group report post-event PTSD, and one-quarter of these were not present at the time of the event. Findings support interventions targeting negative media impact, similar to media reporting guidelines for suicide, and enhancing social support.

8.
PLoS One ; 13(9): e0203343, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30183779

RESUMO

BACKGROUND AND AIM: This study assessed the association between depressive symptom severity and cognition in middle-to-older aged adults with mild-to-moderate depression and cardiovascular risk factors using an online test battery (CogState) and whether changes in depressive symptoms over 3 months were associated with changes in cognition. METHODS: Participants (mean age = 57.8) with cardiovascular risk and mild-to-moderate depressive symptoms completed measures of psychomotor speed, learning, and executive function prior to (n = 445)_and after (n = 334) online depression or attention control interventions. The symptom severity-cognition relationship was examined both cross-sectionally and prospectively. RESULTS: Participants exhibited significantly reduced psychomotor speed and variable impairments on measures of learning and executive functioning relative to normative data. However, there was no association of depression severity with cognition at baseline or of change in depressive symptoms with change in cognitive performance. LIMITATIONS: Participants were well-educated, which may have protected against cognitive decline. Attrition may limit generalisability, though is unlikely to explain the lack of association between depression symptoms and cognition. CONCLUSIONS: Adults with comorbid mild-to-moderate depressive symptoms and cardiovascular risks performed less well than age-matched normative data on three online cognitive tests; however, we were unable to show any symptom-cognition association cross-sectionally or longitudinally, despite significant improvements in depressive symptoms. This challenges the generalisability of such associations found in more severely unwell clinical samples to those with a broader depressive symptom profile, or suggests that underlying cardiovascular disease may account for the association seen in some clinical studies. This has implications for scaling up selective prevention of cognitive decline.

9.
Psychiatry Res ; 2018 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-30190167

RESUMO

Emergency service workers (ESWs) are at increased risk of trauma-related mental disorders. However, volunteer ESWs, who comprise the majority of firefighters in Western countries, have limited access to the necessary support services for mental health problems. This study aimed to examine the impact of the level and types of trauma exposure on the development of mental disorders in a volunteer fire service. Members of an Australian volunteer fire service (N = 459) completed a cross-sectional survey. Information on the number and types of distressing critical incidents involved within the last year was collected. Validated, self-report measures were used to determine probable post-traumatic stress disorder (PTSD) and psychological distress caseness. The risk of probable PTSD was significantly higher for those with the most frequent involvement with distressing incidents and the highest levels of cumulative trauma exposure. Being trapped in a dangerous situation or being assaulted by other people, resulted in the greatest odds of developing a mental disorder. Volunteer fire service members with the highest levels of trauma exposure and involvement with particular types of critical incidents are at elevated risk of mental health problems. The implications for the provision of psychological support measures amongst volunteer emergency services are discussed.

10.
Front Psychiatry ; 9: 320, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30061849

RESUMO

Study objectives: Associations between sleep problems and suicidality are increasingly acknowledged, but prospective data from well-controlled long-term community studies are lacking. Methods: We analyzed data from a longitudinal cohort study with n = 591 young adults from Zurich, Switzerland, prospectively followed from 1979 (age 20/21 years) to 2008 (age 49/50 years). Twelve-month prevalence of various mental disorders, socio-environmental confounders and sleep problems were carefully assessed with semi-structured interviews at 7 assessment waves spanning overall a 30-year observation period. Interviews were conducted with the "Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology" (SPIKE). The 12-month prevalence of sleep problems was graded according to frequency and associated distress of reported symptoms. 12-month prevalence of suicidality was classified as either mild (transient suicidal ideation) or severe (self-harm, suicide attempts). Results: Concurrently, and fully adjusted for several covariates, including mental disorders, relative to no sleep problems there was an odds ratio (OR) of OR = 1.9 (95% confidence interval 1.4-2.5), OR = 3.3 (2.5-4.4), and OR = 1.9 (1.3-2.8) for mild, moderate and severe sleep problems in association with suicidality. There was no evidence for a prospective effect of broad sleep problems on subsequent suicidality. Mild suicidality, but not severe suicidality, prospectively predicted subsequent broad sleep problems in the fully adjusted multivariate model (adjusted OR = 1.5; 1.1-1.9). Disturbed sleep initiation, a proxy for insomnia, significantly predicted subsequent suicidality (OR = 1.5; 1.1-1.9), whereas mild suicidality, but not severe suicidality, significantly predicted subsequent insomnia (OR = 1.5; 1.1-2.0). Conclusions: Sleep problems and suicidality are longitudinally inter-related, which has important implications for clinical practice. Most importantly, the causal pathways appear to be bi-directional and independent of socio-demographics and concomitant mental disorders. More research is needed to examine the possible biopsychosocial etiological mechanisms linking suicidality to sleep problems.

11.
Soc Psychiatry Psychiatr Epidemiol ; 53(9): 897-909, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29869691

RESUMO

PURPOSE: There is increasing concern regarding the mental health impact of first responder work, with some reports suggesting ambulance personnel may be at particularly high risk. Through this systematic review and meta-analysis we aimed to determine the prevalence of mental health conditions among ambulance personnel worldwide. METHODS: A systematic search and screening process was conducted to identify studies for inclusion in the review. To be eligible, studies had to report original quantitative data on the prevalence of at least one of the following mental health outcome(s) of interest (PTSD, depression, anxiety, general psychological distress) for ambulance personnel samples. Quality of the studies was assessed using a validated methodological rating tool. Random effects modelling was used to estimate pooled prevalence, as well as subgroup analyses and meta-regressions for five variables implicated in heterogeneity. RESULTS: In total, 941 articles were identified across all sources, with 95 full-text articles screened to confirm eligibility. Of these, 27 studies were included in the systematic review, reporting on a total of 30,878 ambulance personnel. A total of 18 studies provided necessary quantitative information and were retained for entry in the meta-analysis. The results demonstrated estimated prevalence rates of 11% for PTSD, 15% for depression, 15% for anxiety, and 27% for general psychological distress amongst ambulance personnel, with date of data collection a significant influence upon observed heterogeneity. CONCLUSION: Ambulance personnel worldwide have a prevalence of PTSD considerably higher than rates seen in the general population, although there is some evidence that rates of PTSD may have decreased over recent decades.


Assuntos
Ambulâncias/estatística & dados numéricos , Transtornos de Ansiedade/epidemiologia , Transtorno Depressivo/epidemiologia , Auxiliares de Emergência/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Estresse Psicológico/epidemiologia , Humanos
12.
PLoS One ; 13(5): e0197802, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29791510

RESUMO

Interventions to enhance mental health and well-being within high risk industries such as the emergency services have typically focused on individual-level factors, though there is increasing interest in the role of organisational-level interventions. The aim of this study was to examine the importance of different aspects of manager support in determining the mental health of ambulance personnel. A cross-sectional survey was completed by ambulance personnel across two Australian states (N = 1,622). Demographics, manager support and mental health measures were assessed. Hierarchical multiple linear regressions were conducted to determine the explanatory influence of the employee's perception of the priority management places upon mental health issues (manager psychosocial safety climate) and managers' observed behaviours (manager behaviour) on employee common mental disorder and well-being within ambulance personnel. Of the 1,622 participants, 123 (7.6%) were found to be suffering from a likely mental disorder. Manager psychosocial safety climate accounted for a significant amount of the variance in levels of employee common mental health disorder symptoms (13%, p<0.01) and well-being (13%, p<0.01). Manager behaviour had a lesser, but still statistically significant influence upon symptoms of common mental disorder (7% of variance, p<0.01) and well-being (10% of variance, p<0.05). The perceived importance management places on mental health and managers' actual behaviour are related but distinct concepts, and each appears to impact employee mental health. While the overall variance explained by each factor was limited, the fact that each is potentially modifiable makes this finding important and highlights the significance of organisational and team-level interventions to promote employee well-being within emergency services and other high-risk occupations.


Assuntos
Pessoal de Saúde/psicologia , Saúde Mental , Serviços de Saúde do Trabalhador , Adulto , Ambulâncias , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Transtornos Mentais/patologia , Pessoa de Meia-Idade , Saúde do Trabalhador , Adulto Jovem
13.
Occup Environ Med ; 75(6): 462-470, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29563195

RESUMO

Managers are in an influential position to make decisions that can impact on the mental health and well-being of their employees. As a result, there is an increasing trend for organisations to provide managers with training in how to reduce work-based mental health risk factors for their employees. A systematic search of the literature was conducted to identify workplace interventions for managers with an emphasis on the mental health of employees reporting directing to them. A meta-analysis was performed to calculate pooled effect sizes using the random effects model for both manager and employee outcomes. Ten controlled trials were identified as relevant for this review. Outcomes evaluating managers' mental health knowledge (standardised mean difference (SMD)=0.73; 95% CI 0.43 to 1.03; p<0.001), non-stigmatising attitudes towards mental health (SMD=0.36; 95% CI 0.18 to 0.53; p<0.001) and improving behaviour in supporting employees experiencing mental health problems (SMD=0.59; 95% CI 0.14 to 1.03; p=0.01) were found to have significant pooled effect sizes favouring the intervention. A significant pooled effect was not found for the small number of studies evaluating psychological symptoms in employees (p=0.28). Our meta-analysis indicates that training managers in workplace mental health can improve their knowledge, attitudes and self-reported behaviour in supporting employees experiencing mental health problems. At present, any findings regarding the impact of manager training on levels of psychological distress among employees remain preliminary as only a very limited amount of research evaluating employee outcomes is available. Our review suggests that in order to understand the effectiveness of manager training on employees, an increase in collection of employee level data is required.

14.
BMC Psychiatry ; 18(1): 25, 2018 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-29378536

RESUMO

BACKGROUND: Within high income countries, mental health is now the leading cause of long term sickness absence in the workplace. Managers are in a position to make changes and decisions that have a positive effect on the wellbeing of staff, the recovery of employees with mental ill health, and potentially prevent future mental health problems. However, managers report addressing workplace mental health issues as challenging. The aim of the HeadCoach trial is to evaluate the effectiveness of a newly developed online training intervention to determine whether it is able to build managers' confidence to better support individuals within their teams who are experiencing mental ill health, and the confidence to promote manager behaviour likely to result in a more mentally healthy workplace. METHODS/DESIGN: We will conduct a cluster randomised control trial (RCT) to evaluate the effect of HeadCoach, an online training intervention for managers with a focus on the mental health of their employees, compared to a waitlist control. The target sample is 168 managers, and their direct employees. Managers and employees will be assessed at baseline and at 4-month follow up. Managers will have an additional, intermediate assessment 6-weeks post-baseline. The primary outcome is change from baseline in managers' self-reported confidence when dealing with mental health issues within their team and promoting a mentally healthy workplace. The difference between the intervention and waitlist control groups will be assessed using linear mixed effects repeated measures (MMRM) analysis of variance (ANOVA). Secondary managerial outcomes include mental health literacy, attitudes towards mental health issues in the workplace and managerial behaviour in dealing with mental health matters with their staff. Employee outcomes will be perceived level of manager support, engagement, psychological distress, and rates of sickness absence and presenteeism. DISCUSSION: To our knowledge this will be the first RCT of a purely online training intervention developed specifically for managers that promotes confidence to both support staff experiencing mental ill health and create a mentally healthy work environment. If successful, this intervention has the potential to provide an effective and efficient method of training managers in workplace mental health and to enhance employee wellbeing. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12617000279325.


Assuntos
Instrução por Computador , Internet , Transtornos Mentais/terapia , Saúde Mental/educação , Doenças Profissionais/terapia , Serviços de Saúde do Trabalhador/métodos , Saúde do Trabalhador/educação , Adolescente , Adulto , Protocolos Clínicos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Administração de Recursos Humanos/métodos , Projetos de Pesquisa , Autoeficácia , Método Simples-Cego , Adulto Jovem
15.
BMC Public Health ; 18(1): 145, 2018 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-29343229

RESUMO

BACKGROUND: The disease burden related to mental disorders and metabolic syndrome is growing in low-and middle-income countries (LMIC). The Colombo Twin and Singleton Study (COTASS) is a population-based sample of twins and singletons in Colombo, Sri Lanka. Here we present prevalence estimates for metabolic syndrome (metS) and mental disorders from a follow-up (COTASS-2) of the original study (COTASS-1), which was a mental health survey. METHODS: In COTASS-2, participants completed structured interviews, anthropometric measures and provided fasting blood and urine samples. Depressive disorder, depressive symptoms, anxiety symptoms, post-traumatic stress disorder (PTSD) and hazardous alcohol use were ascertained with structured psychiatric screens (Composite International Diagnostic Interview (CIDI), Beck Depression Inventory (BDI-II), Generalised Anxiety Disorder Questionnaire (GAD-7), PTSD Checklist - Civilian Version (PCL-C), and Alcohol Use Disorders Identification Test (AUDIT)). We defined metS according to the International Diabetes Federation (IDF) criteria and the revised National Cholesterol Education Programme Adult Treatment Panel (NCEP ATP III) criteria. We estimated the prevalence of psychiatric disorders and metS and metS components, and associations with gender, education and age. RESULTS: Two thousand nine hundred thirty-four twins and 1035 singletons were followed up from COTASS-1 (83.4 and 61.8% participation rate, respectively). Prevalence estimates for depressive disorder (CIDI), depressive symptoms (BDI ≥ 16), anxiety symptoms (GAD-7 ≥ 10) and PTSD (PCL-C DSM criteria) were 3.8, 5.9, 3.6, and 4.5% respectively for twins and 3.9, 9.8, 5.1 and 5.4% for singletons. 28.1 and 30.9% of male twins and singletons respectively reported hazardous alcohol use. Approximately one third met the metS criteria (IDF: 27.4% twins, 44.6% singletons; NCEP ATP III: 30.6% twins, 48.6% singletons). The most prevalent components were central obesity (59.2% twins, 71.2% singletons) and raised fasting blood glucose or diabetes (38.2% twins, 56.7% singletons). CONCLUSION: MetS was highly prevalent in twins, and especially high in singletons, whereas the prevalence of mental disorders was low, but consistent with local estimates. The high levels of raised fasting plasma glucose and central obesity were particularly concerning, and warrant national diabetes prevention programmes.


Assuntos
Doenças em Gêmeos/epidemiologia , Doenças em Gêmeos/genética , Transtornos Mentais/epidemiologia , Transtornos Mentais/genética , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Interação Gene-Ambiente , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Prevalência , Fatores Socioeconômicos , Sri Lanka/epidemiologia , Gêmeos/genética , Adulto Jovem
16.
Aust N Z J Psychiatry ; 52(1): 47-58, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28403625

RESUMO

OBJECTIVE: Common mental disorders are the most common reason for long-term sickness absence in most developed countries. Prediction algorithms for the onset of common mental disorders may help target indicated work-based prevention interventions. We aimed to develop and validate a risk algorithm to predict the onset of common mental disorders at 12 months in a working population. METHODS: We conducted a secondary analysis of the Household, Income and Labour Dynamics in Australia Survey, a longitudinal, nationally representative household panel in Australia. Data from the 6189 working participants who did not meet the criteria for a common mental disorders at baseline were non-randomly split into training and validation databases, based on state of residence. Common mental disorders were assessed with the mental component score of 36-Item Short Form Health Survey questionnaire (score ⩽45). Risk algorithms were constructed following recommendations made by the Transparent Reporting of a multivariable prediction model for Prevention Or Diagnosis statement. RESULTS: Different risk factors were identified among women and men for the final risk algorithms. In the training data, the model for women had a C-index of 0.73 and effect size (Hedges' g) of 0.91. In men, the C-index was 0.76 and the effect size was 1.06. In the validation data, the C-index was 0.66 for women and 0.73 for men, with positive predictive values of 0.28 and 0.26, respectively Conclusion: It is possible to develop an algorithm with good discrimination for the onset identifying overall and modifiable risks of common mental disorders among working men. Such models have the potential to change the way that prevention of common mental disorders at the workplace is conducted, but different models may be required for women.

17.
Australas Psychiatry ; 26(3): 276-280, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26823537

RESUMO

OBJECTIVE: This study examined the patterns of direct observation of patients by nursing staff ('nurse specials') and compared those required for mental health/drug health (MH/DH)-related presentations to other patient groups in different care settings. METHODS: A retrospective review of nurse special shifts requested during the 2014 calendar year at an urban teaching hospital. RESULTS: Hospital-wide 14,021 8-hour nursing shifts were ordered for special observation of patients, an average of 39 per day. Of these, 30% were requested for MH/DH-related presentations, with the majority (70%) required for medically unstable patients. However, of the 1917 shifts required in the emergency department, 1841 (96%) were for MH/DH presentations compared to 76 (4%) for patients with unrelated medical conditions (odds ratio 98.2; 95% confidence interval 77.71-124.06, P<0.0001). CONCLUSIONS: In contrast to the rest of the hospital, emergency department-based nurse special requests were significantly more likely to be for MH/DH presentations. This figure represents a considerable staff and financial burden and may be reduced by diversion or more rapid transfer of such presentations to an appropriate inpatient ward.

18.
Aust N Z J Psychiatry ; 52(1): 15-23, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28835112

RESUMO

Mental illness is now the leading cause of long-term sickness absence among Australian workers, with significant costs to the individual, their employers and society more broadly. However, to date, there has been little evidence-informed guidance as to what workplaces should be doing to enhance their employees' mental health and wellbeing. In this article, we present a framework outlining the key strategies employers can implement to create more mentally healthy workplaces. The five key strategies outlined are as follows: (1) designing work to minimise harm, (2) building organisational resilience through good management, (3) enhancing personal resilience, (4) promoting early help-seeking and (5) supporting recovery and return to work. A narrative review is utilised to outline the theoretical evidence for this framework and to describe the available research evidence for a number of key example interventions for each of the five strategies. While each workplace needs to develop tailored solutions, the five strategy framework proposed in this review will hopefully provide a simple framework for employers and those advising them to use when judging the adequacy of existing services and considering opportunities for further enhancements.

19.
Mol Autism ; 8: 63, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29214007

RESUMO

Background: Autism spectrum disorders (ASDs) are complex, pervasive, and heterogeneous neurodevelopmental conditions with varying trajectories, significant male bias and largely unknown etiology. However, an understanding of the biological mechanisms driving pathophysiology is evolving. Immune system aberrations, as identified through cytokine profiles, are believed to have a role in ASD. Altered cytokine levels may facilitate identification of ASD subtypes as well as provide biological markers of response to effective treatments. Research exploring the relationship between cytokine profiles and ASD symptoms is, however, in its infancy. The objective of this study was to explore relationships between cytokine levels and the severity of ASD and other clinical traits. Methods: Multiplex assay techniques were used to measure levels of 27 cytokines in plasma samples from a cohort of 144 children diagnosed with ASD. Results: Overall, results showed a significant negative association between platelet-derived growth factor (PDGF)-BB, and the severity of ASD symptoms. Furthermore, a significant interaction with sex suggested a different immune profile for females compared to males. ASD symptom severity was negatively associated with levels of 4 cytokines, IL-1ß, IL-8, MIP-1ß, and VEGF, in females, but not in males. Conclusions: Results of the present study suggest that an altered cytokine response or profile is associated with the severity of ASD-related symptoms, with sex a potential modifier of this relationship. Further research in larger populations which recognizes the importance of sex comparisons and longitudinal assessments are now required to extend and further describe the role of the immune system in ASD.


Assuntos
Transtorno do Espectro Autista/diagnóstico , Citocinas/sangue , Adolescente , Transtorno do Espectro Autista/metabolismo , Transtorno do Espectro Autista/patologia , Becaplermina , Comportamento/fisiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Proteínas Proto-Oncogênicas c-sis/sangue , Índice de Gravidade de Doença , Fatores Sexuais , Inquéritos e Questionários
20.
PLoS One ; 12(12): e0189904, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29267334

RESUMO

BACKGROUND: Many organisations promote eHealth applications as a feasible, low-cost method of addressing mental ill-health and stress amongst their employees. However, there are good reasons why the efficacy identified in clinical or other samples may not generalize to employees, and many Apps are being developed specifically for this group. The aim of this paper is to conduct the first comprehensive systematic review and meta-analysis evaluating the evidence for the effectiveness and examine the relative efficacy of different types of eHealth interventions for employees. METHODS: Systematic searches were conducted for relevant articles published from 1975 until November 17, 2016, of trials of eHealth mental health interventions (App or web-based) focused on the mental health of employees. The quality and bias of all identified studies was assessed. We extracted means and standard deviations from published reports, comparing the difference in effect sizes (Hedge's g) in standardized mental health outcomes. We meta-analysed these using a random effects model, stratified by length of follow up, intervention type, and whether the intervention was universal (unselected) or targeted to selected groups e.g. "stressed". RESULTS: 23 controlled trials of eHealth interventions were identified which overall suggested a small positive effect at both post intervention (g = 0.24, 95% CI 0.13 to 0.35) and follow up (g = 0.23, 95% CI 0.03 to 0.42). There were differential short term effects seen between the intervention types whereby Mindfulness based interventions (g = 0.60, 95% CI 0.34 to 0.85, n = 6) showed larger effects than the Cognitive Behaviour Therapy (CBT) based (g = 0.15, 95% CI 0.02 to 0.29, n = 11) and Stress Management based (g = 0.17, 95%CI -0.01 to 0.34, n = 6) interventions. The Stress Management interventions however differed by whether delivered to universal or targeted groups with a moderately large effect size at both post-intervention (g = 0.64, 95% CI 0.54 to 0.85) and follow-up (g = 0.69, 95% CI 0.06 to 1.33) in targeted groups, but no effect in unselected groups. INTERPRETATION: There is reasonable evidence that eHealth interventions delivered to employees may reduce mental health and stress symptoms post intervention and still have a benefit, although reduced at follow-up. Despite the enthusiasm in the corporate world for such approaches, employers and other organisations should be aware not all such interventions are equal, many lack evidence, and achieving the best outcomes depends upon providing the right type of intervention to the correct population.


Assuntos
Transtornos Mentais/prevenção & controle , Telemedicina , Terapia Cognitivo-Comportamental , Humanos , Transtornos Mentais/terapia , Atenção Plena , Avaliação de Programas e Projetos de Saúde , Estresse Psicológico
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