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1.
Sleep Med ; 116: 62-70, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38430792

RESUMO

INTRODUCTION: Understanding how persons with narcolepsy conceptualize symptoms, daily impact and illness experience is key to facilitating dialogue between patients and healthcare professionals. These concepts are usually explored from the perspective of healthcare professionals/researchers and rarely from the perspective of those with narcolepsy. METHODS: 127 self-reported persons with narcolepsy were recruited from an Australian patient support group. A short demographic survey was completed. All agreed to participate in a subsequent 1:1 semi-structured interview. Saturation was reached after 24 interviews (mean age = 33 years (SD 11) with 44% reporting cataplexy). A multidisciplinary team of researchers/clinicians analyzed interview transcripts using thematic analysis. RESULTS: Participants perceived physical fatigue, sleepiness, and two separate experiences of 'falling asleep/sleep attacks' as distinct symptoms rather than a multidimensional construct (i.e. excessive daytime sleepiness). We also identified two experiences of cataplexy, one triggered by acute emotion and another by a stressor. Participants determined their narcolepsy to be 'well-managed' by the level of functional impairment rather than the frequency of any symptom. Almost all participants described experiencing anticipated stigma and internalized or 'self-' stigma, likely stemming from societal devaluation of sleep and the conflation of sleepiness with laziness. CONCLUSION: Descriptions of common symptoms often differed between participants and the existing literature. These differences likely impact patient-physician communication, with both parties utilizing the same terminology to communicate different concepts. The characterization of stigma in narcolepsy presents opportunities for future research exploring the impact and possible development of interventions to reduce the substantial psychological comorbidity in persons with narcolepsy.


Assuntos
Cataplexia , Distúrbios do Sono por Sonolência Excessiva , Narcolepsia , Humanos , Adulto , Cataplexia/diagnóstico , Sonolência , Austrália , Narcolepsia/diagnóstico , Distúrbios do Sono por Sonolência Excessiva/diagnóstico
3.
Aust N Z J Psychiatry ; : 48674241237094, 2024 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-38500247

RESUMO

One could argue that we are living through a period of innovation and change in psychiatry unlike that seen before, with repurposed medications emerging as novel treatments. However, despite evidence of enhanced clinical outcomes and potential medium-term savings, delivering these promising interventions is resource-intensive and perceived as difficult in the public sector. Consequently, they are generally only available in the private sector, often at great cost, effectively making them inaccessible to the 'Have Nots'. The arrival of these paradigm-shifting treatments has inadvertently highlighted a growing mental health inequity. The Royal Prince Alfred Hospital's Ketamine Treatment Clinic was the first public-sector ketamine treatment clinic for complex mood disorders in Australia. Based on 3 years' experience establishing, developing and running a public-sector ketamine treatment service, we review the progress, perils and pitfalls for clinicians and health services contemplating establishing a public-sector ketamine treatment service of their own.

4.
J Affect Disord ; 352: 163-170, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38378088

RESUMO

BACKGROUND: Due to its rapid antidepressant effect, ketamine has recently been clinically translated for people with treatment-resistant depression. However, its cognitive profile remains unclear, particularly with repeated and higher doses. In the present study, we report the cognitive results from a recent large multicentre randomised controlled trial, the Ketamine for Adult Depression Study (KADS). METHODS: In this randomised, double-blind, active-controlled, parallel group, multicentre phase 3 trial study we investigated potential cognitive changes following repeated treatment of subcutaneous racemic ketamine compared to an active comparator, midazolam, over 4 weeks, which involved two cohorts; Cohort 1 involved a fixed dose treatment protocol (0.5 mg/kg ketamine), Cohort 2 involved a dose escalation protocol (0.5-0.9 mg/kg) based on mood outcomes. Participants with treatment-resistant Major Depressive Disorder (MDD) were recruited from 7 mood disorder centres and were randomly assigned to receive ketamine (Cohort 1 n = 33; Cohort 2 n = 53) or midazolam (Cohort 1 n = 35; Cohort 2 n = 53) in a 1:1 ratio. Cognitive measurements were assessed at baseline and at the end of randomised treatment. RESULTS: Results showed that in Cohort 1, there were no differences between ketamine and midazolam in cognitive outcomes. For Cohort 2, there was similarly no difference between conditions for cognitive outcomes. LIMITATIONS: The study included two Cohorts with different dosing regimes. CONCLUSIONS: The findings support the cognitive safety of repeated fixed and escalating doses at least in the short-term in people with treatment resistant MDD.


Assuntos
Transtorno Depressivo Maior , Transtorno Depressivo Resistente a Tratamento , Ketamina , Adulto , Humanos , Ketamina/efeitos adversos , Midazolam/efeitos adversos , Depressão/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/psicologia , Método Duplo-Cego , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/psicologia , Cognição , Resultado do Tratamento
5.
JMIR Form Res ; 8: e49110, 2024 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-38393768

RESUMO

BACKGROUND: Supported self-management interventions, which assist individuals in actively understanding and managing their own health conditions, have a robust evidence base for chronic physical illnesses, such as diabetes, but have been underused for long-term mental health conditions. OBJECTIVE: This study aims to co-design and user test a mental health supported self-management intervention, My Personal Recovery Plan (MyPREP), that could be flexibly delivered via digital and traditional paper-based mediums. METHODS: This study adopted a participatory design, user testing, and rapid prototyping methodologies, guided by 2 frameworks: the 2021 Medical Research Council framework for complex interventions and an Australian co-production framework. Participants were aged ≥18 years, self-identified as having a lived experience of using mental health services or working in a peer support role, and possessed English proficiency. The co-design and user testing processes involved a first round with 6 participants, focusing on adapting a self-management resource used in a large-scale randomized controlled trial in the United Kingdom, followed by a second round with 4 new participants for user testing the co-designed digital version. A final round for gathering qualitative feedback from 6 peer support workers was conducted. Data analysis involved transcription, coding, and thematic interpretation as well as the calculation of usability scores using the System Usability Scale. RESULTS: The key themes identified during the co-design and user testing sessions were related to (1) the need for self-management tools to be flexible and well-integrated into mental health services, (2) the importance of language and how language preferences vary among individuals, (3) the need for self-management interventions to have the option of being supported when delivered in services, and (4) the potential of digitization to allow for a greater customization of self-management tools and the development of features based on individuals' unique preferences and needs. The MyPREP paper version received a total usability score of 71, indicating C+ or good usability, whereas the digital version received a total usability score of 85.63, indicating A or excellent usability. CONCLUSIONS: There are international calls for mental health services to promote a culture of self-management, with supported self-management interventions being routinely offered. The resulting co-designed prototype of the Australian version of the self-management intervention MyPREP provides an avenue for supporting self-management in practice in a flexible manner. Involving end users, such as consumers and peer workers, from the beginning is vital to address their need for personalized and customized interventions and their choice in how interventions are delivered. Further implementation-effectiveness piloting of MyPREP in real-world mental health service settings is a critical next step.

6.
J Clin Sleep Med ; 2024 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-38169428

RESUMO

STUDY OBJECTIVES: Parents/carers of a child with narcolepsy (CwN) are often required to become an expert in narcolepsy and navigate healthcare, education, and welfare systems on behalf of their child. Managing pediatric narcolepsy is complex and challenges the child and the entire family, yet few studies have explored carers' experiences. METHODS: Twenty mothers (50% had a CwN <18 years at the time of interview; 85% NT1) participated in a 1:1 semi-structured interview. Participation from fathers was sought; however, none were recruited. A multidisciplinary team of researchers/clinicians analyzed interview transcripts using thematic analysis. RESULTS: Mothers perceived that most people misunderstood the whole-person impact of narcolepsy, including their child's peers, teachers, and support networks. Narcolepsy had a substantial psychological impact on both the child and the whole family, yet was largely unaddressed by healthcare professionals, leaving mothers unsure of where to turn for help. Most parents described negative experiences with their child's specialist, often perceiving the specialists to lack knowledge specific to narcolepsy. Information about illness trajectory and support services was limited or inaccessible, fuelling many mothers' hopes and fears for their child's future. Mothers also frequently described feelings of abandonment by the healthcare system. CONCLUSIONS: Our results contextualize the whole-person impact of narcolepsy from the perspective of parents and carers, highlighting the need for proactive inclusion of parents/carers in developing healthcare policy and practice. It calls for developing tools and resources to capture 'well-managed' narcolepsy from the perspective of parents/carers for use in research and clinical practice.

7.
Transl Behav Med ; 14(3): 172-178, 2024 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-37944050

RESUMO

Making decisions about disclosing mental health conditions in the workplace is complicated. A previous randomized controlled trial showed that web-based decision aid tool (READY?) helped employees make decisions and improved mental health. We aimed to evaluate the implementation of this tool and its outcomes when scaled up by a governmental health and safety agency. We used website analytics and event data of those using the decision aid tool, and self-report stage of decision-making, distress, engagement, and usability data from consenting users of READY? over the first year of it being made publicly available. Over the year 2021, 100 adults opted in to be involved in the research evaluation of the program. This study replicated the previous Randomised Controlled Trial (RCT) that showed at post-intervention; a later stage of decision-making (t1,99 = 6.308, P < .001) with a large effect size (d = 0.87), and psychological distress was significantly reduced (t1,99 = 3.088, P < .001) with a moderate effect size (d = 0.41). READY? facilitated disclosure with 36.3% deciding to disclose after use. Disclosure was associated with a greater reduction in mental ill-health symptoms than non-disclosure [F(2,31) = 18.67, P < .001] with a moderate effect size (d = 0.64). Engagement, usage, and attrition rates were favourable when compared with other digital mental health approaches in community samples. This study shows that READY? is successfully implemented in a real-world sample. Aligning with the RCT results, for many, disclosure can be positive, research should continue to focus on developing organization-wide tools to create better supported and safe workplaces that promote disclosure.


Deciding whether to reveal mental health conditions at work is complex. An earlier study demonstrated that the READY? web-based decision aid tool improved employees' decision-making and mental well-being. This research aimed to assess the tool's implementation and outcomes when introduced in a real-world sample. The results mirrored the previous RCT, showing that after using READY?, individuals were more certain about sharing their mental health status, and experienced reduced distress. The tool facilitated disclosure for users, and sharing was linked to greater reduction in mental health symptoms compared with non-disclosure. Engagement, usage, and dropout rates were favourable compared with other digital mental health tools, especially those in real-world samples. The study confirms READY?'s successful real-world implementation and emphasizes the potential benefits of promoting open discussions about mental health in workplaces.


Assuntos
Transtornos Mentais , Saúde Mental , Adulto , Humanos , Revelação , Tomada de Decisões , Transtornos Mentais/psicologia , Técnicas de Apoio para a Decisão
8.
Aust N Z J Psychiatry ; 58(2): 109-116, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37830221

RESUMO

In this paper, the case study of ketamine as a new treatment for severe depression is used to outline the challenges of repurposing established medicines and we suggest potential solutions. The antidepressant effects of generic racemic ketamine were identified over 20 years ago, but there were insufficient incentives for commercial entities to pursue its registration, or support for non-commercial entities to fill this gap. As a result, the evaluation of generic ketamine was delayed, piecemeal, uncoordinated, and insufficient to gain approval. Meanwhile, substantial commercial investment enabled the widespread registration of a patented, intranasal s-enantiomeric ketamine formulation (Spravato®) for depression. However, Spravato is priced at $600-$900/dose compared to ~$5/dose for generic ketamine, and the ~AUD$100 million annual government investment requested in Australia (to cover drug costs alone) has been rejected twice, leaving this treatment largely inaccessible for Australian patients 2 years after Therapeutic Goods Administration approval. Moreover, emerging evidence indicates that generic racemic ketamine is at least as effective as Spravato, but no comparative trials were required for regulatory approval and have not been conducted. Without action, this story will repeat regularly in the next decade with a new wave of psychedelic-assisted psychotherapy treatments, for which the original off-patent molecules could be available at low-cost and reduce the overall cost of treatment. Several systemic reforms are required to ensure that affordable, effective options become accessible; these include commercial incentives, public and public-private funding schemes, reduced regulatory barriers and more coordinated international public funding schemes to support translational research.


Assuntos
Transtorno Depressivo Maior , Ketamina , Humanos , Ketamina/farmacologia , Ketamina/uso terapêutico , Depressão/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Austrália
9.
Aust N Z J Psychiatry ; 58(3): 207-226, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38140961

RESUMO

OBJECTIVE: Heterogeneous brief non-pharmacological interventions and guidelines exist to treat the burgeoning presentations to both emergency department and inpatient settings, for those in a crisis of mental ill-health. We systematically reviewed the literature to create a taxonomy of these brief non-pharmacological interventions, and review their evaluation methods and effectiveness. METHOD: We conducted a systematic review across Cochrane, CINAHL, DARE, Embase, MEDLINE, PsycINFO databases. Studies meeting quality criteria, using Joanna Briggs Institute tools, were eligible. Interventions were categorised, and outcomes synthesised. RESULTS: Thirty-nine studies were included: 8 randomised controlled trials, 17 quasi-experimental, 11 qualitative studies, and 3 file audits. Taxonomy produced six coherent intervention types: Skills-focussed, Environment-focussed, Special Observation, Psychoeducation, Multicomponent Group and Multicomponent Individual. Despite this, a broad and inconsistent range of outcome measures reflected different outcome priorities and prevented systematic comparison of different types of intervention or meta-analysis. Few brief non-pharmacological interventions had consistent evidential support: sensory modulation rooms consistently improved distress in inpatient settings. Short admissions may reduce suicide attempts and readmission, if accompanied by psychotherapy. Suicide-specific interventions in emergency departments may improve depressive symptoms, but not suicide attempt rates. There was evidence that brief non-pharmacological interventions did not reduce incidence of self-harm on inpatient wards. We found no evidence for frequently used interventions such as no-suicide contracting, special observation or inpatient self-harm interventions. CONCLUSION: Categorising brief non-pharmacological interventions is feasible, but an evidence base for many is severely limited if not missing. Even when there is evidence, the inconsistency in outcomes often precludes clinicians from making inferences, although some interventions show promise.


Assuntos
Intervenção na Crise , Pacientes Internados , Humanos , Psicoterapia/métodos , Tentativa de Suicídio , Serviço Hospitalar de Emergência
10.
Br J Psychiatry ; 223(6): 533-541, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-38108319

RESUMO

BACKGROUND: Prior trials suggest that intravenous racemic ketamine is a highly effective for treatment-resistant depression (TRD), but phase 3 trials of racemic ketamine are needed. AIMS: To assess the acute efficacy and safety of a 4-week course of subcutaneous racemic ketamine in participants with TRD. Trial registration: ACTRN12616001096448 at www.anzctr.org.au. METHOD: This phase 3, double-blind, randomised, active-controlled multicentre trial was conducted at seven mood disorders centres in Australia and New Zealand. Participants received twice-weekly subcutaneous racemic ketamine or midazolam for 4 weeks. Initially, the trial tested fixed-dose ketamine 0.5 mg/kg versus midazolam 0.025 mg/kg (cohort 1). Dosing was revised, after a Data Safety Monitoring Board recommendation, to flexible-dose ketamine 0.5-0.9 mg/kg or midazolam 0.025-0.045 mg/kg, with response-guided dosing increments (cohort 2). The primary outcome was remission (Montgomery-Åsberg Rating Scale for Depression score ≤10) at the end of week 4. RESULTS: The final analysis (those who received at least one treatment) comprised 68 in cohort 1 (fixed-dose), 106 in cohort 2 (flexible-dose). Ketamine was more efficacious than midazolam in cohort 2 (remission rate 19.6% v. 2.0%; OR = 12.1, 95% CI 2.1-69.2, P = 0.005), but not different in cohort 1 (remission rate 6.3% v. 8.8%; OR = 1.3, 95% CI 0.2-8.2, P = 0.76). Ketamine was well tolerated. Acute adverse effects (psychotomimetic, blood pressure increases) resolved within 2 h. CONCLUSIONS: Adequately dosed subcutaneous racemic ketamine was efficacious and safe in treating TRD over a 4-week treatment period. The subcutaneous route is practical and feasible.


Assuntos
Transtorno Depressivo Resistente a Tratamento , Ketamina , Humanos , Ketamina/efeitos adversos , Depressão , Midazolam/efeitos adversos , Austrália , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico
11.
BMJ Open ; 13(12): e074235, 2023 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-38097242

RESUMO

INTRODUCTION: Work-related stress is a social determinant of global health that represents a huge cost to workers' health and reduces work performance. In Australia, mental well-being is a pressing national issue-with one in five Australians experiencing mental disorders. Antidepressants are a first-line medication commonly used to treat mental disorders. Recently, Australia has seen a dramatic increase in the use of prescribed antidepressant medications to treat mental health related illnesses. Australia has also seen a dramatic increase in the use of prescribed opioid analgesics for non-cancer pain including opioid use for psychological distress and social stressors. It is plausible a rise in mental health problems and antidepressant and opioid medication use is partly attributable to the corporate climate for worker mental health (ie, the psychosocial safety climate, PSC). This research aims to identify how PSC and workplace conditions contribute to employee well-being and distress that culminate in antidepressant and opioid medication use. METHODS/ANALYSIS: Data will be collected through creative data linkage from the Australian Workplace Barometer (AWB), to medication data (via the Pharmaceutical Benefits Scheme, PBS). The participant sample will include 1372 working Australians from the AWB project from 2009 to 2021. Four waves of longitudinal data from 2009 to 2021 will be used to investigate the plausible link between Australia's high levels of antidepressant and opioid use and distress at work. The project advances theory by probing the role corporate climate plays in work design, distress, mental health problems and antidepressant and opioid use. It will determine if antidepressant and opioid use has led to an underestimation of work stress effects. Proposed theoretical models will be analysed through linked data, using continuous time structural equation modelling, hierarchical linear modelling, logistic regression and cost estimation. ETHICS AND DISSEMINATION: The study has been approved by the Human Research Ethics Committee of the University of South Australia (Ethics Protocol: 203003). Further, approval from the Australian Institute of Health and Welfare Ethics Committee was also granted for linkage of AWB data and PBS data (EthOS Application EO2022/1/1190).Results of the study will be disseminated through worldwide keynotes, key international settings, high-impact peer-reviewed journals, industry conference presentations and media outlets to reach managers, workers, and industry partners. Further, UniSA requires publications from public projects to be held in an institutional repository which fulfils the Australian Research Council's Open Access Policy.


Assuntos
Saúde Mental , Transtornos Relacionados ao Uso de Opioides , Humanos , Analgésicos Opioides/uso terapêutico , Antidepressivos/uso terapêutico , Austrália/epidemiologia , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Cultura Organizacional , Condições de Trabalho , Estudos Longitudinais , Projetos de Pesquisa , Armazenamento e Recuperação da Informação
12.
Glob Health Action ; 16(1): 2273625, 2023 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-37971492

RESUMO

Risky alcohol use is a major public health problem globally and in Sri Lanka. While a reduction in alcohol consumption can result in physical, mental, and social benefits, behaviour change is difficult to achieve. Effective, context-adapted interventions are required to minimise alcohol-related harm at a community level. THEATRE is a complex, community-based intervention evaluating whether a promising Sri Lankan pilot study that utilised arts-based research to moderate alcohol use can be scaled up. While the scaled-up pilot study protocol is presented elsewhere, the aim of this protocol paper is to describe the intervention programme theory and evaluation design, and modifications made to the study resulting from COVID-19 and the financial crisis. Drawing on the Behaviour Change Wheel (BCW) and Theoretical Domains Framework, behaviour change theories are presented with potential pathways to guide implementation and evaluation. Alcohol consumption patterns and context of drinking is detailed. The multifaceted intervention targets individuals and communities using arts-based interventions. Four of nine BCW functions are employed in the design of the intervention: education, persuasion, modelling and enablement, and training. Modifications made to the study due to COVID-19 and the financial crisis are described. Ethical approval was obtained from the Ethics Review Committee, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka (ERC/2018/21-July 2018 and Feb 2022) and the University of Sydney (2019/006). Findings will be disseminated locally to community members and key stakeholders and via international peer-reviewed publications.


Assuntos
COVID-19 , Educação em Saúde , Humanos , Sri Lanka/epidemiologia , Projetos Piloto , Terapia Comportamental , COVID-19/prevenção & controle
13.
Proc Natl Acad Sci U S A ; 120(49): e2303781120, 2023 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-38011547

RESUMO

Given the observed deterioration in mental health among Australians over the past decade, this study investigates to what extent this differs in people born in different decades-i.e., possible birth cohort differences in the mental health of Australians. Using 20 y of data from a large, nationally representative panel survey (N = 27,572), we find strong evidence that cohort effects are driving the increase in population-level mental ill-health. Deteriorating mental health is particularly pronounced among people born in the 1990s and seen to a lesser extent among the 1980s cohort. There is little evidence that mental health is worsening with age for people born prior to the 1980s. The findings from this study highlight that it is the poorer mental health of Millennials that is driving the apparent deterioration in population-level mental health. Understanding the context and changes in society that have differentially affected younger people may inform efforts to ameliorate this trend and prevent it continuing for emerging cohorts.


Assuntos
Saúde Mental , Humanos , Austrália/epidemiologia , Inquéritos e Questionários
14.
Trials ; 24(1): 686, 2023 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-37875938

RESUMO

BACKGROUND: Existing treatments for young people with severe depression have limited effectiveness. The aim of the Study of Ketamine for Youth Depression (SKY-D) trial is to determine whether a 4-week course of low-dose subcutaneous ketamine is an effective adjunct to treatment-as-usual in young people with major depressive disorder (MDD). METHODS: SKY-D is a double-masked, randomised controlled trial funded by the Australian Government's National Health and Medical Research Council (NHMRC). Participants aged between 16 and 25 years (inclusive) with moderate-to-severe MDD will be randomised to receive either low-dose ketamine (intervention) or midazolam (active control) via subcutaneous injection once per week for 4 weeks. The primary outcome is change in depressive symptoms on the Montgomery-Åsberg Depression Rating Scale (MADRS) after 4 weeks of treatment. Further follow-up assessment will occur at 8 and 26 weeks from treatment commencement to determine whether treatment effects are sustained and to investigate safety outcomes. DISCUSSION: Results from this trial will be important in determining whether low-dose subcutaneous ketamine is an effective treatment for young people with moderate-to-severe MDD. This will be the largest randomised trial to investigate the effects of ketamine to treat depression in young people. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ID: ACTRN12619000683134. Registered on May 7, 2019. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377513 .


Assuntos
Transtorno Depressivo Maior , Ketamina , Humanos , Adolescente , Lactente , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/tratamento farmacológico , Ketamina/efeitos adversos , Depressão/terapia , Austrália , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
BMC Psychiatry ; 23(1): 745, 2023 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-37833680

RESUMO

BACKGROUND: Australian rural and regional communities are marked by geographic isolation and increasingly frequent and severe natural disasters such as drought, bushfires and floods. These circumstances strain the mental health of their inhabitants and jeopardise the healthy mental and emotional development of their adolescent populations. Professional mental health care in these communities is often inconsistent and un-coordinated. While substantial research has examined the barriers of young people's mental health and help-seeking behaviours in these communities, there is a lack of research exploring what adolescents in rural and regional areas view as facilitators to their mental health and to seeking help when it is needed. This study aims to establish an in-depth understanding of those young people's experiences and needs regarding mental health, what facilitates their help-seeking, and what kind of mental health education and support they want and find useful. METHOD: We conducted a qualitative study in 11 drought-affected rural and regional communities of New South Wales, Australia. Seventeen semi-structured (14 group; 3 individual) interviews were held with 42 year 9 and 10 high school students, 14 high school staff, and 2 parents, exploring participants' experiences of how geographical isolation and natural disasters impacted their mental health. We further examined participants' understandings and needs regarding locally available mental health support resources and their views and experiences regarding mental illness, stigma and help-seeking. RESULTS: Thematic analysis highlighted that, through the lens of participants, young people's mental health and help-seeking needs would best be enabled by a well-coordinated multi-pronged community approach consisting of mental health education and support services that are locally available, free of charge, engaging, and empowering. Participants also highlighted the need to integrate young people's existing mental health supporters such as teachers, parents and school counselling services into such a community approach, recognising their strengths, limitations and own education and support needs. CONCLUSIONS: We propose a three-dimensional Engagement, Empowerment, Integration model to strengthen young people's mental health development which comprises: 1) maximising young people's emotional investment (engagement); 2) developing young people's mental health self-management skills (empowerment); and, 3) integrating mental health education and support programs into existing community and school structures and resources (integration).


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Adolescente , Humanos , Saúde Mental , Austrália , Transtornos Mentais/terapia , New South Wales , Pesquisa Qualitativa
17.
Nat Hum Behav ; 7(10): 1652-1666, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37653145

RESUMO

Lockdown was used worldwide to mitigate the spread of severe acute respiratory syndrome coronavirus 2 and was the cornerstone non-pharmaceutical intervention of zero-COVID strategies. Many previous impact evaluations of lockdowns are unreliable because lockdowns co-occurred with severe coronavirus disease related health and financial insecurities. This was not the case in Melbourne's 111-day lockdown, which left other Australian jurisdictions unaffected. Interrogating nationally representative longitudinal survey data and quasi-experimental variation, and controlling for multiple hypothesis testing, we found that lockdown had some statistically significant, albeit small, impacts on several domains of human life. Women had lower mental health (-0.10 s.d., P = 0.043, 95% confidence interval (CI) = -0.21 to -0) and working hours (-0.13 s.d., P = 0.006, 95% CI = -0.22 to -0.04) but exercised more often (0.28 s.d., P < 0.001, 95% CI = 0.18 to 0.39) and received more government transfers (0.12 s.d., P = 0.048, 95% CI = 0.001 to 0.24). Men felt less part of their community (-0.20 s.d., P < 0.001, 95% CI = -0.30 to -0.10) and reduced working hours (-0.12 s.d., P = 0.004, 95% CI = -0.20 to -0.04). Heterogeneity analyses demonstrated that families with children were driving the negative results. Mothers had lower mental health (-0.27 s.d., P = 0.014, 95% CI = -0.48 to -0.06), despite feeling safer (0.26 s.d., P = 0.008, 95% CI = 0.07 to 0.46). Fathers increased their alcohol consumption (0.35 s.d., P = 0.002, 95% CI = 0.13 to 0.57). Some outcomes worsened with lockdown length for mothers. We discuss potential explanations for why parents were adversely affected by lockdown.


Assuntos
COVID-19 , Adulto , Masculino , Criança , Humanos , Feminino , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/psicologia , Efeitos Antropogênicos , Austrália/epidemiologia , SARS-CoV-2 , Saúde Mental
18.
BJPsych Open ; 9(4): e104, 2023 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-37282603

RESUMO

BACKGROUND: Public and patient expectations of treatment influence health behaviours and decision-making. AIMS: We aimed to understand how the media has portrayed the therapeutic use of ketamine in psychiatry. METHOD: We systematically searched electronic databases for print and online news articles about ketamine for psychiatric disorders. The top ten UK, USA, Canadian and Australian newspapers by circulation and any trade and consumer magazines indexed in the databases were searched from 2015 to 2020. Article content was quantitatively coded with a framework encompassing treatment indication, descriptions of prior use, references to research, benefits and harms, treatment access and process, patient and professional testimony, tone and factual basis. RESULTS: We found 119 articles, peaking in March 2019 when the United States Food and Drug Administration approved esketamine. Ketamine treatment was portrayed in an extremely positive light (n = 82, 68.9%), with significant contributions of positive testimony from key opinion leaders (e.g. clinicians). Positive research results and ketamine's rapid antidepressant effect (n = 87, 73.1%) were frequently emphasised, with little reference to longer-term safety and efficacy. Side-effects were frequently reported (n = 96, 80.7%), predominantly ketamine's acute psychotomimetic effects and the potential for addiction and misuse, and rarely cardiovascular and bladder effects. Not infrequently, key opinion leaders were quoted as being overly optimistic compared with the existing evidence base. CONCLUSIONS: Information pertinent to patient help-seeking and treatment expectations is being communicated through the media and supported by key opinion leaders, although some quotes go well beyond the evidence base. Clinicians should be aware of this and may need to address their patients' beliefs directly.

19.
BMJ Open ; 13(6): e064722, 2023 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-37321807

RESUMO

INTRODUCTION: Alcohol consumption is a leading cause of mortality, morbidity and adverse social sequelae in Sri Lanka. Effective community-based, culturally adapted or context-specific interventions are required to minimise these harms. We designed a mixed-methods stepped wedge cluster randomised control trial of a complex alcohol intervention. This paper describes the initial trial protocol and subsequent modifications following COVID-19. METHODS AND ANALYSIS: We aimed to recruit 20 villages (approximately n=4000) in rural Sri Lanka. The proposed intervention consisted of health screening clinics, alcohol brief intervention, participatory drama, film, and public health promotion materials to be delivered over 12 weeks.Following disruptions to the trial resulting from the Easter bombings in 2019, COVID-19 and a national financial crisis, we adapted the study in two main ways. First, the interventions were reconfigured for hybrid delivery. Second, a rolling pre-post study evaluating changes in alcohol use, mental health, social capital and financial stress as the primary outcome and implementation and ex-ante economic analysis as secondary outcomes. ETHICS AND DISSEMINATION: The original study and amendments have been reviewed and granted ethical approval by Rajarata University of Sri Lanka (ERC/2018/21-July 2018 and February 2022) and the University of Sydney (2019/006). Findings will be disseminated locally in collaboration with the community and stakeholders.The new hybrid approach may be more adaptable, scalable and generalisable than the planned intervention. The changes will allow a closer assessment of individual interventions while enabling the evaluation of this discontinuous event through a naturalistic trial design. This may assist other researchers facing similar disruptions to community-based studies. TRIAL REGISTRATION: The trial is registered with the Sri Lanka Clinical Trials Registry; https://slctr.lk/trials/slctr-2018-037.


Assuntos
COVID-19 , Humanos , Sri Lanka/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Educação em Saúde , Aconselhamento/métodos , Consumo de Bebidas Alcoólicas/prevenção & controle
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