The role of self-reliance and denial in the help-seeking process for eating disorders among university students.

OBJECTIVE: This study investigated how self-reliance and denial influence the relationship between help-seeking attitudes and behaviour. METHOD: Australian university students (N = 406) completed an online survey and females with elevated eating disorder (ED) concerns and high impairment were included in the study (N = 137). Participants completed measures of help-seeking attitudes, perceived barriers, and actual help-seeking behaviour. Via moderated logistic regression, we examined self-reliance and denial as perceived barriers to help-seeking. RESULTS: Of the total sample, over 33.7% of university students reported substantial ED concerns and impairment of whom 65.0% believed they needed help. While a majority reported that help-seeking would be useful (85.4%), only a minority of participants had sought professional help for their concerns (38.7%). Self-reliance and denial were frequently endorsed barriers and moderated the relationship between help-seeking attitudes and behaviours. CONCLUSION: ED concerns are common among university students and perceived barriers play a moderating role between attitudes and help-seeking. Future prevention and early intervention programs should address students' denial, while the importance of reaching out for professional help (rather than relying on themselves) could be highlighted with peer support.

A cross-sectional investigation of the mental health and wellbeing among individuals who have been negatively impacted by the COVID-19 international border closure in Australia.

BACKGROUND: The COVID-19 pandemic resulted in the Australian government implementing strict international border closures. However, research has not yet investigated the mental health status of individuals impacted negatively by these international border closures. METHODS: The present study was a cross-sectional online survey of 3968 adults who reported being negatively affected by the border closure during June and July 2021. Psychological distress was measured with the Kessler Psychological Distress Scale (K10), stress with the Perceived Stress Scale (PSS) and wellbeing with the Mental Health Continuum Short Form (MHC-SF). RESULTS: In total, 3968 participants reported being negatively affected by the current restrictions (63.4% in Australia, 36.6% overseas). The vast majority of respondents (83.6%) reported high or very high levels of psychological distress (mean K10 score > 22), and 74.8% reported poor mental wellbeing, with similar risk profiles for participants in Australia or overseas. The most common scenarios of affected individuals included 1) wanting to enter Australia (30.8%), 2) wanting to leave Australia (29.6%) and 3) wanting someone to enter Australia (25.6%). Reasons included wanting to be with partners, family and friends (81.1%), for employment/economic reasons (4.9%), study (4.1%), personal safety/health (2.6%) or holiday (1.4%). While psychological distress was extremely high across all groups, separated partners and those with interrupted study experienced the highest distress (mean K10 = 35.7, n = 155). CONCLUSION: The data suggests a highly elevated mental health risk profile among individuals who report being negatively affected by current Australian international border closures. The results provide valuable data to inform future policy decisions and have clear implications regarding effective service provision for this vulnerable group.

An exploratory investigation of predictors of outcome in face-to-face and online cognitive-behavioural therapy for bulimia nervosa.

OBJECTIVE: Cognitive-behavioural therapy (CBT) delivered face-to-face and via the internet reduces bulimia nervosa (BN) symptoms. However, our empirical understanding of factors affecting patient outcomes is limited. METHOD: Using data from a randomised, controlled trial comparing internet-based (CBT4BN, n = 78) with face-to-face (CBTF2F, n = 71) group CBT (97% female, M = 28 years), we examined general treatment (across conditions) and modality-specific predictors of end-treatment and 1-year outcomes (abstinence, binge-eating frequency, purging frequency). RESULTS: Improved eating disorder-related quality of life (EDQOL) during treatment and follow-up predicted abstinence at end-treatment and 1-year assessments. Improved EDQOL, disordered eating cognitions, and anxiety symptoms predicted less frequent binge eating and purging. Previous CBT and being employed predicted more frequent binge eating and purging at both assessments. Higher self-transcendence and self-directedness predicted less frequent binge eating. More severe binge eating and purging at baseline and end-treatment predicted more frequent binge eating and purging at subsequent assessments. Improved EDQOL was more strongly associated with positive outcome in CBT4BN; improved depressive symptoms and health-related QOL predicted positive outcome in CBT4BN but not CBTF2F. DISCUSSION: Symptom improvement and certain character traits predicted positive outcome, whereas more severe presentation and prior CBT experience predicted poorer outcome. Consideration of intreatment symptom improvement may facilitate care recommendations, particularly for internet-based modalities.

Contemporary treatment of anxiety in primary care: a systematic review and meta-analysis of outcomes in countries with universal healthcare.

BACKGROUND: Anxiety disorders are highly prevalent mental health conditions and are managed predominantly in primary care. We conducted a systematic review and meta-analysis of psychological and pharmacological treatments in countries with universal healthcare, and investigated the influence of treatment provider on the efficacy of psychological treatment. METHOD: PubMed, Cochrane, PsycINFO, CINAHL, and Scopus were searched in April 2017 for controlled studies of evidence-based anxiety treatment in adults in primary care, published in English since 1997. Searches were repeated in April 2020. We synthesised results using a combination of meta-analysis and narrative methods. Meta-analysis was conducted using a random-effects multi-level model to account for intercorrelation between effects contributed different treatment arms of the same study. Moderator variables were explored using meta-regression analyses. RESULTS: In total, 19 articles (from an initial 2,247) reporting 18 studies were included. Meta-analysis including ten studies (n = 1,308) found a pooled effect size of g = 1.16 (95%CI = 0.63 - 1.69) for psychological treatment compared to waitlist control, and no significant effect compared to care as usual (p = .225). Substantial heterogeneity was present (I2 = 81.25). Specialist treatment produced large effects compared to both waitlist control (g = 1.46, 95%CI = 0.96 - 1.96) and care as usual (g = 0.76, 95%CI = 0.27 - 1.25). Treatment provided by non-specialists was only superior to waitlist control (g = 0.80, 95%CI = 0.31 - 1.28). We identified relatively few studies (n = 4) of medications, which reported small to moderate effects for SSRI/SNRI medications and hydroxyzine. The quality of included studies was variable and most studies had at least "unclear" risk of bias in one or more key domains. CONCLUSIONS: Psychological treatments for anxiety are effective in primary care and are more effective when provided by a specialist (psychologist or clinical psychologist) than a non-specialist (GP, nurse, trainee). However, non-specialists provide effective treatment compared with no care at all. Limited research into the efficacy of pharmacological treatments in primary care needs to be considered carefully by prescribers TRIAL REGISTRATION: PROSPERO registration number CRD42018050659.

What prevents young adults from seeking help? Barriers toward help-seeking for eating disorder symptomatology.

OBJECTIVES: The aim of this study was to investigate help-seeking attitudes, intentions, and behaviors, and to systematically explore perceived barriers to help-seeking for eating, weight, or shape concerns among young adults. Differences in perceived barriers as a function of type of eating disorder symptomatology were also examined. METHOD: Data were collected using an online survey among individuals (aged 18-25 years) in Australia. Overall, 291 young adults with varying levels of eating disorder symptoms completed measures of disordered eating, weight or shape concerns, help-seeking barriers, attitudes, intentions, and behaviors. According to their self-reported symptoms, participants were classified into four subgroups (i.e., anorexia nervosa [AN] symptoms, bulimia nervosa [BN] symptoms, binge-eating disorder [BED] symptoms, and other eating disorder symptoms). RESULTS: Despite the belief that help-seeking is useful, only a minority of participants with elevated symptoms, namely those with AN, BN, and BED symptoms, believed they needed help. Across the sample, the most frequently cited barriers to seeking help for eating disorder symptoms were: concern for others, self-sufficiency, fear of losing control, denial and failure to perceive the severity of the illness, and stigma and shame. DISCUSSION: The findings highlight the need to educate young adults about the severity of eating disorders and the importance of seeking help, and to increase the awareness of help-seeking barriers among those designing public health interventions as well as clinicians. Our findings suggest that help-seeking barriers may differ depending on the type of eating disorder symptomology.

Therapist-Assisted Internet-Based Cognitive Behavioral Therapy Versus Progressive Relaxation in Obsessive-Compulsive Disorder: Randomized Controlled Trial.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a highly disabling psychological disorder with a chronic course if left untreated. Cognitive behavioral therapy (CBT) has been shown to be an effective treatment, but access to face-to-face CBT is not always possible. Internet-based CBT (iCBT) has become an increasingly viable option. However, no study has compared iCBT to an analogous control condition using a randomized controlled trial (RCT). OBJECTIVE: A 2-armed RCT was used to compare a therapist-assisted 12-module iCBT to an analogous active attention control condition (therapist-assisted internet-based standard progressive relaxation training, iPRT) in adult OCD. This paper reports pre-post findings for OCD symptom severity. METHOD: In total, 179 participants (117 females, 65.7%) were randomized (stratified by gender) into iCBT or iPRT. The iCBT intervention included psychoeducation, mood and behavioral management, exposure and response prevention (ERP), cognitive therapy, and relapse prevention; the iPRT intervention included psychoeducation and relaxation techniques as a way of managing OCD-related anxiety but did not incorporate ERP or other CBT elements. Both treatments included audiovisual content, case stories, demonstrations of techniques, downloadable audio content and worksheets, and expert commentary. All participants received 1 weekly email, with a maximum 15-minute preparation time per client from a remote therapist trained in e-therapy. Emails aimed to monitor progress, provide support and encouragement, and assist in individualizing the treatment. Participants were assessed for baseline and posttreatment OCD severity with the telephone-administered clinician-rated Yale-Brown Obsessive-Compulsive Scale and other measures by assessors who were blinded to treatment allocation. RESULTS: No pretreatment differences were found between the 2 conditions. Intention-to-treat analysis revealed significant pre-post improvements in OCD symptom severity for both conditions (P<.001). However, relative to iPRT, iCBT showed significantly greater symptom severity improvement (P=.001); Cohen d for iCBT was 1.05 (95% CI 0.72-1.37), whereas for iPRT it was 0.48 (95% CI 0.22-0.73). The iCBT condition was superior in regard to reliable improvement (25/51, 49% vs 16/55, 29%; P=.04) and clinically significant pre-post-treatment changes (17/51, 33% vs 6/55, 11%; P=.005). Those undertaking iCBT post completion of iPRT showed further significant symptom amelioration (P<.001), although the sequential treatment was no more efficacious than iCBT alone (P=.63). CONCLUSION: This study is the first to compare a therapist-assisted iCBT program for OCD to an analogous active attention control condition using iPRT. Our findings demonstrate the large magnitude effect of iCBT for OCD; interestingly, iPRT was also moderately efficacious, albeit significantly less so than the iCBT intervention. The findings are compared to previous internet-based and face-to-face CBT treatment programs for OCD. Future directions for technology-enhanced programs for the treatment of OCD are outlined. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12611000321943; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336704 (Archived by WebCite at http://www.webcitation.org/70ovUiOmd).

The cognitive-behavioural model of hoarding disorder: Evidence from clinical and non-clinical cohorts.

The cognitive-behavioural model of hoarding disorder incorporates information processing difficulties, maladaptive attachment to possessions, erroneous beliefs about the nature of possessions, and mood problems as etiologically significant factors, although developmental experiences such as a compromised early family environment have also been proposed in an augmented model. This study examined the specificity and relevance of variables highlighted in the augmented cognitive-behavioural model. Various clinical participants (n = 89) and community controls (n = 20) were assessed with structured clinical interviews to verify diagnosis. Participants completed self-report measures of hoarding severity, cognitions, meta-memory, and early developmental experiences (e.g., memories of warmth and security in one's family). Hoarding cohorts (with and without obsessive-compulsive disorder) reported poor confidence in memory, but relative to other groups (obsessive-compulsive disorder without hoarding disorder, anxiety disorders, and healthy controls), hoarding-relevant cognitions, need to keep possessions in view, and concerns about the consequences of forgetting were significantly higher. Hoarding groups reported the lowest recollections of warmth in their family, although no differences were found between hoarding and non hoarding clinical cohorts for uncertainty about self and others. Nonetheless, clinical cohorts reported generally higher scores of uncertainty than healthy controls. When predicting hoarding severity, after controlling for age and mood, recollections of lack of warmth in one's family was a significant predictor of hoarding severity, with hoarding-related cognitions and fears about decision-making being additional unique predictors. The study supports the augmented cognitive-behavioural model of hoarding, inclusive of the importance of early developmental influences in hoarding.

Perceived barriers and facilitators towards help-seeking for eating disorders: A systematic review.

OBJECTIVE: To systematically review the literature on perceived barriers and facilitators of help-seeking for eating disorders. METHOD: Three databases (PubMed, PsychInfo, Cochrane) were searched using keywords and Medical Subject Headings (MeSH) terms. Retrieved abstracts (N = 3493) were double screened and relevant papers (n = 13) were double coded. Qualitative and quantitative studies were included if they reported perceived barriers and facilitators towards seeking help for eating disorders. Barriers and facilitators were extracted from the included papers and coded under themes. The most prominent barriers and facilitators were determined by the number of studies reporting each theme. RESULTS: Eight qualitative, three quantitative, and two mixed-methods studies met the inclusion criteria for the current review. The most prominent perceived barriers to help-seeking were stigma and shame, denial of and failure to perceive the severity of the illness, practical barriers (e.g., cost of treatment), low motivation to change, negative attitudes towards seeking help, lack of encouragement from others to seek help and lack of knowledge about help resources. Facilitators of help-seeking were reported in six studies, with the most prominent themes identified as the presence of other mental health problems or emotional distress, and concerns about health. DISCUSSION: Programs targeting prevention and early intervention for eating disorders should focus on reducing stigma and shame, educating individuals about the severity of eating disorders, and increasing knowledge around help-seeking pathways for eating disorders. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:9-21).

Implicit and explicit anti-fat bias among Asian females.

Obesity is not only associated with an increased risk of numerous health problems, but also with high rates of stigmatization and weight-related bias. Anti-fat attitudes have been shown to be prevalent in Western samples; however, there is a lack of studies investigating both implicit and explicit anti-fat bias in Asian populations. There is also limited research investigating the relationship between anti-fat attitudes and weight-related behavioral intentions. Thus, this study aimed to examine anti-fat bias and its effect on behavioral intentions using three types of measures-implicit, explicit, and a revised behavioral intention measure-in a sample of 104 Asian females in Singapore. Significant differences were found between implicit and explicit bias: on average, participants exhibited strong implicit but no explicit anti-fat bias (p < 0.001). Furthermore, only implicit anti-fat bias was found to be a significant predictor of behavioral intentions (p < 0.05), after accounting for body mass index, and sociodemographic variables. In conclusion, the present study revealed that implicit anti-fat bias is present among Asian females and is a valid predictor of weight-related behavioral intentions. However, anti-fat bias is often not expressed explicitly, possibly influenced by collectivistic beliefs. More studies are needed to better understand similarities and differences between Asian and Western populations regarding attitudes toward overweight and obese individuals.

Demographic and psychosocial predictors of major depression and generalised anxiety disorder in Australian university students.

BACKGROUND: Few studies have examined modifiable psychosocial risk factors for mental disorders among university students, and of these, none have employed measures that correspond to clinical diagnostic criteria. The aim of this study was to examine psychosocial and demographic risk factors for major depression and generalised anxiety disorder (GAD) in a sample of Australian university students. METHODS: An anonymous web-based survey was distributed to undergraduate and postgraduate students at a mid-sized Australian university. A range of psychosocial and demographic risk factors were measured, and logistic regression models were used to examine significant predictors of major depression and GAD. RESULTS: A total of 611 students completed the survey. The prevalence of major depression and GAD in the sample was 7.9 and 17.5 %, respectively. In terms of demographic factors, the risk of depression was higher for students in their first year of undergraduate study, and the risk of GAD was higher for female students, those who moved to attend university, and students experiencing financial stress. In terms of psychosocial factors, students with experience of body image issues and lack of confidence were at significantly greater risk of major depression, and feeling too much pressure to succeed, lack of confidence, and difficulty coping with study was significantly associated with risk of GAD. CONCLUSIONS: University students experience a range of unique psychosocial stressors that increase their risk of major depression and GAD, in addition to sociodemographic risk factors. It is important to examine psychosocial factors, as these are potentially modifiable and could be the focus of university-specific mental health interventions.

Understanding stigma in the context of help-seeking for eating disorders.

BACKGROUND: Stigma is a complex construct and its association with help-seeking among those experiencing eating disorders is not well understood. Rates of help-seeking are low for those with eating disorder symptoms and, therefore, determining the role of stigma and shame in this relationship is needed to help inform effective awareness campaigns aimed at improving prognostic outcomes. The current study examined the associations between perceived stigma, self-stigma, shame, and help-seeking behaviour in a community sample of individuals with elevated eating disorder symptoms. METHODS: Participants completed an online survey that included measures of stigma and shame as perceived barriers to help-seeking for individuals with eating disorders. Those with elevated eating disorder symptoms and high clinical impairment were included in the study (N = 333). RESULTS: Using binary logistic regression models controlling for age and gender, results showed that perceived stigma, self-stigma, and shame predicted 64% of help-seeking behaviour (p = .005). The only significant unique predictor of formal help-seeking was "Being concerned that other people believe eating disorders are not real illnesses". No other stigma or shame items were found to significantly predict help-seeking. CONCLUSIONS: The present findings suggest that while stigma plays an important role in help-seeking, it might not be the primary reason preventing individuals with eating disorders from accessing care. The field is encouraged to investigate these factors to promote help-seeking effectively.

Eating disorders are highly prevalent worldwide and have severe mental health and medical consequences. While effective treatments for eating disorders exist, many of those who experience eating disorder symptoms do not reach out for help. Delays in help-seeking are associated with negative outcomes for affected individuals but also their families, caregivers, and the broader healthcare system. To better understand the factors preventing individuals with eating disorders from seeking help, we investigated the role of stigma and shame in this relationship. Participants completed a survey assessing their eating disorder symptoms, help-seeking behaviour, and barriers to seeking help. Those with elevated eating disorder symptoms (e.g., disordered eating and/or high weight and shape concerns negatively affecting their life) were included in the study. Participants reported that stigma and shame, specifically, "Being concerned that other people believe eating disorders are not real illnesses", prevented them from seeking help. Our results help to clarify the types of stigma most relevant to help-seeking, which may be targeted in awareness campaigns to improve access to care for people with eating disorders. It would be beneficial for future studies to explore other prominent help-seeking barriers to improve clinical outcomes.

Implementing a group-based online mental well-being program for women living with and beyond breast cancer - A mixed methods study.

PURPOSE: There is a gap in available mental well-being services in Australia for women diagnosed with breast cancer. This pilot mixed-methods uncontrolled study aimed to assess the feasibility of an online mental health and well-being intervention, the Be Well Plan (BWP), which enables participants to create a personalized, flexible well-being strategy. METHODS: Women diagnosed with stages I-IV breast cancer were recruited into 4 asynchronous groups to participate in the BWP, a 5-week facilitator-led group-based mental health and well-being program. Psychological measures used at baseline and post-intervention included: the Warwick Edinburgh Mental Well-Being Scale, Brief Resilience Scale, Self-compassion Scale, 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder scale, and EORC QLQ-C30. Multivariate analysis of variance and effect sizes were calculated on pre- and post-psychological measures, followed by qualitative content analysis on post-completion interviews with participants. RESULTS: Nineteen women (mean age 45.7, standard deviation = 7.74) were included in the study. Large effect sizes were reported for mental well-being, depressive symptoms, and anxiety (partial ω2 = 0.28, 0.21, and 0.20, respectively). Self-compassion, resilience, and quality of life results were not statistically significant. Qualitative content analysis provided insight into experiences with Program Delivery Experience, Application of the BWP, Mental Health Improvements, Supporter Involvement, Adopted Interventions, and Recruitment. Participants reported benefits in mindfulness, grounding techniques, and physical activities. CONCLUSION: The BWP has the potential to be an effective intervention to support the mental health and well-being of breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: This study highlights flexible interventions that accommodate the diverse needs of breast cancer survivors to improve mental well-being and alleviate psychological distress.

Anxiety management in Australian general practice: an analysis of encounters from 2006 - 2016.

BACKGROUND: Anxiety disorders are highly prevalent mental health conditions managed predominantly by general practitioners (GPs). This study aimed to examine the management of anxiety by Australian GPs since the introduction of the Better Access to Psychiatrists, Psychologists and General Practitioners initiative in 2006. METHODS: We conducted secondary analysis of Bettering the Evaluation and Care of Health data on GP encounters for anxiety from 2006 to 2016 (N = 28,784). We calculated point estimates and used multivariate logistic regression to explore the effect of GP and patient characteristics on rates and types of management. RESULTS: The management rate of anxiety increased from 2.3% of GP encounters in 2006 to 3.2% in 2016. Over the 10-year period, increases were seen in referrals to psychologists (AOR = 1.09, 95%CI = 1.07-1.11, p < .0001) and selective serotonin / serotonin-noradrenalin reuptake inhibitors (AOR = 1.05, 95%CI = 1.03-1.06, p < .0001), and benzodiazepines decreased (AOR = 0.94, 95%CI = 0.92-0.95, p < .0001). Systematic differences in management were found for patient and GP characteristics, including high rates of benzodiazepines in certain groups. CONCLUSIONS: Anxiety is accounting for more of the GP workload, year on year. GP management of anxiety has become more closely aligned with practice guidelines since 2006. However, high rates of benzodiazepine prescribing in certain groups remains a concern. Further research is needed into GP treatment decision making for anxiety.

The Importance of Measuring Mental Wellbeing in the Context of Psychological Distress: Using a Theoretical Framework to Test the Dual-Continua Model of Mental Health.

The dual-continua model of mental health suggests that psychological distress and mental wellbeing operate on two distinct yet related continua, both uniquely contributing to overall mental health. Previous literature provides support for the dual-continua model; however, inconsistent methodologies lacking a common theoretical underpinning have led to findings that are difficult to compare across studies. Using archival data, this study aimed to test the following three theoretically derived criteria proposed to accurately examine the dual-continua model: (1) confirming independent existence, (2) disconfirming bipolarity, and (3) quantifying functional independence. METHOD: In total, 2065 participants (female n = 1193; 57.8%) completed two online assessments (minimum 30 days apart) measuring psychological distress, mental wellbeing, and demographic information. RESULTS: In total, 1.1% of participants experienced high distress as well as mental wellbeing confirming that psychological distress and mental wellbeing exist independently (Criterion 1). Bipolarity (Criterion 2) was partly disconfirmed: mental wellbeing consistently decreased as symptom severity increased for depression; however, anxiety and stress did not meet bipolarity requirements. Functional independence (Criterion 3) was established: longitudinal analysis found that participants reliably and simultaneously increased (2.7%) or decreased (4.2%) in distress and mental wellbeing, while cross-sectional analysis showed that psychological distress only explained 38% of the variance in mental wellbeing. DISCUSSION: Findings provide further support for the dual-continua model through analysis of the proposed assessment criteria, suggesting a further need to measure the dual-continua model at the subdomain level, e.g., depression, anxiety, and stress, as opposed to global psychological distress. Validation for the proposed assessment criteria provides important methodological foundations for future studies.

The Effect of Psychological Distress on Measurement Invariance in Measures of Mental Wellbeing.

A growing literature supports the expansion of mental health assessment to include indicators of mental wellbeing; however, the concurrent use of measures of wellbeing and distress introduces potential sources of measurement error. The current study examines whether the mental health continuum short form is invariant to the level of participants' psychological distress. Measurement invariance testing was conducted within an Australian population (n = 8406) who participated in an online survey. The depression anxiety stress scale was used to construct a non-distressed group (n = 6420) and a severe-distress group (n = 1968). Results showed that metric invariance was not observed, as item loadings on the latent variables were significantly different between the groups. This signifies that wellbeing items may be interpreted and valued differently by distressed and non-distressed individuals. Metric non-invariance indicates that total and subscale scores may not be equivalent, and caution is required when making comparisons between these groups.

A Group-Facilitated, Internet-Based Intervention to Promote Mental Health and Well-Being in a Vulnerable Population of University Students: Randomized Controlled Trial of the Be Well Plan Program.

BACKGROUND: A growing literature supports the use of internet-based interventions to improve mental health outcomes. However, most programs target specific symptoms or participant groups and are not tailored to facilitate improvements in mental health and well-being or do not allow for needs and preferences of individual participants. The Be Well Plan, a 5-week group-facilitated, internet-based mental health and well-being group intervention addresses these gaps, allowing participants to select a range of activities that they can tailor to their specific characteristics, needs, and preferences. OBJECTIVE: This study aims to test whether the Be Well Plan program was effective in improving primary outcomes of mental well-being, resilience, anxiety, and depression compared to a waitlist control group during the COVID-19 pandemic; secondary outcomes included self-efficacy, a sense of control, and cognitive flexibility. The study further seeks to examine participants' engagement and satisfaction with the program. METHODS: A randomized controlled trial (RCT) was conducted with 2 parallel arms, an intervention and a waitlist control group. The intervention involved 5 weekly 2-hour sessions, which were facilitated in group format using Zoom videoconferencing software. University students were recruited via social media posts, lectures, emails, flyers, and posters. RESULTS: Using an intentional randomization 2:1 allocation strategy, we recruited 215 participants to the trial (n=126, 58.6%, intervention group; n=89, 41.4%, waitlist control group). Of the 126 participants assigned to the intervention group, 75 (59.5%) commenced the program and were included in modified intention-to-treat (mITT) analyses. mITT intervention participants attended, on average, 3.41 sessions (SD 1.56, median 4); 55 (73.3%) attended at least 4 sessions, and 25 (33.3%) attended all 5 sessions. Of the 49 intervention group participants who completed the postintervention assessment, 47 (95.9%) were either very satisfied (n=31, 66%) or satisfied (n=16, 34%). The mITT analysis for well-being (F1,162=9.65, P=.002, Cohen d=0.48) and resilience (F1,162=7.85, P=.006, Cohen d=0.44) showed significant time × group interaction effects, suggesting that both groups improved over time, but the Be Well Plan (intervention) group showed significantly greater improvement compared to the waitlist control group. A similar pattern of results was observed for depression and anxiety (Cohen d=0.32 and 0.37, respectively), as well as the secondary outcomes (self-efficacy, Cohen d=0.50; sense of control, Cohen d=0.42; cognitive flexibility, Cohen d=0.65). Larger effect sizes were observed in the completer analyses. Reliable change analysis showed that the majority of mITT participants (58/75, 77.3%) demonstrated a significant reliable improvement in at least 1 of the primary outcomes. CONCLUSIONS: The Be Well Plan program was effective in improving mental health and well-being, including mental well-being, resilience, depression, and anxiety. Participant satisfaction scores and attendance indicated a high degree of engagement and satisfaction with the program. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN12621000180819; https://tinyurl.com/2p8da5sk.

The experience of individuals affected by Australia's international border closure during the COVID-19 pandemic.

This study explored the experiences of individuals who reported being negatively affected by Australia's international border closure during the COVID-19 pandemic. Qualitative data from 1930 adults who responded to a cross-sectional online survey exploring the mental health and wellbeing of individuals affected by border closure were analysed using theoretical thematic analysis, drawing on understandings of the relationship between place and wellbeing. Four themes were identified: 'Disconnection from family and social connections', 'Disconnection from a sense of home and belonging', 'Disconnection and sense of self', and 'A desire for reconnection'. Results provide a rich illustration of the relationship between disconnection from place and wellbeing during COVID-19 and highlight the need to support those affected and consider these adverse effects in future public health planning.

Knowledge and Myths about Eating Disorders in a German Adolescent Sample: A Preliminary Investigation.

Eating disorder mental health literacy (ED-MHL) refers to knowledge about the symptoms, causes, and treatment of eating disorders (EDs) and is an important factor in people's attitudes towards individuals with EDs and help-seeking for EDs. Associations between ED-MHL, stigma, ED symptomatology, and gender were investigated in a sample of N = 194 German high school students. Knowledge and myths about EDs were assessed with 18 factual statements about EDs and agreement/disagreement with common myths about ED. Students also completed the Universal Stigma Scale (USS), the Weight Concerns Scale (WCS), and demographic items. Students judged M = 8.39 (SD = 3.40) statements correctly, while the average agreement with all ED myths was low (M = 0.19, SD = 0.14). Greater ED-MHL was associated with lower stigmatization of EDs. Male participants were less knowledgeable and more likely to agree with the ED myths. Participants displayed moderate ED-MHL; however, certain aspects such as ED risk factors or symptoms of specific disorders such as anorexia nervosa and bulimia nervosa were less well known. These results can inform the design of future MHL interventions for adolescents.

Recruitment, adherence and attrition challenges in internet-based indicated prevention programs for eating disorders: lessons learned from a randomised controlled trial of ProYouth OZ.

BACKGROUND: Growing evidence supports the effectiveness of Internet-based prevention programs for eating disorders, but the adjunctive benefit of synchronous peer support has yet to be investigated. In the current study, a randomised controlled trial was conducted to evaluate the effectiveness of an indicated Internet-based prevention program (ProYouth OZ) with and without peer-to-peer support in reducing disordered eating behaviours and attitudes. METHOD: Fifty young adults (18-25 years) with eating disorder symptoms were randomised to one of three study conditions: (1) ProYouth OZ (without peer-to-peer support), (2) ProYouth OZ Peers (with peer-to-peer support), and (3) a waitlist control group. Outcomes were assessed at three different time points. Eating disorder symptoms (primary outcome) were measured with the Eating Disorder Examination Questionnaire. RESULTS: Of 415 screened participants, 73 (17.6%) were eligible and 213 (51.3%) excluded due to severe eating disorder symptoms. Fifteen participants (30%) completed the post-intervention survey. Of the two intervention groups, 20.6% failed to access any component of the program. Of 17 ProYouth OZ Peers participants, 58.8% attended at least one chat session, 20% attended 2-5 sessions, and 11.8% attended all six sessions. Due to limited outcome data, it was not possible to statistically examine between-group differences in outcomes. Visual inspection of individual profiles revealed that both ProYouth OZ Peers participants who completed the post-intervention survey showed a decrease in disordered eating compared with only one of the six completers in ProYouth OZ. CONCLUSION: Findings highlight the challenges of trialling Internet-based eating disorder prevention programs in the community. The study identified a large group of emerging adults with eating disorders who were interested in an Internet-based program, suggesting a high level of unmet need. Future research on synchronous peer-to-peer support in Internet-based prevention for eating disorders is warranted. Further studies are required to identify optimal strategies for reaching this population (e.g., online vs. offline) and evaluating the effectiveness of a range of strategies for promoting engagement. Finally, there is an urgent need to develop innovative widely accessible interventions for individuals who experience clinically relevant eating disorder symptomatology but may not be ready or able to seek professional face-to-face treatment. TRIAL REGISTRATION: ACTRN12615001250527, Registered 16 November 2015, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615001250527.

Internet-based prevention programs for eating disorders are effective, but a variety of challenges have been found when offering them in real-world settings. The current study aimed to test ProYouth OZ, an Internet-based eating disorder prevention program consisting of multiple components including peer support. In total, 50 young adults (18­25 years) with eating disorder symptoms were allocated to one of three versions of the program. In total, 21% did not access the program. From 17 participants in the peer support group, 60% attended at least one chat session and 12% attended all six sessions. Given that only fifteen participants (30%) completed the questionnaire after the intervention, it is not possible to draw reliable conclusions about the effectiveness of the program. Findings demonstrate the difficulty of recruiting emerging adults, engaging them with the program and collecting data after participation. The majority of interested participants experienced an eating disorder, suggesting they may be searching for help online. Future studies should investigate the use of peer support, identify strategies for reaching eligible participants and develop approaches to increase engagement. Finally, it is important to develop innovative programs that provide self-help strategies and facilitate help-seeking for those who are experiencing an eating disorder.

Interpersonal attachment, early family environment, and trauma in hoarding: A systematic review.

The formation of intense emotional attachments to objects, difficulty parting with possessions, and the extreme accumulation of clutter are key features of Hoarding Disorder (HD). Although substantial literature implicates processes such as dysfunctional beliefs and maladaptive emotional cycles in HD, little is known about the vulnerability factors that lead to their development and hoarding symptomatology. The current review sought to systematically collate and integrate findings from studies investigating the relationship between hoarding symptoms and three proposed vulnerability factors: i) interpersonal attachment, ii) early family environment, and iii) traumatic or adverse life events. A comprehensive search of the databases PsycInfo, PubMed, and Scopus identified a total of 39 studies for inclusion. The results presented a complex pattern that supported the presence of relationships between insecure attachment, cold and controlling family experiences, and exposure to adverse life events with increased hoarding severity. However, the specificity of these factors to HD over other clinical groups remains unclear and findings are limited by the heterogenous and small number of studies. We conclude by discussing the clinical implications and limitations of these findings and propose new directions for future research.