Risk prevalence, readiness and confidence to change lifestyle risk factors among clients of community mental health services.

OBJECTIVE: People with mental health conditions have high rates of chronic physical diseases, partially attributable to lifestyle risks factors. This study examined risk prevalence among community mental health service clients, their readiness and confidence to change, and associations with participant characteristics. METHODS: Cross-sectional survey of adult clients from 12 community mental health services across 3 local health districts in New South Wales, Australia, collected from 2021 to 2022. Participants (n = 486) completed a telephone interview determining five risk factors, and readiness and confidence to change these. Multiple binary logistic regression models determined associations between readiness and confidence (for each risk), and participant characteristics (demographics and diagnosis). RESULTS: Participants most commonly reported a diagnosis of schizophrenia (36.7%) or depression (21.1%). Risk factors were prevalent: ranging from 26% (harmful alcohol use) to 97% (poor nutrition). High readiness was greatest for smoking (68%), weight (66%) and physical inactivity (63%), while confidence was highest for changing alcohol use (67%). Two significant associations were identified; females were more likely than males to have high readiness to change nutrition (odds ratio = 1.14, confidence interval = [1.13, 2.34], p = 0.0092), with males more likely to have high confidence to change physical activity (odds ratio = 0.91, confidence interval = [0.45, 0.99], p = 0.0109). CONCLUSIONS: Many participants were ready and confident to change risk factors. Gender influenced readiness to change nutrition and physical activity confidence. Training to upskill mental health clinicians in provision of preventive care that builds confidence and readiness levels may aid in supporting positive behaviour change.

Children (Homo sapiens), but not rhesus monkeys (Macaca mulatta), perceive the one-is-more illusion.

Visual illusions are of particular interest to cognitive researchers because they reflect the active role of the brain in processing the world around us. Yousif and Scholl (2019) recently described a new visual experience, the one-is-more illusion, in which adult humans perceived continuous objects as longer than sets of discrete objects of equal length. In the current study, we investigated this phenomenon in human children (Homo sapiens) and rhesus macaques (Macaca mulatta). Children were presented with a computerized 2-choice discrimination task and successfully selected the longer of 2 images for control trials. On trials in which 2 versions of the same image were presented (identical in length), and one was of a continuous form and the other consisted of 2 or more distinct units, children showed a bias for the continuous object. Monkeys were given the same computerized task and learned to choose the longer of 2 otherwise identical stimuli. However, monkeys did not show a bias to choose the continuous probe images as longer than the discrete images in the critical test trials with equal-length stimuli. These results are discussed in light of developmental and comparative research on related illusory experiences and perceptual mechanisms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Differential responses toward conditioned and unconditioned stimuli, but decreased hypothalamic-pituitary-adrenal axis responsiveness in neonatal hippocampal lesioned monkeys.

The hippocampus is important for long-term memory storage, but also plays a role in regulating the hypothalamic-pituitary-adrenal (HPA) axis and emotional behaviors. We previously reported that early hippocampal damage in monkeys result in increased anxious expression and blunted HPA responses to an acute stressor. Here, we further probe their responses toward aversive stimuli (conditioned and unconditioned) and evaluate HPA axis dysfunction. Responses toward social, innate, and learned aversive stimuli, fear potentiated acoustic startle, and pituitary-adrenal function were investigated in 13 adult rhesus monkeys with neonatal hippocampal lesions (Neo-Hibo=6) and controls (Neo-C=7). Neo-Hibo monkeys' responses depend on the type of unconditioned stimulus, with increased anxiety behaviors toward social and learned, but decreased reactivity toward innate stimuli. Neo-C and Neo-Hibo monkeys exhibited similar performance learning conditioned cues and safety signals. Neo-Hibo monkeys were less sensitive to HPA axis stimulation, potentially suggesting adrenal fatigue. Current findings suggest that the hippocampus plays a large role in regulating not only anxiety behaviors, but also the HPA-axis, a neural system crucial to regulate how we respond to the world around us. These data have important clinical significance considering that many developmental neuropsychiatric disorders exhibit altered hippocampal structure and function, emotional and HPA axis dysregulation.

Characteristics and service use of NSW Quitline callers with and without mental health conditions.

Introduction: Smoking rates remain higher for people with a mental health condition compared to the general population and contribute to greater chronic disease burden and premature mortality. Quitline services offer telephone-based smoking cessation support to the public and have been shown to be effective. There is limited research exploring the characteristics of smokers with a mental health condition who use the Quitline or the impacts of using the service on their smoking behaviors. Methods: This observational study aimed to compare demographic and smoking related characteristics, service use and quit attempts of callers to the New South Wales Quitline (2016-2018) with and without a mental health condition (N = 4,219). Results: At baseline, 40% of callers reported a current mental health condition. Desire to quit smoking was similar for both groups, however participants with a mental health condition had higher nicotine dependency and had made more quit attempts prior to engaging with the service. During program enrolment, quit attempts and 24 hours smoke free periods were similar, however participants with a mental health condition engaged in a greater number of calls and over a longer period with Quitline compared to those without. Discussion: The findings suggest Quitline efficacy for people with a mental health condition in making a quit attempt for at least 24 h. Increasing the use of Quitline services and understanding service use for this critical group of smokers will increase the likelihood that their quit attempts are transformed into sustained periods of smoking abstinence. Future research should explore whether tailoring of Quitline service provision for people with mental health conditions may increase the likelihood of quit success.

The Effectiveness and Cost of an Intervention to Increase the Provision of Preventive Care in Community Mental Health Services: Protocol for a Cluster-Randomized Controlled Trial.

Preventive care to address chronic disease risk behaviours is infrequently provided by community mental health services. In this cluster-randomised controlled trial, 12 community mental health services in 3 Local Health Districts in New South Wales, Australia, will be randomised to either an intervention group (implementing a new model of providing preventive care) or a control group (usual care). The model of care comprises three components: (1) a dedicated 'healthy choices' consultation offered by a 'healthy choices' clinician; (2) embedding information regarding risk factors into clients' care plans; and (3) the continuation of preventive care by mental health clinicians in ongoing consultations. Evidence-based implementation strategies will support the model implementation, which will be tailored by being co-developed with service managers and clinicians. The primary outcomes are client-reported receipt of: (1) an assessment of chronic disease risks (tobacco smoking, inadequate fruit and vegetable consumption, harmful alcohol use and physical inactivity); (2) brief advice regarding relevant risk behaviours; and (3) referral to at least one behaviour change support. Resources to develop and implement the intervention will be captured to enable an assessment of cost effectiveness and affordability. The findings will inform the development of future service delivery initiatives to achieve guideline- and policy-concordant preventive care delivery.