Centre for Youth Mental Health - Theses
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ItemTreatment decision making for young people diagnosed with major depressive disorders( 2011)Adolescence is a crucial period of risk for depression, with one in every five people experiencing a depressive episode before the time they are 18 years old. Engaging young people in effective treatment during this time is essential to prevent potential long-term negative impact. Guidelines advocate for young people to be involved in treatment decision making, both in terms of receiving information about treatment options, and also making choices about their own care. These recommendations are in line with a model of decision making called ‘shared decision making’ (SDM), one of several models of medical decision making. Yet little is known about processes related to treatment decision making in this age group or young people’s preferred model of treatment decision making. What little literature that exists suggests young people would value involvement in treatment decision making and that such involvement may enhance engagement. In order to address this gap in our understanding of treatment decision making in young people, semi-structured, qualitative interviews were conducted with clients (n=10), caregivers (n=5) and clinicians (n=22) about their experiences and beliefs about treatment decision making for young people diagnosed with major depressive disorder (MDD). Thematic analysis was used to identify key themes in the data. Clients and caregivers reported a range of experiences regarding how involved they were in treatment decision making, yet, consistent with the small body of literature identified, they all wanted involvement of some sort. Clinicians also wanted clients, and caregivers as appropriate, to be involved. All participants (clients, caregivers and clinicians) reported a lack of information exchange (e.g. information about potential risks and benefits of different treatment options) and wanted resources to fill this gap. Overall, the findings from these interviews indicated a preference for involvement in treatment decision making that was in line with a SDM model. In response, an evidence-based decision aid that facilitates SDM was developed for young people diagnosed with MDD who are faced with the decision about which treatment option is best for them. The decision aid was developed according to international standards, and included field-testing with clients (n=5) and clinicians (n=3), who all found the tool acceptable and useful. The current study provides the basis from which an understanding of treatment decision making for young people diagnosed with MDD can be further built, and from which additional resources can be developed and tested in order to contribute to the emerging field of youth SDM. Approaches that support young people to make evidence-based and preference-based treatment decisions have the potential to increase guideline-concordant care, satisfaction, adherence and clinical outcomes.
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ItemNavigating the digital disconnect: understanding the use of information communication technologies by the youth health workforce to help improve young people's mental health and wellbeing( 2011)Despite local and national efforts to address the challenge, the mental ill-health of young people in Australia remains a leading public health concern. Over a quarter of all young Australians aged 16 to 24 experience a mental disorder in any one year (Australian Bureau of Statistics, 2010b). Suicide rates remain high, with suicide now the foremost cause of death in the 15 to 24 year old age group (Australian Bureau of Statistics, 2010a). Aside from its significant social impacts, mental ill-health has enormous economic implications. Economic modelling estimates that in 2009 the direct costs of untreated mental disorders in Australian young people totalled $10.6 billion (Access Economics, 2009). Unless addressed, the effects of mental ill-health can persist over an individual’s lifetime (Costello et al., 2006) and lead to further occupational, economic and interpersonal difficulties. Presently, only 29% of young Australians with a mental disorder seek help when they need it (Burns et al., 2010a, Slade et al., 2009). Timely and evidence-based treatments are only encountered by a small proportion of those young people who do receive care (Andrews et al., 2000, Libby et al., 2007). This has a substantial effect on the overall wellbeing of our community. (For full abstract see document)
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ItemMental health first aid for eating disorders: the development of first aid guidelines and interventions for the public( 2010)Background: Eating disorders are a significant health issue. They commonly affect young women, create considerable disability and impose great burden on individuals, their family and community. Despite the availability of effective treatments, very few people with a diagnosable eating disorder seek appropriate treatment and public knowledge of symptoms and their effects is poor. If the considerable burden caused by eating disorders is to be reduced, interventions that increase the public’s knowledge, and the likelihood of help-seeking by individuals with eating disorders, are needed. Interventions that target the social network appear to be the most promising because of the important role family and friends can play in recognising an eating disorder, reducing stigmatising attitudes and facilitating engagement with treatment. One promising community-based intervention is mental health first aid training. Mental health first aid is defined as the help provided to a person developing a mental health problem or experiencing a mental health crisis. The first aid is given until appropriate professional treatment is received, or the crisis resolves. Mental health first aid training courses provide information to the public about how to assist those with mental illness to seek appropriate help, and are known to be effective in increasing mental health literacy, the provision of assistance, and in decreasing stigmatising attitudes. The development of mental health first aid interventions for eating disorders provides a promising avenue for increasing appropriate help-seeking and ultimately decreasing the burden they cause. This research aimed to establish which strategies should be used by members of the public when providing mental health first aid for eating disorders, and to explore how providing interventions, which describe and encourage the provision of appropriate mental health first aid strategies, affects mental health literacy and help-seeking behaviours. Method: This research involved three separate studies. The first was a Delphi consensus study, which used three different expert panels consisting of 14 consumers, 24 carers and 27 clinicians, to develop a guideline document describing how members of the public can best provide mental health first aid to someone who is developing or experiencing an eating disorder. The second study was an online evaluation of the usefulness and impact of the previously developed guideline document, on web-users’ first aid behaviours. This involved providing web-users who downloaded the document with two consecutive, self-report questionnaires, to assess how the information had been received and utilised. The third study was an uncontrolled evaluation trial of a mental health first aid training intervention, designed to teach young adults in contact with those at risk of developing an eating disorder, how to provide appropriate mental health first aid strategies for eating disorders. The evaluation, which aimed to assess the effectiveness of the training in changing knowledge, attitudes and behaviours towards eating disorders, involved a series of self-report questionnaires administered at baseline, post-training and six month follow-up. Results: In the first study, 200 first aid strategies, from a total of 456 gleaned from a systematic literature search, were endorsed by 80% or more of expert participants as essential or important to the provision of mental health first aid for eating disorders. These strategies were used to develop the document Eating Disorders: First aid guidelines. The inclusion of experts from clinical, carer and consumer backgrounds ensured that the developed guidelines covered broad content pertinent to providing assistance specifically for eating disorders. In the second study, 362 participants reported downloading the eating disorders guideline document over a 10 month period. These web-users ranged widely in age and country of residence, though a very large majority were women. The most common reason for accessing the guideline document was because of contact with individuals with eating disorders in the workplace. Ninety-six participants completed the second questionnaire and provided data about the utility and impact of the guidelines. This showed that web-users who access the guidelines pay careful attention to content and regard the information as helpful and relevant for the future. Twenty-two participants reported trying to assist someone with an eating disorder after reading the guidelines. Although it was found that only a small number of web-users changed their first aid behaviours, the guidelines appeared to play a role in increasing help-seeking in a number of instances where first aid was provided. The guidelines were also reported to be associated with more understanding and support, as offered by web-users providing first aid. In the third study, 85 participants were presented with a four hour, single session, eating disorders mental health first aid training intervention. Of those, 73 participants completed the questionnaires at all time points. Results for the items assessing knowledge showed that the training was associated with an immediate and sustained improvement in eating disorder problem recognition, knowledge of effective treatments and appropriate first aid strategies. However, changes to a number of other areas of knowledge were not maintained over time. Results for the items assessing attitudes towards eating disorders indicated that the sample at baseline were already very empathic and it was therefore difficult to produce any further change. Findings from measures of behavior suggested that there were not statistically significant changes over time, however, information provided in open-ended responses showed some limited evidence for a change in first aid behaviours, and an increase in appropriate help-seeking, albeit among a small number of participants. Of the 73 participants, 20 had provided assistance to someone with a suspected eating disorder, seven of whom reported that professional help had been sought as a result of their first aid interaction. Furthermore, many participants reported feeling more understanding and supportive towards individuals with eating disorders, as a result of the training, irrespective of whether they had an opportunity to provide mental health first aid. The results also provided no evidence that the training had a negative impact on the mental health of participants or the individuals they provided assistance to. Many of the findings from this third study concurred with those of previous mental health first aid training evaluations employing a six month follow-up period. Discussion: This research established that there are appropriate mental health first aid strategies which members of the public can use when providing assistance to someone developing or experiencing an eating disorder. These strategies were used to create the document Eating Disorders: First aid guidelines. This research also established that these guidelines can be usefully implemented and are associated with the provision of appropriate mental health first aid strategies to those with eating disorders and with subsequent, appropriate help-seeking. Although the third study provided some preliminary evidence that the training intervention was associated with increases in some aspects of mental health literacy, future research is needed to elucidate the optimal duration of the training to achieve sustained increases in knowledge and attitudes, and to assess whether statistically significant changes in first aid behaviour emerge over time. The current investigation, however, can confirm that the concept of mental health first aid can be usefully applied to improve mental health literacy and help-seeking behaviours for the eating disorders.