Centre for Youth Mental Health - Theses
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ItemEarly psychosis workforce: development of core competencies for mental health professionals working in the early psychosis field( 2016)Background: Evidence for early intervention in psychosis has steadily grown over the last 20 years leading to increasing investment in early psychosis service development and a rapidly expanding workforce. Although training of staff has been identified as critical to early psychosis model fidelity and the effective delivery of early psychosis services, to date there has been limited peer-reviewed research in this area. The development and use of competency standards has been identified as useful in supporting health professionals’ education and training, and in health workforce development. Currently the most common approach to competency standards development in healthcare is expert consensus. The overall aim of this thesis was to identify the core competencies required of mental health professionals working in the early psychosis field, which could function as an evidence-based tool to support the early psychosis workforce, strengthen early psychosis model fidelity and in turn assist early psychosis service implementation. The Delphi method was used to establish expert consensus on the core competencies Method: A two-stage Delphi method was used to establish expert consensus on the core competencies. In the first stage, a systematic literature search was conducted to generate competency items. A Delphi Reference Group consisting of 5 clinicians and researchers further reviewed these competency statements for overlap and redundancy. In the second stage, an expert panel consisting of expert early psychosis clinicians from around the world was formed. Panel members then rated each of the competency items on how essential they are to the clinical practice of all early psychosis clinicians. A comparison group of experts in adult severe mental illness was also formed. Data from the comparison group was not included in the primary study. Post-hoc comparisons were made to determine whether there were any differences or similarities in response patterns between the two different panels. Results: In total, 1023 pieces of literature, including textbooks, journal articles and grey literature were reviewed, from which 4667 competency statements were extracted for potential inclusion in the study. After review by the Delphi Reference Group, a final 542 competency statements were identified for inclusion in the questionnaire. 63 early psychosis experts participated in three questionnaire rating rounds. The overall retention rate was 93.6% across all three rating rounds. Of the 542 competency items, 242 competency statements were rated as ‘Essential’ or ‘Important’ by 90% or more of the expert panel and are thus identified as the required core competencies of an early psychosis clinician. Twenty-nine of these competency statements were endorsed by 62 or more of the 63 early psychosis experts. Due to the very high level of consensus achieved, these highest-rated competency statements may be considered the foundational competencies for early psychosis practice. A comparison group of 15 experts in adult severe mental illness participated in one rating round. There were few notable differences between the two expert groups. However the differences identified indicate that there may be important philosophical differences between mainstream mental health services and an early intervention approach to early psychosis care. Conclusion: The study generated a set of core competencies required of clinicians working in the early psychosis field. The core competencies provide a common language for early psychosis clinicians across professional disciplines and regardless of country of practice. The findings thus provide a useful resource to support early psychosis workforce development and early psychosis service reform.
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ItemAn examination on cognitive functioning following a first episode of mania in people treated with lithium and quetiapine monotherapy: a 12-month follow-up study( 2016)Cognitive impairments that persist during remission in bipolar disorder have received intensive investigation over the past couple of decades. Nevertheless, the onset and extent of cognitive deficits that occur either prior to, or following, a first episode of mania (FEM), and the trajectory of cognitive functioning in the early stages of illness remain unclear. Moreover, the effect of treatment medication on cognitive functioning in people with bipolar disorder warrants systematic investigation. Specifically, lithium carbonate and quetiapine fumurate have shown to be effective in the treatment of mania and bipolar depression and are both postulated to have neuroprotective properties. The aims of this research program were to: (i) examine cognitive functioning in people following FEM; (ii) assess cognitive changes following FEM over a 12-month period; and (iii) compare the effects of lithium and quetiapine monotherapy on cognitive functioning over the same 12-months. A systematic review of all peer-reviewed studies on cognitive functioning in people with FEM during both the acute and remission phases of the illness was conducted. This involved a systematic search of the literature from three electronic databases from 1980 to 2014. The search identified seven studies on cognitive functioning in people with FEM. The limited studies in the acute phase focussed only on aspects of executive functioning, with findings of impairment in cognitive flexibility, but not in response inhibition or verbal fluency. Although deficits in several cognitive domains were identified during the remission phase, the findings between studies were largely inconsistent. Nevertheless, the most consistent finding during remission was a deficit in working memory, and that verbal fluency and nonverbal memory were not affected. The systematic review highlighted the need for further studies and clarification on the extent of cognitive impairment following FEM, and assisted in the formation of the hypotheses of the empirical studies. For the empirical studies, a total of 61 participants with FEM randomised to lithium or quetiapine monotherapy, and 21 demographically matched healthy controls (HCs) were recruited. FEM participants and HCs were compared on cognitive functioning using an extensive cognitive battery over a 12-month follow-up period. FEM participants were assessed on cognitive functioning at baseline, 3-months, and 12-months, whereas, cognitive functioning of HCs was assessed at baseline and 12-months. The cognitive assessment included measurements of processing speed, attention, sustained attention, verbal learning and memory, nonverbal memory, working memory, verbal fluency, executive functioning, and intelligence. The first empirical study involved a cross-sectional analysis comparing cognitive functioning in FEM participants following stabilisation relative to HCs. Although the groups were matched in age, sex and premorbid intelligence, the findings revealed that FEM participants had significantly lower full-scale IQ (FSIQ) and education level than HCs. However, the difference between groups in FSIQ was no longer significant after controlling for premorbid intelligence. FEM participants displayed cognitive deficits of medium to large effect in processing speed, verbal learning and memory, and working memory compared to HCs. There were no significant differences between groups on other measures of cognition after controlling for FSIQ, education and premorbid intelligence. The second empirical paper involved a longitudinal analysis that assessed the trajectory of cognitive functioning in the FEM participants relative to HCs over 12-months. The findings revealed a significant group by time interaction in one measure of processing speed (Trail Making Test – Part A), and immediate verbal recall (Rey Auditory Verbal Learning Test – trial 1), with a significant improvement observed in the FEM group relative to HCs over time. On the contrary, a significant group by time interaction was observed in a processing speed measure of focussed reaction time (CogstateTM Detection), with FEM participants showing a slower performance relative to HCs over time. A significant group by time interaction was also observed in one aspect of executive functioning - effortful inhibitory control (Stroop effect), revealing that HCs improved in performance over 12-months, whereas the FEM participants did not. There were no other group by time interactions for other measures of cognition. The final empirical study was a randomised-controlled trial, which examined the effects of lithium and quetiapine monotherapy in people following FEM over a 12-month period. The results showed a significant group by time interaction in phonemic verbal fluency, with an improved performance in lithium-treated participants compared to quetiapine-treated participants over time. There were no other significant group by time interactions after controlling for multiple comparisons. In conclusion, the findings from this research program revealed that FEM participants had poorer global intelligence relative to HCs, as well as impairments in some but not all cognitive domains following stabilisation from FEM. There appears to be stability in cognitive functioning for most domains over the 12-month period following FEM. However, an improvement was observed in immediate verbal memory and one measure of processing speed over time in FEM participants relative to HCs, although FEM participants performed slower over time on a simple processing speed test of focused reaction time. In addition, there may be a developmental arrest in effortful inhibitory control, as HCs showed an improvement in this function over the 12-month period that was not evident in the FEM group. There were no significant differences between lithium-treated and quetiapine-treated participants on most cognitive domains, apart from phonemic verbal fluency, in which lithium-treated participants showed a significant improvement relative to quetiapine-treated participants over the 12-month period. These findings suggest that neuroprotective properties of lithium may benefit aspects of cognitive functioning when commenced in the early stages of illness. The presence of cognitive deficits in FEM signifies that cognitive changes may occur very early in the illness course. The findings from this research program did not provide evidence for a progressive deterioration in cognitive functioning following FEM, although more rigorous longitudinal studies involving subgroup analysis are warranted. Future studies should examine the relationship between brain abnormalities and cognitive functioning in people following FEM, as well as assess the effects of lithium and quetiapine monotherapy on clinical and neuroanatomical changes over time.
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ItemSuicide prevention in young people( 2014)Suicide-related behaviour is a significant problem among young people in Australia. Although the reduction of youth suicide is a national priority there remains a lack of intervention research upon which to base preventative efforts. This thesis argues that there is the need for a greater number of intervention studies in suicide prevention, including brief, innovative interventions across a number of settings. The thesis begins by systematically reviewing the literature in the field of youth suicide prevention with an in-depth focus on suicide-related behaviour in school and clinical settings. The empirical component comprises four sequentially conducted studies that together aimed to examine the status quo with regard to suicide prevention research among young people in Australia and specifically examined the safety, acceptability and efficacy of two novel interventions designed to reduce suicide risk among youth in both a clinical and an educational setting. The studies employed a range of methodologies, and together sought to address some of the gaps in current research. Study One reported on the extent of suicide research that was conducted in Australia during the period 2007–2011, via an examination of published journal articles and funded grants. Study Two was a randomised controlled trial that tested the effects of a brief postcard intervention among 165 at-risk young people who had sought help from a specialist mental health service (the Postcard Study). Study Three was a cross-sectional survey administered to a random sample of school wellbeing staff across Victoria, Australia. The survey sought specific information regarding their views on approaches to suicide prevention in school settings, and in particular, with regard to using the Internet for the delivery of suicide prevention programs. The final study, Study Four, was a pilot study that employed a pre-test/post-test design to examine the efficacy, safety and acceptability of a cognitive behavioural therapy program (Reframe-IT), delivered via the Internet to 21 secondary school students at risk of suicide. Together, these studies demonstrated a lack of intervention research in the field of youth suicide prevention, as evidenced by a lack of both published papers and funded grants. They also showed that although schools are considered to be an appropriate setting for suicide prevention programs, school staff feel under-skilled when working with at-risk youth. That said a raft of approaches were reported as being required in schools, including information and awareness programs, specific suicide prevention training, screening programs and greater access to clinical services. The study also identified that school staff consider schools to be an appropriate and acceptable setting for conducting suicide prevention activities. The two intervention studies demonstrated that it is feasible and safe to conduct intervention research, including randomised controlled trials, with suicidal young people. Although the Postcard Study demonstrated no differences between the treatment and control groups, the intervention was considered to be acceptable and appeared to have no iatrogenic effects. Participants in the Reframe-IT Program all demonstrated reduced suicidal ideation, reduced depressive symptoms and reduced hopelessness at the end of the program. In addition, no iatrogenic effects were evident, indicating that there are safe ways of talking with young people about suicide via the Internet. As with much suicide research, each of these studies suffered from some methodological limitations. Despite this, these findings add to a growing body of evidence that is arguing for greater intervention research in this field. Indeed, it appears that it is feasible, safe and acceptable to test novel interventions with suicidal young people in both clinical and school settings and that interventions do exist that hold promise with this population. Hence, there is no reason for the continued exclusion of suicidal young people from research studies. The thesis concludes by outlining a number of opportunities for the future of suicide prevention research, and specifically articulates the need for a more collaborative and strategic approach to suicide research in Australia. This would enable many of the methodological limitations that frequently hamper suicide research to be overcome, and some of the pessimism that exists with regard to our ability to prevent youth suicide to be challenged.
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ItemSocial inclusion and mental illness( 2014)Background: Social inclusion is increasingly recognised as an important contributor to good mental health and greater mental health outcomes, in particular for people with mental illness. Despite increased understanding of the positive impact that social inclusion can have, the potential to make progress has been slowed by some key limitations. The key, underlying problem regarding social inclusion, is the lack of a specific operationalised definition, with only some consensus regarding what it means to be socially included. This lack of specificity has made it difficult to accurately measure the impact of initiatives designed to improve social inclusion. Nonetheless, several attempts at developing measures of social inclusion have been made, in particular for use with people with mental illness. Psychometric testing has been conducted on some, but not all of the measures, and has not been completed on any of them. The overall aim of this thesis was to develop a measure of social inclusion for use with people with mental illness. The measure was designed in a series of studies ensuring the representative input of people with a lived experience of mental illness. The measure was titled the SIMI-LE, an abbreviation of a measure of Social Inclusion for people with Mental Illness – Long Edition. Method: The development of the SIMI-LE took place over three sequential studies. The first study involved a thematic analysis of literature regarding social inclusion to obtain the opinions of professionals regarding key contributors of social inclusion. Seventy-one pieces of literature were reviewed (academic literature regarding social inclusion in general n=25, academic literature regarding social inclusion and mental illness n=26, and organisational reports n=20). The second was a Delphi study, conducted to obtain a consensus between three groups regarding the importance or relevance of contributors identified in the first study. Participants included 32 consumers of a mental health service, 32 carers of a person with mental illness and 40 community members. The third study involved the construction of the measure, and preliminary testing with a sample of ninety participants (30 consumers, 30 family members of a person with mental illness and 30 community members). Results: A comprehensive list of contributors was compiled during the first study. A consensus across three groups regarding how important or relevant each of these contributors were, was obtained during the second study. Finally, the SIMI-LE was constructed and preliminary testing conducted. The measure was seen to have good face validity and was highly acceptable to participants. Preliminary findings demonstrated poorer outcomes for people with mental illness as compared to those without, with differences seen in each of the five categories. Discussion: Overall, the aim of developing a measure of social inclusion for use with people with mental illness was achieved. In the process of developing the measure, a greater understanding of social inclusion from the perspective of people with mental illness was obtained. The measure has demonstrated excellent preliminary psychometric properties and has displayed the ability to differentiate between groups, as expected. Implications for use and suggestions for future research are detailed.
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ItemAffective processes and alcohol use in mid-adolescence( 2013)The aim of this thesis was to prospectively examine the role of affective processes in driving mid-adolescent drinking behaviour across multiple stages of use. While previous studies have provided considerable evidence that affective processes are related to adolescent alcohol use, there have been few prospective, longitudinal studies that have comprehensively examined how different components and dimensions of affect contribute to various stages of drinking. Methods: This thesis draws on data from the Orygen Adolescent Development Study, an ongoing longitudinal research project that has obtained multi-method assessments of affective processes from approximately 250 adolescents since 2004. Incorporated into analyses were four measures of affect, gathered at age 12: (i) self-report measures of clinical symptoms; (ii) self-report measures of affective temperament; (iii) observation of adolescent affective behaviours during a parent-child conflict resolution task; and (iv) structural magnetic resonance imaging (MRI) of key brain regions implicated in affective processes. These measures were used to prospectively predict the onset of use, heavy drinking, and the experience of alcohol-related problems four years later, at age 16. Results: Few variables predicted early onset and heavy drinking, although the results indicated that adolescents who have a tendency to seek out pleasurable experiences are at greater risk of early initiation of alcohol use. In contrast, the experience of alcohol-related problems was consistently predicted by variables associated with higher levels of negative affect and poorer behavioural and affective self-regulation. This relationship was evident across all four domains of affect examined. Conclusions: Among Australian adolescents, the initiation of alcohol use during mid-adolescence and tendency to drink heavily by age 16 may be not be strongly motivated by individual differences in affect. In contrast, affective dysregulation appears to be a robust predictor of alcohol-related problems during this period, and can impart risk over and above the influence of heavy use. These findings suggest a number of avenues for prevention and intervention efforts aimed to reduce the prevalence of underage drinking and its associated harms.
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ItemDesign and refinement of the MATE program: Mindful Awareness Training and Education: how do young people understand and practise mindfulness?( 2012)Background and aims: Young people (aged 15-24) often experience difficulties regulating their emotions. This is thought to be a key mediator of distress and ill health. Improving emotion regulation is an important target for mental health promotion in this age group. Mindfulness practice includes cultivating awareness of emotions and developing skilful ways to deal with them. Mindfulness training has been shown to improve mental health in adults. Preliminary investigations have also been reported in children and adolescents. Few studies specific to young people are available and none have reported engaging young people themselves in the design process. Very little research has been reported into online delivery, and all of this work so far has involved adults. Using the Internet to provide mindfulness training has the potential to improve accessibility for young people. Very little research, all of which has involved adults, has been reported into online delivery. The aim in this project was to use a participatory, mixed methods approach to the design and preliminary evaluation of a mindfulness training program for young people in live and online editions. Methods: Initial design of the Mindful Awareness Training and Education program, MATE version 1, was informed by a review of the literature and discussion with experts. MATE v.2 was created after consultation with 13 mindfulness-naïve young people. The live edition of MATE v.2 was trialled with 11 participants. Evaluation included qualitative interviews, a focus group, written and online feedback, and quantitative measurement. The latter was conducted at commencement, immediately after the program and at six weeks’ follow-up. Qualitative data collection and analysis were informed by grounded theory. Results: Consultees on MATE v.1 described mindfulness training as a desirable activity for young people and offered valuable suggestions regarding program structure and content. Recruitment of participants for the pilot trial of MATE v.2 was difficult. Those enrolled showed a high level of engagement with both the program content and evaluation process: 73% completed all program stages, 88% of whom also attended either a focus group or interview. Benefits, in terms of improved emotion regulation and well-being, and reduction in symptoms of stress, anxiety and depression were suggested by qualitative and quantitative data. An explanatory model of participants’ experience was devised indicating that: (1) key initial benefits were a calmer mind and greater sense of agency; and (2) that with ongoing practice, additional benefits may occur. Greater understanding of their minds helped participants develop enhanced confidence and perceived competence in managing day-to-day challenges. Some participants reported transient increased distress in the middle weeks of the program. MATE v.3, the final version of the program, in live and online editions, resulted from an integration of findings. Conclusions: Mindfulness training appears to be acceptable to young people and a feasible strategy to enhance mental health and well-being in this age group. Participants in the live trial were able, within a short time, to develop a sophisticated understanding and application of mindfulness. The MATE program, as devised and refined in this project, is ready for large-scale face to face trial and for website development in its online edition.
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ItemThe development and evaluation of guidelines and an information website for adult caregivers of adults with bipolar disorder( 2012)Background and aim: Bipolar disorder is a challenging and usually chronic illness associated with occupational and social consequences that affect the lives of both the person and those who care for them. Family members and friends with a primary role in supporting an adult with bipolar disorder (caregivers) are at risk of caregiver burden, depression and health problems. However, there is little evidence-based information to guide caregivers in ways to provide helpful support and maintain their own wellbeing. Thus, the aim of this project was to develop an easily accessible resource with relevant and useful information and suggestions for caregivers. Methods: The project was divided into two phases. In the first phase a Delphi consensus study was conducted with expert clinician, caregiver and consumer panel members to establish what information and suggestions to include in guidelines for adult caregivers of adults with bipolar disorder (N=143). In the second phase of the project, a web-based version of the guidelines www.bipolarcaregivers.org was developed to make this information easily accessible over the Internet. A formative evaluation of the website was conducted to establish the relevance and usefulness of the information to caregivers and how it could be improved. This involved an initial online survey for visitors to the website (N=536) and a more detailed follow-up email feedback survey, sent to interested caregivers of adults with bipolar disorder a month later (N=121). Results: There was mostly high consensus about what to include in the guidelines between the different Delphi panels. Out of a total of 626 survey items rated by the Delphi panels over three survey rounds, 537 (86%) were included in the guidelines. In the evaluation study, the majority of caregiver visitors who completed the initial feedback survey (97%) reported thinking that the information on www.bipolarcaregivers.org was “very useful” or “useful”. Similarly, between 86.4%-97.4% of caregivers who responded to the follow-up survey rated the information they read as “very useful" or “useful”. Nearly 93% found the information relevant and all participants said it gave them the impression that others were going through similar experiences. Over two thirds reported using the sections on providing support and working with the person to manage the illness and gave concrete examples of how they implemented the guidelines. Nevertheless, despite the overall positive results, qualitative feedback suggested practical ways the website could be further refined. Discussion: This project resulted in a publicly accessible information resource www.bipolarcaregivers.org that was reported to be relevant and useful by most of the users in the evaluation study. The website includes brief information summaries and a PDF of the guidelines that can easily be printed. The guidelines have been translated into booklets in Portugal and Brazil. According to Google Analytics, traffic to the website continues to increase. Www.bipolarcaregivers.org may form an initial step in providing basic information to caregivers caring for an adult with bipolar disorder. Those who care for people with more severe and complex illness presentations might benefit from additional support and training to cope with their caregiving role. Similarly, more detailed or tailored information and support may be suitable for caregivers who are already very experienced or well informed. A strength of this project is its consideration of the views of stakeholders and careful comparison and integration with the research literature. Future studies could combine stakeholder involvement with more rigorous evaluation of www.bipolarcaregivers.org and its long-term effect on caregiver and consumer outcomes. If funds become available, the website could be made more interactive to enhance learning of information and skills, and offer more tangible and tailored support. Background and aim: Bipolar disorder is a challenging and usually chronic illness associated with occupational and social consequences that affect the lives of both the person and those who care for them. Family members and friends with a primary role in supporting an adult with bipolar disorder (caregivers) are at risk of caregiver burden, depression and health problems. However, there is little evidence-based information to guide caregivers in ways to provide helpful support and maintain their own wellbeing. Thus, the aim of this project was to develop an easily accessible resource with relevant and useful information and suggestions for caregivers. Methods: The project was divided into two phases. In the first phase a Delphi consensus study was conducted with expert clinician, caregiver and consumer panel members to establish what information and suggestions to include in guidelines for adult caregivers of adults with bipolar disorder (N=143). In the second phase of the project, a web-based version of the guidelines www.bipolarcaregivers.org was developed to make this information easily accessible over the Internet. A formative evaluation of the website was conducted to establish the relevance and usefulness of the information to caregivers and how it could be improved. This involved an initial online survey for visitors to the website (N=536) and a more detailed follow-up email feedback survey, sent to interested caregivers of adults with bipolar disorder a month later (N=121). Results: There was mostly high consensus about what to include in the guidelines between the different Delphi panels. Out of a total of 626 survey items rated by the Delphi panels over three survey rounds, 537 (86%) were included in the guidelines. In the evaluation study, the majority of caregiver visitors who completed the initial feedback survey (97%) reported thinking that the information on www.bipolarcaregivers.org was “very useful” or “useful”. Similarly, between 86.4%-97.4% of caregivers who responded to the follow-up survey rated the information they read as “very useful" or “useful”. Nearly 93% found the information relevant and all participants said it gave them the impression that others were going through similar experiences. Over two thirds reported using the sections on providing support and working with the person to manage the illness and gave concrete examples of how they implemented the guidelines. Nevertheless, despite the overall positive results, qualitative feedback suggested practical ways the website could be further refined. Discussion: This project resulted in a publicly accessible information resource www.bipolarcaregivers.org that was reported to be relevant and useful by most of the users in the evaluation study. The website includes brief information summaries and a PDF of the guidelines that can easily be printed. The guidelines have been translated into booklets in Portugal and Brazil. According to Google Analytics, traffic to the website continues to increase. Www.bipolarcaregivers.org may form an initial step in providing basic information to caregivers caring for an adult with bipolar disorder. Those who care for people with more severe and complex illness presentations might benefit from additional support and training to cope with their caregiving role. Similarly, more detailed or tailored information and support may be suitable for caregivers who are already very experienced or well informed. A strength of this project is its consideration of the views of stakeholders and careful comparison and integration with the research literature. Future studies could combine stakeholder involvement with more rigorous evaluation of www.bipolarcaregivers.org and its long-term effect on caregiver and consumer outcomes. If funds become available, the website could be made more interactive to enhance learning of information and skills, and offer more tangible and tailored support.
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ItemLabelling of mental disorders and help-seeking in young people( 2012)BACKGROUND: Mental disorders are the most common health problem affecting young people, yet their rates of help-seeking are amongst the lowest. Improving help-seeking rates amongst young people is vital. The labels used to describe emerging physical health problems have been found to influence the effectiveness of help-seeking choices. In regard to mental health, accurate psychiatric labelling of mental disorders is promoted in community awareness campaigns designed to increase help-seeking rates. However, research examining the association between labelling of mental disorders and help-seeking is scarce, particularly with young people. Indeed, it has been contended that the use of psychiatric labels to describe mental disorders may be coupled with stigmatizing beliefs and thus inhibit help-seeking, in which case lay mental health or non-specific labels may be less harmful. Motivated by these factors, the aim of this thesis was to examine the range of labels young people use to describe mental disorders, the association between label use and help-seeking intentions and beliefs, and the association between label use and stigmatising beliefs. METHOD: A national telephone survey was conducted with 2802 Australian young people aged 12-25 years and 1528 co-resident parents from June to August 2006. Respondents were randomly assigned a vignette describing a young person experiencing symptoms of depression, psychosis or social phobia. This was followed by a series of questions relating to the vignette that examined the label used to describe the problem, help-seeking intentions and beliefs, and stigmatizing beliefs. The range of labels used was examined using percent frequencies. Factors associated with label use and the association between label use and help-seeking choices and label use and stigma were examined using binary logistic regression analyses. RESULTS: Depression was accurately labelled twice as frequently as was psychosis, whereas social phobia was rarely accurately labelled and was most commonly labelled using lay terms. Use of accurate labels increased with age and females were more likely to use them. For all vignettes, likelihood of using an accurate label was associated with exposure to mental health community awareness campaigns and accuracy of label used by a parent. Accurate labelling was associated with a preference for professionally recommended sources of help with greater consistency than any other labels commonly used. Stigma was not commonly associated with label use. Most mental health labels were associated with seeing the person as “sick” rather than “weak”, and accurate psychiatric labels had the strongest effect sizes. However, for the psychosis vignette, the “dangerous/unpredictable” component of stigma was associated with mental health labels, and the accurate psychiatric label showed the strongest association. DISCUSSION: It can be broadly concluded that accurate psychiatric labels are linked to mental health specific sources of help while generic lay labels are linked to more general sources of help. Using an accurate label may act as a schematic hub for conceptualizing an emerging mental disorder that enables effective selection of recommended sources of help. Stigma is not commonly associated with use of an accurate label and is therefore unlikely to be a barrier to help-seeking in most instances. These findings can help to inform and improve the effectiveness of community awareness strategies designed to increase help-seeking rates for mental disorders in young people.
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ItemPromotion of self-help strategies for sub-threshold depression: an e-mental health randomised controlled trial( 2012)Background: Sub-threshold depression refers to clinically relevant depressive symptoms that fall short of a diagnosis of major depression. Sub-threshold depression is very common in the general population, impairs functioning, increases the risk of developing major depression, and poses a significant burden at the population level. Public promotion of greater use of effective self-help strategies for depression has been proposed as one technique to reduce this population burden. Improving self-help strategies could reduce symptoms of sub-threshold depression and prevent major depression. Depression experts have identified several self-help strategies that are helpful for sub-threshold depression. The aim of the study was to develop messages based on these strategies that could be promoted to members of the public with sub-threshold depression, and to test whether their promotion was effective. Method: Twelve email messages (‘Mood Memos’) were developed, based on self-help strategies endorsed as effective and feasible by depression experts. The email messages were developed with reference to theories of behaviour change, persuasion, and health communication, in order to persuade recipients to engage in the self-help behaviours. The effectiveness of these emails was evaluated in a randomised controlled trial. Recruitment was via internet-based sources and participants joined the study by visiting the website www.moodmemos.com. Adults aged 18+ with sub-threshold depression who were not receiving professional treatment for depression were eligible to participate. Participants were randomly allocated to receive emails twice weekly for six weeks in a fully automated intervention. The active group received emails based on the effective self-help strategies and the control group received emails containing general information about depressive disorders. Assessment points were at baseline, midway through the intervention and at the end of the intervention (6 weeks post-baseline). The primary outcome was depression symptom score on the Patient Health Questionnaire-9 (PHQ-9). Secondary outcomes were psychological distress, assessed with the ten-item Kessler Psychological Distress Scale (K10), and level of functioning, assessed with the Work and Social Adjustment Scale. The primary hypotheses were that the emails containing self-help strategies would reduce depression symptoms and reduce the incidence of major depression more than the control emails post-intervention. Results: The study recruited an international sample of 1,326 adults with sub-threshold depression. There was a small, significant difference in depression symptoms post-intervention, favouring the active group (Cohen’s d = 0.17, 95% CI: 0.01 to 0.34). There was also a higher, though non-significant, risk of major depression in the control group (Relative Risk = 1.32, 95% CI: 0.89 to 1.98). A similar effect was found for psychological distress (d = 0.22, 95% CI: 0.05 to 0.38), but effects on functioning were less strong, with no significant difference between the active and control groups (d = 0.12, 95% CI: -0.05 to 0.28). A mediation analysis indicated that the effect of the emails on depression symptoms was completely mediated by the use of the self-help strategies promoted in the emails. Discussion: Overall, the results indicate that promoting effective self-help strategies to the public via automated emails was effective for sub-threshold depression. The improvement in depression was associated with use of the self-help strategies promoted in the emails. The delivery of self-help messages via email is a scalable, easily disseminated intervention. The study is a novel contribution with potential to reduce the large population burden of depression.
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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.