Psychiatry - Research Publications
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ItemQuality of life in patients with schizophrenia: A 2-year cohort study in primary mental health care in rural China.(Frontiers Media SA, 2022)OBJECTIVE: Quality of life (QoL) has been always an important way to evaluate the outcomes of schizophrenia, but there have been few previous longitudinal studies and few in middle-income countries. This study aimed to explore the QoL in Chinese patients with schizophrenia treated in primary mental health care and the risk factors of QoL over time. METHODS: Patients with schizophrenia treated in primary mental health care in rural/regional areas in Luoding, Guangdong, PR China, were evaluated with an extended questionnaire including the Chinese version of the World Health Organization Quality of Life (WHOQOL-BREF) at baseline and 2-year follow-up. Bivariate and multivariate analyses were conducted including Generalized Estimated Equation analyses (GEE). RESULTS: Four hundred and ninety-one patients with schizophrenia in primary care completed the 2-year follow up evaluation. The QoL physical, environmental, and social relationships domains showed improvement after the 2-year period, but the psychological domain did not. GEE results showed that earlier age of onset, older age, being employed, being unmarried, the thicker waist circumference, less use of clozapine or other SGAs, fewer hospitalizations, more frequent insomnia, more severe depressive and negative symptoms as well as worse treatment insight were independently associated with poor QoL in patients with schizophrenia. CONCLUSION: According to our results, to improve the quality of life of patients with schizophrenia in primary care, we should pay more attention to the treatment of depression, negative and insomnia symptoms of schizophrenia, the choice and dosage of antipsychotic medication and improvement in the treatment compliance. The combined use of educational and behavioral strategies may improve treatment adherence.
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ItemSelf-reported needs of people living with psychotic disorders: Results from the Australian national psychosis survey.(Frontiers Media SA, 2022)Person-centered care is a collaborative approach to health care. To provide effective, person-centered care to people living with severe mental illness, it is necessary to understand how people view their own needs. The Perceived Need for Care Questionnaire (PNCQ) was used in the Australian National Survey of High Impact Psychosis (SHIP) to deepen understanding and evaluate, at a population level, the needs of Australian adults living with psychotic illness. SHIP participants were 1,825 adults, aged 18-65 years, living with psychotic illness and in contact with public specialized mental health services across Australia in 2010. The survey package included demographic and clinical items, and various scales including the PNCQ appraising a comprehensive range of life domains. Logistic regressions measured the impact that various demographic, clinical and psychosocial independent variables (e.g., loneliness, health-related quality of life, disability, accommodation type) had on the likelihood of inadequately met PNCQ domain-related need. Over two-thirds of people living with psychosis reported at least two areas of unmet need for care despite most being in contact with mental health services. Work or using one's time and socializing, counseling, and self-care domains had the largest proportion of inadequately met needs (range between 49 and 57%). Feelings of loneliness and/or social isolation were significantly associated with unmet needs across all PNCQ domains, except for financial needs. Health-related quality of life was significantly associated with unmet needs across all domains, except for housing needs. Disability was significantly associated with unmet social, occupation (work or time use), housing and medication-related needs. Consumers view their needs for care as unmet across many life areas despite being in contact with mental health services. Loneliness, unmet psychosocial needs, and health-related quality of life appear strongly interconnected and warrant greater attention in the delivery of person-centered care for people living with psychosis. Support to address social, work or time use and housing related needs among people living with psychosis appears less well targeted toward those with disability. Results underscore the link between quality of life, recovery and needs. These inter-relationships should be considered in mental health services research and evaluation.
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ItemHow can mental health practitioners collaborate with child welfare practitioners to improve mental health for young people in out of home care?(WILEY, 2021-01-21)BACKGROUND: Young people who grow up in out of home care have higher risk of poor mental health outcomes than peers who grow up with their family-of-origin. Interagency collaboration is an important service-level intervention to improve access to mental healthcare. However, few descriptions of collaboration provide guidance about collaboration between individual practitioners. AIM: This substudy aimed to contribute to a larger study-the Ripple project-through exploring the experiences of practitioners working across child welfare and mental health services regarding collaboration in the care of young people; and to identify practices that might enhance collaborative work and improve mental health outcomes. METHODS: Practitioners from across child welfare and mental health services were purposively sampled and participated in focus groups. Recordings and transcriptions of focus groups were analysed to identify themes within and between groups. A cross-sector expert advisory group was involved in this work. RESULTS: Focus groups were convened with 43 practitioners. We identified four themes during analysis, these were: shared understanding of the history and context of problems; specific skills and practices; self-awareness of workers and carers; and involving and supporting carers. CONCLUSIONS: A number of practices were identified that might lead to enhanced collaboration between agencies and across interdisciplinary care teams. Supporting mental health practitioners to adopt these might assist interagency and interdisciplinary working.
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ItemPerceived needs of carers of people with psychosis: An Australian longitudinal population-based study of caregivers of people with psychotic disorders(Wiley - John Wiley & Sons, 2018-01-01)
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ItemImplementing a family-inclusive practice model in youth mental health services in Australia(WILEY, 2019-06-01)AIM: A brief family-inclusive practice model, single session family consultation (SSFC), was introduced at 4 youth mental health service sites to determine the extent to which the model could be implemented in this context and its acceptability as a means of engaging families of young people. METHODS: Within an action research paradigm, both quantitative and qualitative measures were used for this implementation project with the former reported here. There were 2 components: (1) evaluation of the experiences of young people and their families and (2) evaluation of the extent of implementation of SSFC. Quantitative data were analysed descriptively (item scores, range and any changes over time). RESULTS: Twenty practitioners who were trained and supported in the use of SSFC participated in the 6-month implementation evaluation. In 6 months, 131 SSFC sessions were conducted across the 4 sites and the young people and their families were very satisfied with sessions (overall mean = 5.2, range = 0-6). Six months post-training, there were statistically significant improvements in the practitioners' confidence in providing family interventions (mean improvement = -0.47 (95% confidence interval (CI) = -0.91, -0.04), P = .035) and familiarity with approaches to working with families (mean improvement = -0.61 (95% CI = -1.13, -0.10, P = .023). Practitioners perceived significant improvement in organizational support for working with families. CONCLUSIONS: SSFC was acceptable to clients and their families, was adopted by practitioners and was successfully implemented in the participating sites. This suggests that SSFC, when appropriately implemented, is useful to engage families in the treatment of young people facing mental health issues.
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ItemUnderstanding the complex family experiences of Behavioural Family Therapy(WILEY, 2018-02-01)
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ItemUnderstanding How Young People Exit Homelessness in Australia: A Critical Realist Approach(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2021-08-21)Despite years of policy attention and increasing intervention, the numbers of young people experiencing homelessness in Australia continue to increase. Previous meta-theoretical approaches to understanding homelessness amongst young people are largely unable to explain the conditions which enable young people to exit homelessness and maintain stable housing. We put forward Critical Realism as a way of overcoming the limitations of the main approaches which have been used to date: Empiricism, Interpretivism, and Interactionism/Epidemiology. The meta-theoretical assumptions made by Critical Realism can allow researchers to more robustly explain what enables young people to exit homelessness and maintain stable housing by identifying what it is about the structures and mechanisms, or the absence of these structures and mechanisms, which leads to this outcome. By using a Critical Realist approach, we hope to be able to contribute to more robust explanations of how young people exit homelessness and maintain housing.
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ItemWork participation for people with severe mental illnesses: An integrative review of factors impacting job tenure(WILEY, 2016-04-01)BACKGROUND: Enabling people with severe mental illness to sustain employment remains a challenge. This is despite most wishing to be employed, and the development of effective vocational interventions and employment supports for this population. To better understand how to enable their sustained involvement in the workforce, this review sought to identify, analyse and summarise studies investigating the factors that impact the job tenure of workers with severe mental illness, irrespective of the type of employment support they received. METHODS: An integrative literature review approach was employed to locate, appraise and synthesise quantitative and qualitative research focused on job tenure published in the 20 years up to 2013. Findings from nineteen studies were extracted and integrated using thematic analytic strategies. RESULTS: Job tenure was mostly conceptualised across the reviewed studies as time spent in individual jobs rather than as ongoing participation in the workforce. Three themes describe the factors contributing to job tenure: (1) the worker's experience of doing the current job; (2) natural supports in the workplace; and (3) strategies for integrating work, recovery and wellness, each of which could either support or impede ongoing employment. CONCLUSION: Occupational therapists, other vocational specialists and mental health staff can use these factors as a guide to supporting people with severe mental illness in employment. More detailed examination of job tenure is required in future research not only on job duration but also on the quality of jobs held, their value for career development and the role of services in supporting tenure.
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ItemM99. INVESTIGATING THE BEST PREDICTIVE CLINICAL FEATURES OF ANTI-N-METHYL-D-ASPARTATE RECEPTOR (NMDAR) ENCEPHALITIS IN THE 2010 AUSTRALIAN NATIONAL SURVEY OF HIGH IMPACT PSYCHOSIS (SHIP) COHORT(Oxford University Press (OUP), 2020-05-18)Abstract Background Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, a recently reported autoimmune disorder, can be mistakenly diagnosed as a psychotic disorder, especially schizophrenia, as patients can present with prominent psychotic symptoms, in particular persecutory ideation, hallucinations and disturbed speech. In this study we used machine learning of the clinical data in a large cohort of persons with a positive psychosis history to ascertain whether we could predict NMDAR-positive cases, and which variables most accurately distinguished between NMDAR-positive and -negative cases. Methods SHIP collected nationally representative data from 1825 individuals with a psychotic illness. Plasma samples were available for n=472. To investigate the prevalence of NMDAR autoantibodies a recombinant indirect immunofluorescence test was performed (EuroImmun AG, Lübeck, Germany), with NMDAR transfected human embryonic kidney (HEK) 293 cells quantified using NIS Elements software. NMDAR-positive cases were estimated. Gradient boosting machine learning (the data were randomly split: 60% for initial ascertainment and 40% for validation) was subsequently performed using the clinical data available: 120 variables in total across various domains of sociodemographic, medical history, psychiatric diagnosis and current psychiatric symptoms. Only the variables found to have significant (or near significant) association with being NMDAR-positive were used to develop rules for identifying cases. Results There were 38 NMDAR-positive cases. They were more likely to be associated with a schizophrenia /schizoaffective and a depressive psychosis diagnosis, and less likely to be associated with a bipolar diagnosis, than antibody-negative cases. They were also more likely to be associated with a single episode with good recovery, and with anxiety symptoms and dizziness in the prior 12 months (which included light headedness, feeling faint and unsteady). For the present state symptoms, restricted affect was more likely to be present whereas poverty of speech was rare. Initial insomnia and a medical history that included epilepsy were not present for any of the NMDAR-positive cases. The machine learning algorithm was able to successfully classify 94% of cases to the correct antibody group. Discussion In this significant Australian epidemiological cohort, we have identified key clinical features associated with anti-NMDAR encephalitis, including diagnosis, and symptoms and clinical course. The novel and insightful analyses afforded by using machine learning should be replicated in other samples to confirm the important clinical findings reported in the current work.
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ItemNo Preview AvailableImproving Cognitive Skills for People with Mental Illness to Increase Vocational and Psychosocial Outcomes: The Employ Your Mind Program.(Springer Science and Business Media LLC, 2021)Cognitive impairments contribute to difficulty obtaining employment for people with severe mental illness (SMI). We describe an evaluation of a program, Employ Your Mind (EYM), which integrates cognitive remediation with vocational rehabilitation to improve cognitive skills and psychosocial outcomes relevant to employment. Participants with SMI were referred to WISE Employment and completed the six-month EYM program. Assessments of psychosocial functioning, cognition and vocational data were collected at baseline and completion, and additional vocational outcomes were collected at 12-month follow-up. Psychosocial functioning and cognition were compared pre- and post-EYM and vocational outcomes were compared for the year prior to EYM and for the 12-month follow-up for program completers. Thirty-two participants commenced the EYM program and 21 (65.6%) completed it. Completers reported significant improvements in mental wellbeing, quality of life and enhanced overall perceived working ability. Participants also demonstrated significantly enhanced speed of processing. Of the 15 participants who reported vocational outcomes, four (26.6%) were engaged in competitive paid employment in the year prior to EYM commencement and eight (53.3%) in the year following EYM commencement. The results indicate that EYM helps improve cognitive performance, psychosocial outcomes, and work readiness in people with SMI.