Psychiatry - Research Publications
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ItemPrevalence of gambling problems, help-seeking, and relationships with trauma in veterans(PUBLIC LIBRARY SCIENCE, 2022-05-25)BACKGROUND AND AIMS: Veterans who have recently left the military (i.e., transitioned) may be vulnerable to the development of psychiatric disorders, but little is known about gambling problems in this population. This study investigated the prevalence and risk factors of gambling problems, help-seeking amongst veterans with gambling problems, and relationships with trauma and posttraumatic psychopathology. METHODS: Cross-sectional self-report survey data from 3,511 Australian Defence Force members who left the military within the past five years. Surveys included measures of gambling problems (PGSI); depressive symptoms (PHQ-9); posttraumatic stress disorder (PCL-5); help-seeking behaviours; military and non-military-related trauma. RESULTS: Prevalence rates for problem gambling (PGSI ≥ 5) were 4.6%, while an additional 8.8% were classified in terms of at-risk gambling (PGSI = 1-4). Time since leaving the military was not associated with gambling problems. Only 2.1% of veterans with problem gambling reported help-seeking for their gambling. While trauma exposure, depression, and Posttraumatic Stress Disorder (PTSD) were all related to gambling problems at the bivariate level, only arousal and dysphoric-related affect were uniquely associated with gambling problems when adjusting for covariates. DISCUSSION: Gambling problems may be under-recognised relative to other psychiatric issues. Posttraumatic mental health problems, rather than trauma exposure per se, may explain the relationship between trauma and gambling problems. CONCLUSIONS: Some veterans are in a period of vulnerability during transition out of military service, and harms associated with gambling problems may be exacerbated during this period.
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ItemA Systematic Review of Psychological and Pharmacological Treatments for Adjustment Disorder in Adults(WILEY, 2018-06-01)Adjustment disorder is a common psychiatric disorder, yet knowledge of the efficacious treatments for adjustment disorder is limited. In this systematic review, we aimed to examine psychological and pharmacological interventions that target adjustment disorder in adults to determine which interventions have the best evidence for improving adjustment disorder symptoms. We performed database searches for literature published between January 1980 and September 2016 and identified studies that included both a sample majority of individuals diagnosed with adjustment disorder and findings on adjustment disorder symptom outcomes. There were 29 studies that met the inclusion criteria for qualitative synthesis; the majority of studies (59%) investigated psychological therapies rather than pharmacological treatments (35%). The range of psychological therapies tested was diverse, with the majority containing cognitive behavioral therapy (CBT) components (53%), followed by three studies that were psychodynamic-related, three studies that were behavioral therapy-based, and two studies that involved relaxation techniques. We rated individual studies using a modified National Health and Medical Research Council quality and bias checklist and then used the Grading of Recommendations Assessment, Development and Evaluation (GRADE; Grade Working Group, 2004) system to rate the overall quality of the evidence. Despite several randomized controlled trials, the quality of the evidence for positive effects of all psychological and pharmacological treatments on symptoms of adjustment disorder was ranked as low to very low. Future high-quality research in the treatment of adjustment disorder has the potential to make a significant difference to individuals who struggle to recover after stressful events.
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ItemNo Preview AvailablePreventing the onset of post traumatic stress disorder(PERGAMON-ELSEVIER SCIENCE LTD, 2021-04-12)Post-traumatic stress disorder (PTSD) is a common mental health condition that requires exposure to a traumatic event. This provides unique opportunities for prevention that are not available for other disorders. The aim of this review was to undertake a systematic review and evaluation of randomized controlled trials (RCTs) of interventions designed to prevent PTSD in adults. Searches involving Cochrane, Embase, Medline, PsycINFO, PILOTS and Pubmed databases were undertaken to identify RCTs of pre-incident preparedness and post-incident interventions until May 2019. Six pre-incident and 69 post-incident trials were identified that could be included in meta-analyses. The overall quality of the evidence was low. There was emerging evidence that some interventions may be helpful but an absence of evidence for any intervention that can be strongly recommended for universal, selected or indicated prevention before or within the first three months of a traumatic event. The strongest results were found for cognitive-behavioural therapy with a trauma focus (CBT-T) in individuals with a diagnosis of acute stress disorder which supports calls to detect and treat individuals with significant symptoms rather than providing blanket preventative interventions. Further research is required to optimally configure existing interventions with some evidence of effect and to develop novel interventions to address this major public health issue.
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ItemDefining post-traumatic stress disorder recovery in veterans: Benchmarking symptom change against functioning indicators(WILEY, 2020-12-28)Improved metrics of Post-traumatic stress disorder (PTSD) treatment response that extend beyond a focus on symptom reduction to incorporate meaningful, patient-centred indicators of functioning are needed in veteran populations. The aim of this study was to extend previous research by investigating whether indicators of functioning can successfully distinguish against symptom response categories derived from the Post-Traumatic Stress Disorder Checklist (PCL-5) pre- and post- PTSD treatment. Participants were 472 veterans receiving hospital-based treatment for PTSD. In addition to the PCL-5, measures included quality of life, social relationships, physical health and psychological distress. Four mutually exclusive, progressive response categories were used to define treatment response including: No Response, Response, Response and Below Threshold, and Remission. PTSD symptom reductions were associated with corresponding improvements in broader indicators of functioning. However, it was only when the magnitude of symptom reduction placed the individual in the 'Response and Below Threshold' category that improvement on functioning measures achieved levels indicative of a good end state. Traditional metrics of treatment 'response' in PTSD treatment do not necessarily indicate recovery on important functioning indicators. Only when an individual both responds to treatment and drops below threshold for probable disorder are they likely to report having meaningful levels of functioning.
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ItemAnger Dimensions and Mental Health Following a Disaster: Distribution and Implications After a Major Bushfire(WILEY, 2020-11-02)Anger is an important dimension of affect and a prominent feature of posttraumatic mental health, but it is commonly overlooked in postdisaster settings. We aimed to examine the distribution and implications of significant anger problems in the aftermath of a natural disaster, via analyses of Beyond Bushfires survey data from 736 residents of rural communities 5 years after the 2009 Black Saturday bushfires in Victoria, Australia. Assessments included the five-item Dimensions of Anger Reaction (DAR-5) scale along with measures of PTSD, depression, and significant mental illness, and indicators of life satisfaction, suicidality, hostile aggressive behavior, and violence exposure. The results indicated that approximately 10% of respondents from areas highly affected by the bushfires scored above the provisional cutoff criteria for significant anger problems on the DAR-5, which was a more than 3-fold increase, OR = 3.26, relative to respondents from areas of low-to-moderate bushfire impact. The rates were higher among women, younger participants, and those who were unemployed, and co-occurred commonly, although not exclusively, with other postdisaster mental health problems. Anger problems were also associated with lower life satisfaction, β = -.31, an 8-fold increase in suicidal ideation, OR = 8.68, and a nearly 13-fold increase in hostile aggressive behavior, OR = 12.98. There were associations with anger problems and violence exposure, which were reduced when controlling for covariates, including probable PTSD. The findings provide evidence indicating that anger is a significant issue for postdisaster mental health and should be considered routinely alongside other posttraumatic mental health issues.
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ItemA mental health training program for community members following a natural disaster.(Informa UK Limited, 2013)This study reports data on a disaster mental health training program to enhance the capacity of lay people from disaster-affected communities, to provide assistance to others following a bushfire disaster. Local facilitators conducted training sessions which were actively promoted within communities. Participants were asked to complete an anonymous pre- and post-training survey to obtain data on the impact and quality of the training program. Responses from 462 (80%) of 577 people who attended 39 sessions showed substantial and significant increases in key competencies including confidence in their abilities to detect difficulties coping in others and to provide assistance. The quality of the program and materials were rated highly. The findings of the evaluation provide support for the program as a beneficial, acceptable and feasible community-level intervention following disaster.
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ItemGender Difference in Outcomes Following Trauma-Focused Interventions for Posttraumatic Stress Disorder: Systematic Review and Meta-Analysis(EDUCATIONAL PUBLISHING FOUNDATION-AMERICAN PSYCHOLOGICAL ASSOC, 2016-05-01)OBJECTIVE: Currently, there is a lack of evidence on whether women and men respond differently to trauma-focused psychological treatments for posttraumatic stress disorder (PTSD). This study was a systematic review and meta-analysis to examine whether gender is associated with response to trauma-focused psychological interventions for PTSD. METHOD: The Cochrane Collaboration systematic review methodology (Higgins & Green, 2011) was used as a guide for this study. Randomized controlled trials comparing trauma-focused interventions for PTSD with comparison conditions were identified in a literature review. RESULTS: Forty-eight randomized controlled trials were included in the meta-analysis: 25 had a mixed gender sample, 18 were female only, and 5 were male only. There was evidence that women had greater reductions than men in the primary outcome measure of clinician-rated PTSD symptoms when trauma-focused psychological interventions were compared with any comparison condition at both postintervention and short-term follow-up. This finding was supported by a direct effects meta-analysis of studies that provided data on both females and males. CONCLUSIONS: The current findings support a gender difference in outcomes following trauma-focused psychological interventions for PTSD. Future research should seek to identify specific factors related to gender that facilitate or inhibit response to these interventions. (PsycINFO Database Record
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ItemVicarious trauma, secondary traumatic stress or simply burnout? Effect of trauma therapy on mental health professionals(INFORMA HEALTHCARE, 2009-01-01)OBJECTIVES: The aim of the present study was to perform an assessment for secondary traumatic stress (STS), vicarious trauma (VT) and workplace burnout for Australian mental health professionals involved in clinical practice. METHODS: Recruited directly by mail, randomly selected participants were invited to submit a questionnaire by post or online. Of the 480 participants contacted, 152 mental health professionals completed the questionnaire, which contained measures of STS, VT and burnout. RESULTS: Exposure to patients' traumatic material did not affect STS, VT or burnout, contradicting the theory of the originators of STS and VT. Rather, it was found that work-related stressors best predicted therapist distress. CONCLUSIONS: These findings have significant implications for the direction of research and theory development in traumatic stress studies, calling into question the existence of secondary trauma-related phenomena and enterprises aimed at treating the consultants.
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ItemChanges in long term neural connectivity following psychological trauma(ELSEVIER IRELAND LTD, 2009-02-01)OBJECTIVE: Neural connectivity differences between adults reporting childhood, adulthood or no history of trauma were examined. METHODS: A total of 39 participants completed the Post-traumatic Stress Diagnostic Scale (PDS; Foa EB. Post-traumatic Stress Diagnostic Scale (PDS) Manual. Minneapolis, MN: National Computer Systems, 1995), a Word Memory Task (WMT; [McNally RJ, Metzger LJ, Lasko NB, Clancy SA, Pitman RK. Directed forgetting of trauma cues in adult survivors of childhood sexual abuse with and without post-traumatic stress disorder. J Abnorm Psychol 1998;107:596-601]) and EEG analysis. Intelligence was not assessed during the study. RESULTS: As predicted, those with childhood trauma had significantly higher EEG coherence than those with either adulthood trauma or no past trauma. CONCLUSIONS: Significant differences were observed over frontal, central, temporal and parietal areas. Evidence was found suggesting that childhood psychological trauma may have a lasting impact on neuronal connectivity. SIGNIFICANCE: This is the first study to demonstrate the suspected long term effect of trauma over central, temporal and parietal areas. Long term neural correlates of childhood and adult trauma appear to suggest information processing differences--differences that may, eventually, lead to better interventions following trauma.