Melbourne School of Population and Global Health - Theses
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ItemDevelopment and evaluation of a training program in cross-cultural psychiatric assessment for crisis assessment and treatment teams (CATTs)( 2005-02)The aim of the current project was to improve the cross-cultural clinical competence of mental health staff in Victoria’s Crisis Assessment and Treatment Teams (CATTs) by developing, delivering and evaluating a training program in Cross-Cultural Psychiatric Assessment (CPA). The project was guided by a program logic framework. A literature review demonstrated cross-cultural differences in manifestations of mental disorders and disparities in mental health service provision to racial and ethnic groups, suggesting clinician bias, unfamiliarity with cross-cultural manifestations, or delayed help-seeking by ethnic groups. No research has been identified into crisis service provision to ethnic communities. (For complete abstract open document)
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ItemMemory and resettlement: Somali women in Melbourne and emotional wellbeing( 2003)This thesis derives from ethnographic research that explored the lives of forty-two Somali women who migrated to Australia as a result of the Somali civil war. In particular, it explores Somali women's experiences of depression and emotional well-being. Studies of refugee mental health are frequently premised on an audible discourse that construes refugees as suffering predominantly from war, persecution and trauma. Further, the mental health ‘problems’ of refugees are firmly situated within the bodies and minds of those classified as refugees. The experiences documented in this thesis have a different focus, reflecting the ways in which Somali women's narratives encompassed their histories, changing social relations, and idioms of home and exile. Their accounts of depression lay partly within the language and experience of war and persecution, but emotional distress was frequently attributed to contemporary realities of family separation, loss of community cohesion, marginalisation, isolation, and the hardships of resettlement. Accordingly, this thesis is not an ethnography of a fixed place or social and cultural life, but provides a longitudinal account of a refugee population in Australia. The underlying focus of the research has been 'refugee mental health', however, analysis of the research findings has involved engagement with broader theoretical areas of historical memory, identity, community, home and exile, and transnationalism. The chapters that follow give an account of the idioms through which Somali women situate and give meaning to depression. In so doing, this thesis frames refugee mental health within the broader processes and interconnections of histories, displacement and resettlement, as well as the socio-political context of war.
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ItemThe epidemiology and impact of viral respiratory infections in pre-school aged children( 2009)BACKGROUND: There are significant gaps in our knowledge of the epidemiology of globally endemic respiratory viruses. Current community research methods are expensive, requiring invasive specimen collection at a home visit by health‐care workers. METHODS: Two cohort studies were conducted to collect better information about the epidemiology and impact of community‐managed respiratory illnesses in pre‐school aged children. The pilot study recruited 121 Melbourne children aged one to four years over winter/spring of 2001. Parents collected daily respiratory symptoms and completed an impact diary, including time seeking health‐care and caring for an ill child, when a pre‐defined acute respiratory illness (ARI) occurred. The Respiratory Virus Study (ReVS) followed 234 Melbourne children less than five years of age for approximately one year from January 2003. A combined nose‐throat swab (NTS), collected by parents when an ARI occurred, was added to pilot study methods. NTS specimens were transported to the Victorian Infectious Diseases Reference Laboratory (VIDRL) for polymerase chain reaction (PCR) to test for influenza A, influenza B, respiratory syncytial virus (RSV), parainfluenza viruses I, II, and III, adenoviruses, and picornaviruses (rhinoviruses, enteroviruses). At the end of the study, available specimens and nucleic acid extracts were shipped on dry ice to the Queensland Paediatric Infectious Diseases (Qpid) Laboratory and tested for human metapneumovirus and human coronavirus NL63. RESULTS: The incidence rate for community‐managed ARI in the pilot study was 0.44 episodes per childmonth (95% CI 0.38 to 0.51) with an average cost per illness of $241 (95% CI $191 to $291). The key cost driver was carer time away from usual activities caring for the ill child, making up 70% of costs. There were 730 ARIs identified in ReVS children for a rate of 0.48 ARIs per child‐month (95% CI 0.45 to 0.52). At least one virus was identified in 401 of 543 ARIs (74%) with a specimen returned, and picornaviruses were identified in 269 ARIs (50%). The total cost of all illnesses with a burden diary returned was $161,454, with over one‐third, $52,597, from illnesses where a picornavirus was identified in isolation. The mean cost of all ARIs was $309 (95% CI $263 to $354), and time spent caring for an ill child was again the key cost driver, responsible for 82% of all costs. The point estimate for the mean cost of influenza A illnesses ($904; 95% CI $89 to $1,719) was three times higher than RSV ($304; 95% CI $194 to $415), the next most expensive illness. Collection by a health‐care worker parent, collector‐reported quality, or presence of a throat swab made no difference to the proportion of specimens positive for any virus. DISCUSSION: Acute respiratory illnesses in community dwelling pre‐school aged children are common and a virus can be detected in 74% of parent‐collected specimens. Use of daily symptom diaries and parent‐collected specimens were effective and efficient study methods, and provide a new model for the future conduct of community‐based epidemiological studies for respiratory pathogens, including efficacy studies for new preventative vaccines and treatments.