bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cigarette Smoking in Psychiatric Settings: Occupational Health, Safety, Welfare and Legal Concerns
Authors: Lawn Sharon 
Published: December 2009

Objective: In the current climate of growing concern for the harmful effects of cigarette smoking and passive smoking, the high prevalence of this activity within psychiatric settings can no longer be ignored. This paper reviews the findings of research in a public stand-alone psychiatric facility in South Australia where significant legal and occupational health, safety and welfare (OHSW) concerns were apparent for both patients and staff as a consequence of the strong culture of smoking in that setting. The aim of this paper is to raise awareness of this significant health and legal issue and to inform policy and practice change. Method: This paper reviews legal issues associated with smoking in psychiatric settings and presents relevant findings from previous studies in which in-depth interviews and observations in community and inpatient psychiatric settings were conducted. Results: Significant legal and OHSW concerns were apparent for both patients and staff in all settings. The potential for future litigation was high. Conclusions: There are a number of legal and OHSW implications of continued smoking by staff and patients within mental health settings. Several administrative, clinical and cultural practices need to change within this system of care in order to improve overall patient wellbeing and to avoid the potential for litigation by patients and staff.
Dissociative Disorders: Pathways to Diagnosis, Clinician Attitudes and Their Impact
Authors: Leonard David , Brann Susan , Tiller John 
Published: December 2009

Objectives: To study the attitudes and experiences of Australian clinicians with dissociative disorders and the paths to diagnosis and experiences of patients. Method: The attitudes of Australian clinicians to dissociative disorders and the experiences of patients were assessed by questionnaires. The clinicians were mental health specialists and a small number of general medical practitioners. The patients had all been diagnosed with a dissociative disorder. Results: Of the 250 clinicians, 21% reported experience with more than six cases on average of any one of the dissociative disorders, 38% with less than six, 42% with none; 55% regarded them as valid diagnoses, 35% dubiously valid and 10% invalid. Of the 55 patients, 76% reported delays in diagnosis (57%, <3 years and 25%, <10 years) with adverse consequences in 64%; 80% had experienced sceptical or antagonistic attitudes from clinicians, rated as destructive by 48%. They were disabled (60% rated as <50% impaired) and were heavy consumers of health services (48% hospitalized, 68% <5 times). There was considerable comorbidity including moderate or severe depression (96%), self-harm (68%), suicide attempts (69%), panic disorder (53%), eating disorders (75%), substance abuse (25%), poor physical health (44%), major interpersonal (70%) and sexual problems (90%). Patients rated individual psychotherapy as the most helpful treatment (90%) but medications, such as antidepressants, were also valued (60%). Conclusions: Although over half of the responding Australian clinicians thought that dissociative disorders were valid, the rest were dubious about their validity with 10% believing them to be invalid. Only 21% had considerable experience with the disorders. These findings may relate to some of the difficulties perceived by patients, which included delays in diagnosis, suboptimal treatment and negative experiences with clinicians.
The Public's Ability to Recognize Mental Disorders and their Beliefs about Treatment: Changes in Australia Over 8 Years
Authors: Jorm Anthony F. , Christensen Helen , Griffiths Kathleen M. 
Published: December 2009

Objective: A national survey of Australian adults in 1995 showed a low level of recognition of mental disorders and beliefs about treatment that were often discordant with those of professionals. The present study aimed to find out whether recognition and treatment beliefs have changed over 8 years. Method: A national survey of 2001 adults in 2003–2004 included the same questions as the 1995 survey. These interview questions were based on a vignette of a person with either depression or schizophrenia. Results: Over the 8 years, the public showed better recognition of depression and schizophrenia and gave more positive ratings to a range of interventions, including help from mental health professionals, medications, psychotherapy and psychiatric ward admission. Conclusions: The Australian public's beliefs have changed over 8 years to be more like those of mental health professionals. This change may have positive implications for helpseeking and treatment concordance.
Positive Relationships Between Public Awareness Activity and Recognition of the Impacts of Depression in Australia
Authors: Highet Nicole J. , Luscombe Georgina M. , Davenport Tracey A. , Burns Jane M. , Hickie Ian B. 
Published: December 2009

Objective: This report records the level of exposure to depression-related information across the Australian community and explores associations with recognition of depression and relevant sociodemographic factors. Method: A cross-sectional telephone survey was conducted with a representative community sample. Participants consisted of 3200 respondents (400 respondents across each Australian State/Territory). Results: Sixty-five point four per cent (n=2089/3193) of respondents indicated that they or someone close to them had experienced depression, of whom 18.7% (n=391/2089) reported a personal experience of this illness. Various measures of recent exposure to depression-related information were high with 69.0% (n=2207/3200) reporting that they had seen, read or heard something in the media in the last 12 months. Recognition of beyondblue: the national depression initiativewas also surprisingly high (61.9%, 1982/3200). Those with greater understanding that depression is common and debilitating were more likely to recall recent media stories, spontaneously recall relevant organizations such as beyondblue, to have had direct or family experiences, to be younger and to have achieved higher levels of education. Depression, however, is rarely mentioned (1.3%, 47/3720) as a major general health as distinct from a mental health problem. Conclusion: The active promotion of depression-related material to the community appears to have contributed to recognition of the commonality and impacts of this illness. Although depression is commonly recognized as a mental health problem, it is not yet considered a major general health problem. Further, like many public health campaigns, those initially reached appear more likely to be female, younger, better educated and residing in metropolitan areas.
Adolescents' Responses to Peers with Depression or Conduct Disorder
Authors: Kelly Claire M. , Jorm Anthony F. , Rodgers Bryan 
Published: December 2009

Objective: To determine how young people are likely to respond to a peer with mental illness, or who has severe behavioural problems. Method: A mental health literacy survey was conducted with 1137 adolescents in years 8, 9 and 10 in South Australia and the Australian Capital Territory. Respondents were presented with a vignette of either a 16-year-old boymeeting criteria for conduct disorder or a 16-year-old girl meeting criteria for major depression. As part of the survey, respondents were asked to write in words what they would do if the person in the vignette was a friend of theirs and they wished to help. Responses were coded into categories. Results: Over half the sample (53%) described positive social support as the only action they would take to help. A further 23% said they would engage an adult such as a parent, teacher or school counsellor to help with the situation. Those responding to the conduct disorder vignette were more likely to describe engaging an adult to help and males were more likely to say they would do nothing. Female students tended to answer differently to the conduct disorder and depression vignettes, while male students responded similarly to the two vignettes. Conclusions: Many adolescents do not respond to friends' distress in ways which are likely to facilitate appropriate help. Mental health education in schools should include skills for offering help and encouraging peers to seek help.
Risk and Protective Factors for Medically Serious Suicide Attempts: A Comparison of Hospital-Based with Population-Based Samples of Young Adults
Authors: Donald Maria , Dower Jo , Correa-Velez Ignacio , Jones Mark 
Published: December 2009

Objective: To investigate risk and protective factors for medically serious suicide attempts among young Australian adults. Method: The study used a case–control design. A clinical sample of 18–24 year olds was recruited via the emergency department of a large public hospital following a suicide attempt (n=95) and was compared to a sample of 18–24 year olds who participated in a population-based survey (n=380). Results: Risk factors for medically serious suicide attempts included early school leaving, parental divorce (males only), distress due to problems with parents (females only), distress due to problems with friends, distress due to the break-up of a romantic relationship, tobacco use, high alcohol use, current depressive symptomatology and a previous diagnosis of depression. Protective factors included social connectedness, problem-solving confidence and locus of control. There was a trend for social connectedness to be more protective among those with high rather than low levels of depressive symptomatology, and among smokers rather than non-smokers. Conclusions: Results are discussed in terms of designing evidence-based suicide prevention activities for young adults.
Correlates of the use of Purging and Non-Purging Methods of Weight Control in a Community Sample of Women
Authors: Mond Jonathan J. , Hay Phillipa J. , Rodgers Bryan , Owen Cathy , Mitchell James 
Published: December 2009

Objective: To inform the classification of bulimic-type eating disorders, the correlates of purging and non-purging methods of weight control were examined in a large community sample of young adult women reporting recurrent episodes of binge eating. Method: Scores on self-report measures of eating disorder psychopathology, functional impairment and health-service utilization were compared among individuals who reported (recurrent episodes of binge eating and) the use of either purging (self-induced vomiting, laxative or diuretic misuse; n = 41) or non-purging (extreme dietary restriction, excessive exercise, or use of diet pills; n = 62) methods of weight control. Individuals who reported recurrent binge eating in the absence of extreme weight control behaviours (n = 442) were also included in the analysis. Results: Non-purgers tended to be younger and heavier and have higher levels of eating disorder psychopathology and functional impairment than purgers and non-compensating binge eaters, however these differences were not statistically significant. Purgers were more likely than non-purgers to have sought treatment specifically for a problem with eating, however this difference was no longer significant after age and body mass index were statistically controlled. In multivariate analysis, frequency of extreme dietary restriction was the best predictor of functional impairment. Conclusions: These findings call into question the validity of subtyping of bulimia nervosa into purging and non-purging forms as outlined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders.
Seizure Threshold Determination for Electroconvulsive Therapy: Stimulus dose Titration Versus Age-Based Estimations
Authors: Tiller John W.G. , Ingram Nicholas 
Published: December 2009

Objective: This study compared electroconvulsive therapy (ECT) seizure threshold determined by stimulus dose titration with age-based estimations. Method: Patients with major depressive disorder had their initial seizure thresholds determined by stimulus dose titration and the results compared with age-based estimations. There are no significant differences in thresholds determined by these methods. Results: Two hundred and three psychiatric patients (149 females, 54 males) had their seizure thresholds determined by stimulus dose titration. There was a significant positive correlation between seizure thresholds and age for males and females with male thresholds greater than female thresholds. Age determinations of seizure threshold would have resulted in excessive initial treatment stimuli for 30% of females and 8% of males. Ineffective stimulus doses would have been given to 2% of females and 7% of males on a full age basis and 64% using a half age strategy. Conclusions: For effective high-dose right unilateral ECT, initial seizure threshold should be determined by stimulus dose titration.
Firearms Legislation and Reductions in Firearm-Related Suicide Deaths in New Zealand
Authors: Beautrais A. L. , Fergusson D. M. , Horwood L. J. 
Published: December 2009

Objective: To examine the impact of introducing more restrictive firearms legislation (Amendment to the Arms Act, 1992) in New Zealand on suicides involving firearms. Method: National suicide data were examined for 8 years before, and 10 years following the introduction of the legislation. Results: After legislation, the mean annual rate of firearm-related suicides decreased by 46% for the total population (p < 0.0001), 66% for youth (15–24 years; p < 0.0001) and 39% for adults (≥25 years; p < 0.01). The fraction of all suicides accounted for by firearm-related suicides also reduced for all three populations (p < 0.0001). However, the introduction of firearms legislation was not associated with reductions in overall rates of suicide for all three populations. Conclusions: Following the introduction of legislation restricting ownership and access to firearms, firearm-related suicides significantly decreased, particularly among youth. Overall rates of youth suicide also decreased over this time but it is not possible to determine the extent to which this was accounted for by changes in firearms legislation or other causes.
Mental Disorders in Female Prisoners
Authors: Tye Christine S. , Mullen Paul E. 
Published: December 2009

Objective: The objective of the study was to investigate the rates of mental disorder among women in prison in Victoria, and to compare with community rates. Design: A midnight census of all women in prison in Victoria was undertaken. Respondents were interviewed with a version of the Composite International Diagnostic Interview (CIDI), an adapted version of the Personality Diagnostic Questionnaire (PDQ-4+) and a demographics questionnaire. Main Outcome Measures: Twelve-month prevalence rates of ICD-10 mental disorders including depressive disorders, anxiety disorders and drug-related disorders were examined. Prevalence of personality disorders was also investigated. Results: Eighty-four per cent of the female prisoners interviewed met the criteria for a mental disorder (including substance harmful use/dependence) in the year prior to interview. This rate was reduced to 66% when drug-related disorders were excluded. Fortythree per cent of subjects were identified as cases on a personality disorder screener. For all disorders, (except obsessive-compulsive disorder and alcohol harmful use) women in prison had a significantly greater likelihood of having met the 12-month diagnostic criteria when compared to women in the community. The most prevalent disorders among the female prisoners were: drug use disorder (57%), major depression (44%), Posttraumatic stress disorder (36%), and personality disorders. Almost a quarter (24%) of respondents were identified as a ‘case’ on the psychosis screen. Conclusions: In the present study female prisoners had significantly higher rates of the mental disorders investigated (with the exceptions of OCD and alcohol harmful use) when compared with women in the community. The pattern of disorder found among female prisoners is consistent with the abuse literature, suggesting that histories of abuse among the prison population may account for part of the discrepancy. These results highlight the need for improved assessment and treatment resources to meet the demands of this population.
Using Participatory Action Research in a Community-Based Initiative Addressing Complex Mental Health Needs
Authors: Knightbridge Stephen M. , King Robert , Rolfe Timothy J. 
Published: December 2009

Objective: This paper describes the first phase of a larger project that utilizes participatory action research to examine complex mental health needs across an extensive group of stakeholders in the community. Method: Within an objective qualitative analysis of focus group discussions the social ecological model is utilized to explore how integrative activities can be informed, planned and implemented across multiple elements and levels of a system. Seventy-one primary care workers, managers, policy-makers, consumers and carers from across the southern metropolitan and Gippsland regions of Victoria, Australia took part in seven focus groups. All groups responded to an identical set of focusing questions. Results: Participants produced an explanatory model describing the service system, as it relates to people with complex needs, across the levels of social ecological analysis. Qualitative themes analysis identified four priority areas to be addressed in order to improve the system's capacity for working with complexity. These included: (i) system fragmentation; (ii) integrative case management practices; (iii) community attitudes; and (iv) money and resources. Conclusions: The emergent themes provide clues as to how complexity is constructed and interpreted across the system of involved agencies and interest groups. The implications these findings have for the development and evaluation of this community capacity-building project were examined from the perspective of constructing interventions that address both top-down and bottom-up processes.
Pathways to the First Contact with Specialist Mental Health Care
Authors: Steel Zachary , Mcdonald Robert , Silove Derrick , Bauman Adrian , Sandford Phil , Herron Jennifer , Harry Minas I. 
Published: December 2009

Objective: To examine the pathways to mental health care followed by patients presenting for the first time to community- and hospital-based services and the degree to which individual characteristics, cultural background, illness type, severity and service-related variables influence the time and pathways taken to reach care. Method: One hundred and forty-six consecutive Australian-born, Asian and Arabicspeaking patients making their first lifetime contact with mental health services in two area health regions were included. Symptom severity was assessed using the Health of the Nations Outcome Scales. Illness explanatory models, social support, English-language proficiency and acculturation were also assessed. Results: An average of three professional consultations were made prior to first contact with public mental health services. Family physicians occupied a pivotal role in the helpseeking pathway with 53% of patients consulting a general practitioner. The median time taken to reach specialist mental health services was 6 months, with significantly shorter time for patients with psychotic disorders. Individual variables such as gender, social support, ethnicity and English flency were not associated with delays in receiving public mental health care. Ethnicity was associated with lower utilization of allied health professionals. Conclusions: The data suggest that social and cultural factors influence the range of professionals consulted by those with a mental illness but do not delay their presentation to public mental health services.
Survey of Quality of Life and Related Risk Factors for a Taiwanese Village Population 3 Years Post-Earthquake
Authors: Wu Hung-Chi , Chou Pesus , Huang-Chih Chou Frank , Su Chao-Yueh , Tsai Kuan-Yi , Ou-Yang Wen-Chen , Tung-Ping Su Tom , Chao Shin-Shin , Sun Wen-Jung , Chen Ming-Chao 
Published: December 2009

Objective: To investigate quality of life (QOL) and related risk factors in Taiwanese earthquake survivors diagnosed with different psychiatric disorders 3 years after the 1999 Chi-Chi earthquake. Method: This study was a population survey. Trained assistants used the Medical Outcomes Study Short Form-36 (MOS SF-36) and questionnaires to interview 405 respondents (189 men and 216 women) aged 16 years or older, who had been exposed to the earthquake. Psychiatrists interviewed the same respondents using the Mini-International Neuropsychiatric Interview, with an adjusted response rate of 70.2%. Results: The prevalence range for psychiatric disorders in the earthquake survivors was 0.2–7.2% 3 years after the Chi-Chi earthquake, with rates for major depression (MD) and posttraumatic stress disorder (PTSD) of 6.4% and 4.4%, respectively. The QOL scores for the PTSD/MD group were lower than for the other two diagnostic groups, as determined by assessment of physical and mental aspects of functional integrity from MOS SF-36 scores. The predictors for poor QOL were age, female gender, economic problems, physical illness, subjective assessment of memory and social-activity decline and diagnosis of PTSD or MD. Conclusion: The QOL for earthquake survivors with psychiatric disorders, especially PTSD or MD, was inferior compared with the mentally healthy analogues, with contemporaneous decreases in mental and physical function scores across the QOL subscales. The persistence of long-term economic problems was one of many important factors affecting QOL.
Changes in Private Sector Electroconvulsive Treatment in Australia
Authors: Doessel Darrel P. , Scheurer Roman W. , Chant David C. , Whiteford Harvey A. 
Published: December 2009

Objectives: This paper reports on changes, over time and between states, in the use of electroconvulsive therapy (ECT) in the private psychiatric sector in Australia between 1984 and 2004. Method: Data for ECT services, and all specialist psychiatry services provided under the Medicare system, have been analysed in absolute numbers and as utilization rates. Results: Changes in the use of ECT over time are different from other services provided by private psychiatrists. As in other countries, the use of ECT initially declined in period studied but has increased in recent years. In addition, there is a clear pattern of differential use of ECT between the states and territories. Conclusions: This descriptive study cannot ‘explain’ the results obtained: other data, incorporated into an explanatory model using regression analysis, are needed to determine the factors underlying the utilization patterns obtained in this study. Thus, further work is needed. Furthermore, it is important to analyse data at a lower level of geographical aggregation than that of the state/territory: this (state/territory) aggregation conceals differences in utilization between metropolitan, minor city, rural and remote regions of the country.