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Craven K, De Dios Pérez B, Holmes J, Fisher R, Radford KA. Factors influencing employers' support for employees with acquired brain injuries or mental illness to return to- and stay in work: A qualitative systematic review. Work 2024:WOR230214. [PMID: 38217562 DOI: 10.3233/wor-230214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND People with acquired brain injuries (ABIs) often experience residual limitations and co-morbid mental illnesses that restrict work participation. Employers are key in enabling successful return-to-work and job retention. OBJECTIVE This review aimed to explore employers' perspectives of factors influencing their support for people with ABIs and/or mental illness to return to- and stay in work. Review questions focused on barriers and facilitators to their support, and contextual characteristics present at the time. METHODS Five databases were searched from October 2010 until November 2023 for relevant qualitative studies published in English. Findings from included studies (N = 25) were synthesised using thematic synthesis. RESULTS Included studies focused on employees with ABI or mental illness, rather than dually diagnosed ABI and mental illness. Employers' support was influenced by their awareness/knowledge of- and attitudes towards the employee's condition/illness; their skills and experience in supportive strategies; factors related to provision of work accommodations; and stakeholder influence. Similarities and differences in influential factors were observed across the ABI and mental illness literature. Contextual characteristics related to organisational characteristics, cultural taboo, and involvement of certain stakeholders. CONCLUSIONS ABI survivors (with and without co-morbid mental illness) and their employers may benefit from specialist support and resources to guide them through the return-to-work process. Further research is needed to investigate employers' knowledge of ABI and mental illness and supportive strategies. Exploration of the influence of other stakeholders, socio-demographic characteristics, and contextual factors on employers' return-to-work and retention support for ABI survivors with co-morbid mental illness is warranted.
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Affiliation(s)
- Kristelle Craven
- Centre for Rehabilitation & Ageing Research (CRAR), University of Nottingham, Nottingham, United Kingdom
| | - Blanca De Dios Pérez
- Centre for Rehabilitation & Ageing Research (CRAR), University of Nottingham, Nottingham, United Kingdom
| | - Jain Holmes
- Centre for Rehabilitation & Ageing Research (CRAR), University of Nottingham, Nottingham, United Kingdom
| | | | - Kathryn A Radford
- Centre for Rehabilitation & Ageing Research (CRAR), University of Nottingham, Nottingham, United Kingdom
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Li Z, Jin Y, Lu C, Luo R, Wang J, Liu Y. Effects of patient decision aids in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Int J Nurs Pract 2021; 27:e12914. [PMID: 33657667 DOI: 10.1111/ijn.12914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/13/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Abstract
AIMS This study aimed to systematically evaluate the effectiveness of patient decision aids on knowledge, decisional conflict and decisional self-efficacy outcomes in patients with diabetes. METHODS A comprehensive database search was performed using the Web of Science, Cochrane Library, PubMed, Embase, PsycINFO (Ovid), CINAHL (EBASCO), CNKI, VIP, Wan Fang Database and the Ottawa Decision Aid Library Inventory (http://decisionaid.ohri.ca/index.html) from inception to 13 October 2019. Two reviewers independently searched databases, screened articles, extracted data and evaluated the risk bias of included studies. Then Rev Man 5.3 software was adopted for statistical analysis. RESULTS Ten articles containing 1,452 people with diabetes were selected. The results of meta-analysis showed that patient decision aids had a positive effect on reducing decisional conflict and improving decisional self-efficacy among patients with type 2 diabetes. Meanwhile, this article also revealed that patient decision aids have beneficial short-term effects on improving knowledge, but there was no significant long-term effect. CONCLUSION Patient decision aids are capable of becoming support tools to improve shared decision making. Further implementation studies are required to transform patient decision aids tools into clinical practice.
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Affiliation(s)
- Zimeng Li
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yinghui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Center for Evidence-Based and Translational Medicine, Wuhan University, Hubei, China
| | - Cui Lu
- Emergency Department, Tianjin TEDA Hospital, Tianjin, China
| | - Ruzhen Luo
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jiayao Wang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yanhui Liu
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Gignac MAM, Bowring J, Jetha A, Beaton DE, Breslin FC, Franche RL, Irvin E, Macdermid JC, Shaw WS, Smith PM, Thompson A, Tompa E, Van Eerd D, Saunders R. Disclosure, Privacy and Workplace Accommodation of Episodic Disabilities: Organizational Perspectives on Disability Communication-Support Processes to Sustain Employment. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:153-165. [PMID: 32410153 PMCID: PMC7954721 DOI: 10.1007/s10926-020-09901-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Purpose Employers increasingly are asked to accommodate workers living with physical and mental health conditions that cause episodic disability, where periods of wellness are punctuated by intermittent and often unpredictable activity limitations (e.g., depression, anxiety, arthritis, colitis). Episodic disabilities may be challenging for workplaces which must comply with legislation protecting the privacy of health information while believing they would benefit from personal health details to meet a worker's accommodation needs. This research aimed to understand organizational perspectives on disability communication-support processes. Methods Twenty-seven participants from diverse employment sectors and who had responsibilities for supporting workers living with episodic disabilities (e.g., supervisors, disability managers, union representatives, occupational health representatives, labour lawyers) were interviewed. Five participants also had lived experience of a physical or mental health episodic disability. Participants were recruited through organizational associations, community networks and advertising. Semi-structured interviews and qualitative content analysis framed data collection and analyses, and mapped communication-support processes. Results Seven themes underpinned communication-support process: (1) similarities and differences among physical and mental health episodic disabilities; (2) cultures of workplace support, including contrasting medical and biopsychosocial perspectives; (3) misgivings about others and their role in communication-support processes; (4) that subjective perceptions matter; (5) the inherent complexity of the response process; (6) challenges arising when a worker denies a disability; and (7) casting disability as a performance problem. Conclusions This study identifies a conceptual framework and areas where workplace disability support processes could be enhanced to improve inclusion and the sustainability of employment among workers living with episodic disabilities.
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Affiliation(s)
- Monique A M Gignac
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Julie Bowring
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
| | - Arif Jetha
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Dorcas E Beaton
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
| | - F Curtis Breslin
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
| | | | - Emma Irvin
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
| | - Joy C Macdermid
- School of Physical Therapy, Western University, London, ON, Canada
| | | | - Peter M Smith
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Aaron Thompson
- Workplace Safety and Insurance Board (WSIB), Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Emile Tompa
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Dwayne Van Eerd
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
| | - Ron Saunders
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
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Stratton E, Choi I, Peters D, Calvo RA, Harvey SB, Glozier N. Co-Designing a Web-Based Decision Aid Tool for Employees Disclosure of Mental Health Conditions: A Participatory Study Design Using Employee and Organizational Preferences. JMIR Form Res 2020; 4:e23337. [PMID: 33155982 PMCID: PMC7679208 DOI: 10.2196/23337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Decisions of whether to disclose mental health conditions are extremely personal and require the consideration of multiple factors associated with the disclosure process (eg, weighing the risks and benefits). Decision aid tools help people make these complex decisions. Such an aid needs to be confidential, easily accessible, and easy to use with the potential to access the tool on multiple occasions. Web programs are well suited to meet these requirements and, if properly developed, can provide feasible, accessible, affordable, and effective workplace interventions. OBJECTIVE This study aims to gain insights from potential end users, in this case both employees and organizations, into what type of components including language, style, and content would avoid potential stigma and ensure that elements of clear value for users would be built into a web-based decision aid tool that aims to assist employees in making decisions about the disclosure of their mental health condition at work. METHODS A participatory design approach was used to allow developers, researchers, experts, and end users to collaborate in co-designing the tool. During the user research phase of the development of the web-based tool, a participatory design workshop approach was selected as a part of a larger study of focus groups. Australian employees and managers in rural, suburban, and urban locations participated in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for a decision aid tool. RESULTS A total of 2 workshops were conducted with 13 participants. The majority were from a transport company (9/13, 69%), male (8/13, 62%), and employed full time (11/13, 85%). Six employees had previous experience disclosing their own mental health condition, and 7 were in a supervisory role and had previously been disclosed to. In any co-design development, there are certain trade-offs that need to be made between the views of experts, developers, end users, and the available budget. In this specific instance of a very delicate, personal decision, the end users provided valuable design insights into key areas such as language, and they were very antipathetic to a key feature, the avatar, which was thought to be desirable by experts and developers. Findings including aspects of the tool where all stakeholders were in agreement, aspects where some stakeholders disagreed and adaptations were implemented, where disagreements could not be implemented because of financial constraints, and misalignment between stakeholders and how to decide on a balance were shared. CONCLUSIONS The co-design with a lived experience approach is useful for contributing much to the design, language, and features. The key in this study was balancing the needs of the workers and the potential impact for the managers and organizations, while ensuring legislation and regulation requirements were upheld.
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Affiliation(s)
- Elizabeth Stratton
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Isabella Choi
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Dorian Peters
- Dyson School of Design Engineering, Imperial College, London, United Kingdom
| | - Rafael A Calvo
- Dyson School of Design Engineering, Imperial College, London, United Kingdom.,School of Electrical and Information Engineering, The University of Sydney, Sydney, Australia
| | - Samuel B Harvey
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Black Dog Institute, Sydney, Australia.,St George Hospital, Sydney, Australia
| | - Nicholas Glozier
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Guo L, Rohde J, Farraye FA. Stigma and Disclosure in Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2020; 26:1010-1016. [PMID: 32556190 DOI: 10.1093/ibd/izz260] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Indexed: 12/16/2022]
Abstract
Stigma in patients suffering from chronic disease is associated with worse clinical outcomes and secondary medical issues such as depression, anxiety, and decreased quality of life. We believe various forms of stigma can have different clinical significance in patients with inflammatory bowel disease (IBD). With further insight and research, we suggest that these forms of stigma could be identified and targeted by researchers or clinicians to lessen the psychological disease burden in patients and to potentially improve their physical well-being. In the current review, we discuss public perceptions, knowledge, and stigmatization of IBD, the prevalence of various forms of IBD stigma, and the impact of such stigma on patient outcomes. We also discuss IBD disclosure, its association with stigma, and the tendencies and effects of such disclosures among youth and adult patient populations. We finish the review by highlighting possible modalities and research areas for future IBD interventions.
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Affiliation(s)
- Ling Guo
- Section of Gastroenterology, Boston Medical Center, Boston, Massachusetts, USA
| | - Jacob Rohde
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Francis A Farraye
- Section of Gastroenterology, Boston Medical Center, Boston, Massachusetts, USA.,Department of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, Jacksonville, Florida, USA
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Janssens KME, van Weeghel J, Henderson C, Joosen MCW, Brouwers EPM. Evaluation of an intervention to support decisions on disclosure in the employment setting (DECIDES): study protocol of a longitudinal cluster-randomized controlled trial. Trials 2020; 21:443. [PMID: 32471478 PMCID: PMC7257205 DOI: 10.1186/s13063-020-04376-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/05/2020] [Indexed: 11/28/2022] Open
Abstract
Background Unemployment rates are higher among people with mental health issues/illness (MHI) than in the general working population, and many of them face the dilemma of whether or not to disclose their MHI when searching for employment. Disclosure can lead to rejection and discrimination, but alternatively can also have important advantages that may be necessary to retain employment. Whether disclosure decisions lead to sustainable employment depends on many factors, of which unemployed people themselves can only influence their decision to disclose or not and the way in which they communicate. This study evaluates the cost-effectiveness of an intervention to support unemployed people with MHI in their disclosure decision and communication. Methods This is a two-armed, clustered, randomized controlled trial with longitudinal design and randomization at organization level. An intervention will be examined, which consists of a disclosure decision aid tool (CORAL.NL) for unemployed people and workplace stigma-awareness training especially designed for employment specialists, which focusses on how to support unemployed people in their disclosure decisions. Participants in the intervention group are unemployed people who receive support from trained employment specialists from organizations allocated to the intervention group, and receive the CORAL.NL decision aid after baseline. The control group consists of unemployed people who receive support as usual from employment specialists from different organizations allocated to the control group. Primary outcomes are: cost-effectiveness of the intervention, e.g. healthcare costs, having employment, days until start of employment, independency of social security, having other forms of employment and decision making about disclosing MHI. Secondary outcomes are mental health and wellbeing, stigma and discrimination and work-related factors. Financial income data are collected via the registration systems of Dutch municipalities and Statistics Netherlands, and by questionnaires at baseline, and at 3, 6 and 12 months. Discussion If using a decision aid to decide about disclosure of MHI leads to people finding and retaining employment more often, this study will contribute to lowering healthcare and societal costs. Trial registration Netherlands Trial Register: NL7798. Registered on 4 June 2019.
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Affiliation(s)
- K M E Janssens
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
| | - J van Weeghel
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.,Kenniscentrum Phrenos, Utrecht, The Netherlands
| | - C Henderson
- Department of Health Services and Population Research, King's College London, London, UK
| | - M C W Joosen
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.,Department Human Resource Studies, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - E P M Brouwers
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Stratton E, Choi I, calvo R, Hickie I, Henderson C, Harvey SB, Glozier N. Web-based decision aid tool for disclosure of a mental health condition in the workplace: a randomised controlled trial. Occup Environ Med 2019; 76:595-602. [DOI: 10.1136/oemed-2019-105726] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/18/2019] [Accepted: 07/07/2019] [Indexed: 11/04/2022]
Abstract
ObjectivesMaking decisions about disclosing a mental illness in the workplace is complicated. Decision aid tools are designed to help an individual make a specific choice. We developed a web-based decision aid to help inform decisions about disclosure for employees. This study aimed to examine the efficacy of this tool.MethodWe conducted a randomised controlled trial with recruitment, randomisation and data collection all online. Participants had access to the intervention for 2 weeks. Assessments occurred at baseline, postintervention and 6 weeks’ follow-up. The primary outcome was decisional conflict. Secondary outcomes were stage and satisfaction of decision-making and mental health symptoms.Results107 adult employees were randomised to READY (n=53) or the control (n=54). The sample was predominantly female (83.2%). Participants using READY showed greater reduction in decisional conflict at postintervention (F(1,104)=16.8, p<0.001) (d=0.49, 95% CI 0.1 to 0.9) and follow-up (F(1,104)=23.6, p<0.001) (d=0.61, 95% CI 0.1 to 0.9). At postintervention the READY group were at a later stage of decision-making (F(1,104)=6.9, p=0.010) which was sustained, and showed a greater reduction in depressive symptoms (F(1,104)=6.5, p=0.013). Twenty-eight per cent of READY users disclosed, and reported a greater improvement in mental health than those who did not disclose.ConclusionsREADY provides a confidential, flexible and effective tool to enhance employee’s decision-making about disclosure. Its use led to a comparative improvement in depressive symptoms compared with the current information provided by a leading mental health non-governmental organisation, without apparent harm. READY seems worth evaluating in other settings and, if these results are replicated, scaling for wider use.Trial registration numberACTRN12618000229279.
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Stratton E, Einboden R, Ryan R, Choi I, Harvey SB, Glozier N. Deciding to Disclose a Mental Health Condition in Male Dominated Workplaces; A Focus-Group Study. Front Psychiatry 2018; 9:684. [PMID: 30618865 PMCID: PMC6305748 DOI: 10.3389/fpsyt.2018.00684] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/26/2018] [Indexed: 12/18/2022] Open
Abstract
Objectives: Deciding to disclose a mental illness in the workplace requires thoughtful informed decision making. Decision aids are increasingly used to help people make complex decisions, but need to incorporate relevant factors for the context. This study aimed to identify factors and processes that influence decision making about such disclosure to inform the development of a disclosure decision aid tool for employees in male dominated industries. Methods: We invited 15 partner organisations in male dominated industries to facilitate the recruitment of employees who either had disclosed a mental health condition in their workplace; or occupied a position to whom employees disclosed to focus groups addressing the aims. Results: The majority of the organisations had explicit policies that employees must disclose and so were unable to be seen countenancing non-disclosure as an option. Two focus groups were conducted (n = 13) with mainly male (62%), full-time employees (85%), and both disclosed (46%) and authority (54%) groups. Six themes, all barriers, were identified as influencing decision making processes: knowledge about symptoms, and self-discrimination (internal), stigma and discrimination by others, limited managerial support, dissatisfaction with services, and/or a risk of job or financial loss (external). Conclusion: Decisions to disclose mental health conditions, even by those who had done so, appear driven entirely by consideration of negative aspects. This suggests that anti-discrimination policy, legislation, awareness campaigns, and manager training have yet to change negative perceptions, and that any decision aid tool needs to incorporate counterfactual positive aspects that appear not to be an important consideration in such male dominated workplaces. There is a disconnect between organisational policies favouring disclosure and employees favouring non-disclosure that has caused tension within the organisational culture. Decision aid tools may assist employees with an active disclosure without waiting for an event to occur, giving the control of the decision back to the employee.
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Affiliation(s)
- Elizabeth Stratton
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,School of Psychiatry, University of Sydney, Sydney, NSW, Australia
| | - Rochelle Einboden
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Rose Ryan
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Isabella Choi
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,School of Psychiatry, University of Sydney, Sydney, NSW, Australia
| | - Samuel B Harvey
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia.,St George Hospital, Sydney, NSW, Australia
| | - Nicholas Glozier
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,School of Psychiatry, University of Sydney, Sydney, NSW, Australia
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