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Stratton E, Player MJ, Glozier N. Online mental health training program for male-dominated organisations: a pre-post pilot study assessing feasibility, usability, and preliminary effectiveness. Int Arch Occup Environ Health 2023; 96:641-649. [PMID: 36800032 DOI: 10.1007/s00420-023-01961-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE The emergence of digital health interventions for mental ill-health in the workplace is expansive. Digital interventions delivered in male-dominated settings are less so. This pilot study aimed to assess the usability, feasibility, acceptability, and preliminary effects of an online intervention in a male-dominated organization. We focus on male-dominated as mental ill-health is frequently unrecognized and underdiagnosed among males. METHODS Unwind, a 7-week internet-based program with stress-management components, was tested in a pre-post pilot study. Unwind gets users to identify and understand their stress triggers and assists them to develop adaptive ways to manage these and their stress. Participants were Australian adults employed in a mining company. Follow-up assessment occurred 8 weeks after baseline. The primary outcome measure was change in stress symptoms, with secondary outcomes; change in depression, anxiety, insomnia, well-being, and alcohol use. User feedback and program data were analyzed to assess usability, engagement, and intervention adherence. RESULTS Eligible participants n = 87 showed significant reductions in stress (g = 0.46, p < 0.001), depression (g = 0.47, p < 0.001), anxiety (g = 0.50, p < 0.001), insomnia (g = 0.44, p < 0.001), and well-being (g = 0.32, p = 0.004) post-intervention. Significant improvements were observed in both well and unwell (mental ill-health) and male and female participants. There was no gender effect on outcomes. A dose-response was observed as the number of modules used was related positively to improvement in anxiety (F1,86 = 5.735, p = 0.019; R2 = 0.25). Overall users rated Unwind as useful and engaging. CONCLUSION This study presents evidence base that Unwind is a feasible and acceptable approach to reducing employees' mental health-related symptoms in typically difficult-to-reach male-dominated industries. Unwind is feasible for larger scale delivery within male-dominated industries.
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Affiliation(s)
- Elizabeth Stratton
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Office 8, Lvl 5, Professor Marie Bashir Building, Missenden Road, Camperdown, NSW, 2006, Australia. .,ARC Centre of Excellence for Children and Families Over the Life Course, University of Sydney, Office 8, Lvl 5, Professor Marie Bashir Building, Missenden Road, Camperdown, NSW, 2006, Australia.
| | - Michael J Player
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Office 8, Lvl 5, Professor Marie Bashir Building, Missenden Road, Camperdown, NSW, 2006, Australia
| | - Nick Glozier
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Office 8, Lvl 5, Professor Marie Bashir Building, Missenden Road, Camperdown, NSW, 2006, Australia.,ARC Centre of Excellence for Children and Families Over the Life Course, University of Sydney, Office 8, Lvl 5, Professor Marie Bashir Building, Missenden Road, Camperdown, NSW, 2006, Australia
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Stratton E, Player MJ, Dahlheimer A, Choi I, Glozier N. Prevalence and association of discrimination and bullying and the impact on mental health in an occupational setting. IJWHM 2020. [DOI: 10.1108/ijwhm-02-2020-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeDiscrimination and bullying contribute to mental ill-health in the workplace. At face value, they would seem linked but are often dealt with by different legislations. Workplace studies generally focus on bullying and population studies on discrimination. The authors aimed to evaluate the prevalence and relationship of discrimination and bullying in a male-dominated workforce, associated factors and relative impact on mental ill-health.Design/methodology/approachAn online cohort survey was conducted amongst employees of an Australian mining company, measuring discrimination, bullying, demographics and workplace and health factors over two months. Cross-sectional and prospective analyses assessed the prevalence of each, their association and their effects on depression and anxiety.FindingsA total of 580 employees (82% male) participated. There was no association between workplace bullying (n = 56, 9.7%) and discrimination (n = 160, 27.6%). Discrimination, but not bullying, was associated with higher depression, anxiety and suicidal ideation and lower well-being and resilience. After controlling for demographic, workplace and health and well-being factors, depression had the main effect on discrimination ß = 0.39, p = 0.003. Discrimination predicted an increase in depression scores at follow-up F (1, 129) = 4.88, p = 0.029.Originality/valueIn this male-dominated industry, discrimination was more prevalent than bullying. Discrimination, but not bullying, was associated with poorer mental health both cross sectionally and prospectively. Supporting the need to assess and manage discrimination and bullying in the workplace independently and the need for interventions to reduce a broader range of adverse interpersonal behaviours.
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Fogarty AS, Spurrier M, Player MJ, Wilhelm K, Whittle EL, Shand F, Christensen H, Proudfoot J. Tensions in perspectives on suicide prevention between men who have attempted suicide and their support networks: Secondary analysis of qualitative data. Health Expect 2017; 21:261-269. [PMID: 28806484 PMCID: PMC5750756 DOI: 10.1111/hex.12611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 12/02/2022] Open
Abstract
Background Men generally have higher rates of suicide, despite fewer overt indicators of risk. Differences in presentation and response suggest a need to better understand why suicide prevention is less effective for men. Objective To explore the views of at‐risk men, friends and family about the tensions inherent in suicide prevention and to consider how prevention may be improved. Design Secondary analysis of qualitative interview and focus group data, using thematic analysis techniques, alongside bracketing, construction and contextualisation. Setting and participants A total of 35 men who had recently made a suicide attempt participated in interviews, and 47 family and friends of men who had made a suicide attempt took part in focus groups. Participants recounted their experiences with men's suicide attempts and associated interventions, and suggested ways in which suicide prevention may be improved. Results Five tensions in perspectives emerged between men and their support networks, which complicated effective management of suicide risk: (i) respecting privacy vs monitoring risk, (ii) differentiating normal vs risky behaviour changes, (iii) familiarity vs anonymity in personal information disclosure, (iv) maintaining autonomy vs imposing constraints to limit risk, and (v) perceived need for vs failures of external support services. Conclusion Tension between the different perspectives increased systemic stress, compounding problems and risk, thereby decreasing the effectiveness of detection of and interventions for men at risk of suicide. Suggested solutions included improving risk communication, reducing reliance on single source supports and increasing intervention flexibility in response to individual needs.
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Affiliation(s)
- Andrea S Fogarty
- Black Dog Institute and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Michael Spurrier
- Black Dog Institute and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Michael J Player
- Black Dog Institute and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kay Wilhelm
- Black Dog Institute and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Faces in the Street, St Vincent's Hospital, St Vincent's Urban Mental Health Research Institute, Sydney, NSW, Australia.,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Erin L Whittle
- Black Dog Institute and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Fiona Shand
- Black Dog Institute and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Helen Christensen
- Black Dog Institute and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Judith Proudfoot
- Black Dog Institute and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Fogarty AS, Proudfoot J, Whittle EL, Clarke J, Player MJ, Christensen H, Wilhelm K. Preliminary Evaluation of a Brief Web and Mobile Phone Intervention for Men With Depression: Men's Positive Coping Strategies and Associated Depression, Resilience, and Work and Social Functioning. JMIR Ment Health 2017; 4:e33. [PMID: 28798009 PMCID: PMC5571234 DOI: 10.2196/mental.7769] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/13/2017] [Accepted: 07/13/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous research has identified that men experiencing depression do not always access appropriate health services. Web-based interventions represent an alternative treatment option for men, are effective in reducing anxiety and depression, and have potential for wide dissemination. However, men do not access Web-based programs at the same rate as women. Programs with content explicitly tailored to men's mental health needs are required. OBJECTIVE This study evaluated the applicability of Man Central, a new Web and mobile phone intervention for men with depression. The impact of the use of Man Central on depression, resilience, and work and social functioning was assessed. METHODS A recruitment flier was distributed via social media, email networks, newsletters, research registers, and partner organizations. A single-group, repeated measures design was used. The primary outcome was symptoms of depression. Secondary outcomes included externalizing symptoms, resilience, and work and social functioning. Man Central comprises regular mood, symptom, and behavior monitoring, combined with three 15-min interactive sessions. Clinical features are grounded in cognitive behavior therapy and problem-solving therapy. A distinguishing feature is the incorporation of positive strategies identified by men as useful in preventing and managing depression. Participants were directed to use Man Central for a period of 4 weeks. Linear mixed modeling with intention-to-treat analysis assessed associations between the intervention and the primary and secondary outcomes. RESULTS A total of 144 men aged between 18 and 68 years and with at least mild depression enrolled in the study. The symptoms most often monitored by men included motivation (471 instances), depression (399), sleep (323), anxiety (316), and stress (262). Reminders were scheduled by 60.4% (87/144). Significant improvements were observed in depression symptoms (P<.001, d=0.68), depression risk, and externalizing symptoms (P<.001, d=0.88) and work and social functioning (P<.001, d=0.78). No change was observed in measures of resilience. Participants reported satisfaction with the program, with a majority saying that it was easy (42/51, 82%) and convenient (41/51, 80%) to use. Study attrition was high; 27.1% (39/144) and 8.3% (12/144) of the participants provided complete follow-up data and partial follow-up data, respectively, whereas the majority (93/144, 64.6%) did not complete follow-up measures. CONCLUSIONS This preliminary evaluation demonstrated the potential of using electronic health (eHealth) tools to deliver self-management strategies to men with depressive symptoms. Man Central may meet the treatment needs of a subgroup of depressed men who are willing to engage with an e-mental health program. With further research, it may provide an acceptable option to those unwilling or unable to access traditional mental health services. Given the limitations of the study design, prospective studies are required, using controlled designs to further elucidate the effect of the program over time.
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Affiliation(s)
| | | | | | | | | | | | - Kay Wilhelm
- St Vincent's Hospital, Faces in the Street, Darlinghurst, Australia
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Fogarty AS, Proudfoot J, Whittle EL, Player MJ, Christensen H, Hadzi-Pavlovic D, Wilhelm K. Men's use of positive strategies for preventing and managing depression: A qualitative investigation. J Affect Disord 2015; 188:179-87. [PMID: 26363615 DOI: 10.1016/j.jad.2015.08.070] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/30/2015] [Accepted: 08/29/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND One in eight men experience depression and men account for 75% of suicides. Previous research has focused on men's reluctance to seek help and use of unhelpful coping strategies. METHOD Thematic analysis was used on transcripts from 21 focus groups and 24 in-depth interviews focused on positive strategies men use to prevent and manage depression. RESULTS In total, 168 men were recruited and the majority (63%) reported no current depression. Four major themes were identified, where men: (1) used a broad variety of positive strategies and made clear distinctions between prevention and management, (2) used strategies that were "typically masculine", as well as challenged expectations of manliness, (3) felt powerless in the face of suicide, and (4) had accumulated wisdom they felt was beneficial for others. Men specifically advised others to talk about problems. Prevention relied upon regular routines for "balance", while management relied upon "having a plan". LIMITATIONS The majority of the men were aged over 55 years and highly educated. Younger men or those without tertiary education may favour different strategies. CONCLUSIONS In contrast to using only unhelpful strategies, the men used a broad range of positive strategies and adapted their use depending on mood, symptom or problem severity. Use of positive strategies was sophisticated, nuanced, and often underlined by a guiding philosophy. Rather than simply reacting to problems, men actively engaged in preventing the development of depressed moods, and made conscious choices about when or how to take action. Clinical and public health implications are discussed.
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Affiliation(s)
- Andrea S Fogarty
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia.
| | - Judy Proudfoot
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia; NHMRC Centre for Research Excellence in Suicide Prevention, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Erin L Whittle
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Michael J Player
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Helen Christensen
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia; NHMRC Centre for Research Excellence in Suicide Prevention, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Dusan Hadzi-Pavlovic
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kay Wilhelm
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia; Faces in the Street, Urban Mental Health and Wellbeing Institute, Level 6, O'Brien Building, Victoria Street, Darlinghurst, NSW 2010, Australia
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Proudfoot J, Fogarty AS, McTigue I, Nathan S, Whittle EL, Christensen H, Player MJ, Hadzi-Pavlovic D, Wilhelm K. Positive strategies men regularly use to prevent and manage depression: a national survey of Australian men. BMC Public Health 2015; 15:1135. [PMID: 26573270 PMCID: PMC4647287 DOI: 10.1186/s12889-015-2478-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/07/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Men are at greater risk than women of dying by suicide. One in eight will experience depression--a leading contributor to suicide--in their lifetime and men often delay seeking treatment. Previous research has focused on men's use of unhelpful coping strategies, with little emphasis on men's productive responses. The present study examines the positive strategies men use to prevent and manage depression. METHOD A national online survey investigated Australian men's use of positive strategies, including 26 strategies specifically nominated by men in a previous qualitative study. Data were collected regarding frequency of use or openness to using untried strategies, depression risk, depression symptoms, demographic factors, and other strategies suggested by men. Multivariate regression analyses explored relationships between regular use of strategies and other variables. RESULTS In total, 465 men aged between 18 and 74 years participated. The mean number of strategies used was 16.8 (SD 4.1) for preventing depression and 15.1 (SD 5.1) for management. The top five prevention strategies used regularly were eating healthily (54.2 %), keeping busy (50.1 %), exercising (44.9 %), humour (41.1 %) and helping others (35.7 %). The top five strategies used for management were taking time out (35.7 %), rewarding myself (35.1 %), keeping busy (35.1 %), exercising (33.3 %) and spending time with a pet (32.7 %). With untried strategies, a majority (58 %) were open to maintaining a relationship with a mentor, and nearly half were open to using meditation, mindfulness or gratitude exercises, seeing a health professional, or setting goals. In multivariate analyses, lower depression risk as measured by the Male Depression Risk Scale was associated with regular use of self-care, achievement-based and cognitive strategies, while lower scores on the Patient Health Questionnaire-9 was associated with regular use of cognitive strategies. CONCLUSIONS The results demonstrate that the men in the study currently use, and are open to using, a broad range of practical, social, emotional, cognitive and problem-solving strategies to maintain their mental health. This is significant for men in the community who may not be in contact with professional health services and would benefit from health messages promoting positive strategies as effective tools in the prevention and management of depression.
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Affiliation(s)
| | | | | | - Sally Nathan
- School of Public Health and Community Medicine, UNSW, Sydney, Australia.
| | | | | | | | - Dusan Hadzi-Pavlovic
- Black Dog Institute, UNSW, Sydney, Australia.
- School of Psychiatry, UNSW, Sydney, Australia.
| | - Kay Wilhelm
- School of Psychiatry, UNSW, Sydney, Australia.
- Faces in the Street, St Vincent's Urban Mental Health and Wellbeing Research Institute, Sydney, Australia.
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Shand FL, Proudfoot J, Player MJ, Fogarty A, Whittle E, Wilhelm K, Hadzi-Pavlovic D, McTigue I, Spurrier M, Christensen H. What might interrupt men's suicide? Results from an online survey of men. BMJ Open 2015; 5:e008172. [PMID: 26474936 PMCID: PMC4611172 DOI: 10.1136/bmjopen-2015-008172] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Men are almost two times more likely to die by suicide than women, yet little research has focused on what is required to prevent suicide among men. This paper aims to investigate what factors interrupt suicidal behaviour in men, and to examine differences according to known suicide risk factors. SETTING Australia. PARTICIPANTS 251 Australian men aged 18 years and over who had made a suicide attempt 6-18 months prior to completing the survey. OUTCOMES The survey canvassed the language men use to describe their depression and suicidality, warning signs, barriers to accessing help and what is needed to interrupt a suicide attempt. ORs and χ(2) were used to test for differences by age, geographic location and current depression severity. RESULTS Of 299 men screened and eligible to participate, 251 completed all or part of the survey. Participants identified different words and warning signs for depression compared with suicidality. The most commonly endorsed barriers to accessing help were not wanting to burden others (66%) and having isolated themselves (63%). Men overwhelmingly endorsed 'I thought about the consequences for my family' as the factor which stopped a suicide attempt (67%). 'I need support from someone I really trust and respect' was also strongly endorsed. There were few differences by age, region or depression severity. CONCLUSIONS Participants were able to identify signs, albeit often subtle ones, that they were becoming depressed or suicidal. Similarly, most were able to identify active strategies to interrupt this downward spiral. Men wanted others to notice changes in their behaviour, and to approach them without judgement.
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Affiliation(s)
- Fiona L Shand
- Black Dog Institute, Sydney, New South Wales, Australia
- NHMRC Centre for Research Excellence in Suicide Prevention, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Judy Proudfoot
- Black Dog Institute, Sydney, New South Wales, Australia
- NHMRC Centre for Research Excellence in Suicide Prevention, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael J Player
- Black Dog Institute, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrea Fogarty
- Black Dog Institute, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Erin Whittle
- Black Dog Institute, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kay Wilhelm
- Black Dog Institute, Sydney, New South Wales, Australia
- NHMRC Centre for Research Excellence in Suicide Prevention, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Faces in the Street, O'Brien Centre, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Dusan Hadzi-Pavlovic
- Black Dog Institute, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Isabel McTigue
- Black Dog Institute, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Spurrier
- University of New South Wales, Sydney, New South Wales, Australia
| | - Helen Christensen
- Black Dog Institute, Sydney, New South Wales, Australia
- NHMRC Centre for Research Excellence in Suicide Prevention, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Whittle EL, Fogarty AS, Tugendrajch S, Player MJ, Christensen H, Wilhelm K, Hadzi-Pavlovic D, Proudfoot J. Men, depression, and coping: Are we on the right path? Psychology of Men & Masculinity 2015. [DOI: 10.1037/a0039024] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Player MJ, Proudfoot J, Fogarty A, Whittle E, Spurrier M, Shand F, Christensen H, Hadzi-Pavlovic D, Wilhelm K. What Interrupts Suicide Attempts in Men: A Qualitative Study. PLoS One 2015; 10:e0128180. [PMID: 26090794 PMCID: PMC4474962 DOI: 10.1371/journal.pone.0128180] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/24/2015] [Indexed: 11/23/2022] Open
Abstract
Despite higher rates of suicide in men, there is a dearth of research examining the perspectives and experiences of males at risk of suicide, particularly in terms of understanding how interventions can be tailored to men’s specific needs. The current study aimed to examine factors assisting, complicating or inhibiting interventions for men at risk, as well as outlining the roles of family, friends and others in male suicide prevention. Thirty-five male suicide survivors completed one-to-one interviews, and forty-seven family and friends of male suicide survivors participated in eight focus groups. Thematic analysis revealed five major themes: (1) development of suicidal behaviours tends to follow a common path associated with specific types of risk factors (disrupted mood, unhelpful stoic beliefs and values, avoidant coping strategies, stressors), (2) men at risk of suicide tend to systematically misinterpret changes in their behaviour and thinking, (3) understanding mood and behavioural changes in men enables identification of opportunities to interrupt suicide progression, (4) distraction, provision of practical and emotional supports, along with professional intervention may effectively interrupt acute risk of harm, and (5) suicidal ideation may be reduced through provision of practical help to manage crises, and helping men to focus on obligations and their role within families. Findings suggest that interventions for men at risk of suicidal behaviours need to be tailored to specific risk indicators, developmental factors, care needs and individuals’ preferences. To our knowledge this is the first qualitative study to explore the experiences of both suicidal men and their family/friends after a suicide attempt, with the view to improve understanding of the processes which are effective in interrupting suicide and better inform interventions for men at risk.
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Affiliation(s)
- Michael J. Player
- Black Dog Institute, Sydney, Australia
- Centre for Research Excellence in Suicide Prevention, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- * E-mail:
| | - Judy Proudfoot
- Black Dog Institute, Sydney, Australia
- Centre for Research Excellence in Suicide Prevention, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Andrea Fogarty
- Black Dog Institute, Sydney, Australia
- Centre for Research Excellence in Suicide Prevention, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Erin Whittle
- Black Dog Institute, Sydney, Australia
- Centre for Research Excellence in Suicide Prevention, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Michael Spurrier
- Black Dog Institute, Sydney, Australia
- Centre for Research Excellence in Suicide Prevention, Sydney, Australia
| | - Fiona Shand
- Black Dog Institute, Sydney, Australia
- Centre for Research Excellence in Suicide Prevention, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Helen Christensen
- Black Dog Institute, Sydney, Australia
- Centre for Research Excellence in Suicide Prevention, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Dusan Hadzi-Pavlovic
- Black Dog Institute, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kay Wilhelm
- Black Dog Institute, Sydney, Australia
- Faces in the Street, O’Brien Centre, St Vincent’s Hospital, Darlinghurst, Sydney, Australia
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Player MJ, Taylor JL, Weickert CS, Alonzo A, Sachdev PS, Martin D, Mitchell PB, Loo CK. Increase in PAS-induced neuroplasticity after a treatment course of transcranial direct current stimulation for depression. J Affect Disord 2015; 167:140-7. [PMID: 24968188 DOI: 10.1016/j.jad.2014.05.063] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 05/28/2014] [Accepted: 05/29/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Several lines of evidence suggest that neuroplasticity is impaired in depression and improves with effective treatment. However until now, this evidence has largely involved measures such as learning and memory which can be influenced by subject effort and motivation. This pilot study aimed to objectively measure neuroplasticity in the motor cortex using paired associative stimulation (PAS), which induces short term neuroplastic changes. It is hypothesized that neuroplasticity would improve after effective treatment for depression. METHODS Neuroplasticity was measured in 18 depressed subjects before and after a course of anodal transcranial direct current stimulation (tDCS), given as treatment for depression. The relationships between PAS results, mood state and brain-derived neurotrophic factor (BDNF) serum levels were examined. RESULTS Neuroplasticity (PAS-induced change) was increased after a course of tDCS (t(17)=-2.651, p=0.017). Treatment with tDCS also led to significant mood improvement, but this did not correlate with improved neuroplasticity. Serum BDNF levels did not change after tDCS, or correlate with change in neuroplasticity after tDCS treatment. LIMITATIONS While this study showed evidence of improved neuroplasticity in the motor cortex after effective treatment, we are unable to present evidence that this change is generalized in the depressed brain. Also, the presence of antidepressant medications and the small sample of patients (n=18) meant the study could not definitively resolve the relationship between neuroplasticity, mood and BDNF. CONCLUSION This novel preliminary study provides evidence that a treatment course of tDCS can improve neuroplasticity in depressed patients.
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Affiliation(s)
- Michael J Player
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Hospital Road, Randwick, Sydney, NSW 2031, Australia
| | - Janet L Taylor
- Neuroscience Research Australia, Sydney, Australia; School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Cynthia Shannon Weickert
- School of Psychiatry, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; Schizophrenia Research Institute, Darlinghurst, Sydney, Australia
| | - Angelo Alonzo
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Hospital Road, Randwick, Sydney, NSW 2031, Australia
| | - Perminder S Sachdev
- School of Psychiatry, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia; Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Australia
| | - Donel Martin
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Hospital Road, Randwick, Sydney, NSW 2031, Australia
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Hospital Road, Randwick, Sydney, NSW 2031, Australia
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Hospital Road, Randwick, Sydney, NSW 2031, Australia; St. George Hospital, South Eastern Sydney Health, Australia.
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Player MJ, Taylor JL, Weickert CS, Alonzo A, Sachdev P, Martin D, Mitchell PB, Loo CK. Neuroplasticity in depressed individuals compared with healthy controls. Neuropsychopharmacology 2013; 38:2101-8. [PMID: 23676792 PMCID: PMC3773676 DOI: 10.1038/npp.2013.126] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/22/2013] [Accepted: 04/29/2013] [Indexed: 01/03/2023]
Abstract
Several lines of evidence suggest that neuroplasticity is impaired in depression. This study aimed to compare neuroplasticity in 23 subjects with DSM-IV major depressive episode and 23 age- and gender-matched healthy controls, using an objective test that is independent of subject effort and motivation. Neuroplasticity was assessed in the motor cortex using a brain stimulation paradigm known as paired associative stimulation (PAS), which induces transient changes in motor cortical function. Motor cortical excitability was assessed before and after PAS using single-pulse transcranial magnetic stimulation (TMS) to induce motor evoked potentials (MEPs) in a hand muscle. After PAS, MEP amplitudes significantly increased in healthy controls compared with depressed subjects (P=0.002). The functional significance of motor cortical changes was assessed using a motor learning task-a computerized version of the rotor pursuit task. Healthy controls also performed better on motor learning (P=0.02). BDNF blood levels and genotype were assayed to determine any relationship with motor cortical plasticity. However, PAS results did not correlate with motor learning, nor appear to be related to BDNF measures. The significance of these findings is that it provides one of the first direct demonstrations of reduced neuroplasticity in depressed subjects, using an objective test.
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Affiliation(s)
- Michael J Player
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia,Black Dog Institute, Sydney, NSW, Australia
| | - Janet L Taylor
- Neuroscience Research Australia, Sydney, NSW, Australia,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Cynthia Shannon Weickert
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia,Neuroscience Research Australia, Sydney, NSW, Australia,The Schizophrenia Research Institute, Sydney, NSW, Australia
| | - Angelo Alonzo
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia,Black Dog Institute, Sydney, NSW, Australia
| | - Perminder Sachdev
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia,Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Donel Martin
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia,Black Dog Institute, Sydney, NSW, Australia
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia,Black Dog Institute, Sydney, NSW, Australia
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia,Black Dog Institute, Sydney, NSW, Australia,St George Hospital, South Eastern Sydney Health, Sydney, NSW, Australia,Black Dog Institute, Hospital Road, Randwick, Sydney, NSW 2031, Australia, Tel: +61 2 9382 8319, Fax: +61 2 9382 8208, E-mail:
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