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Keast S, Broatch JR, Chung S, Dixon R, Dongol R, Emerson L, Hayes A, Iuliano S, Levinger I, Lin X, McKnight E, Moore K, Nagano H, Parker AG, Said CM, Sales M, Thomas R, White C, Zanker J, Gilmartin-Thomas J. Best practice in dementia health care: Key clinical practice pointers from a national conference and innovative opportunities for pharmacy practice. Res Social Adm Pharm 2024; 20:1014-1021. [PMID: 39122588 DOI: 10.1016/j.sapharm.2024.07.005] [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: 03/26/2024] [Revised: 06/24/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE Sub-optimal care of people living with dementia has serious consequences for older populations. The 2021 Australian Royal Commission noted that a large proportion of older adults in aged care live with dementia, yet there are limitations in the knowledge and understanding of staff who care for them. In the pursuit of educating pharmacists, physicians, allied health care professionals, researchers, academics, people living with dementia and their carers, and the public, who are facing the challenges of dementia management, the 'Best Practice in Dementia Health Care' conference was held on November 10, 2022 at Western Health (Sunshine Hospital, Melbourne, Australia). METHODS Sixteen experts presented on the current practice and challenges associated with delivering best practice dementia health care to older Australians, often highlighting how medication-related challenges impacted on their area of practice. RESULTS Presenters highlighted the importance of individualised medication management plans, considerations of culture and Indigenous communities, the role of technology, and the impact of exercise and the physical environment on care of people living with dementia. Key clinical practice messages from each expert presenter fit into four main topics: 'navigating complexities of medication management'; 'enhancing wellbeing'; 'supportive settings and environments'; and 'programs and services improving care'. CONCLUSIONS Pharmacists are crucial members of allied health care teams. They have the necessary medication and comorbidity expertise to review medication regimens, liaise with all health care providers, and provide holistic, pharmacological and non-pharmacological patient education. Towards providing best practice dementia health care, pharmacists can contribute in several ways, such as providing health practitioner education to increase understanding about medications and how they can impact on allied health practice, to ensure that medications are prescribed appropriately and safely. Further, pharmacists can make available resources to ensure people living with dementia receive culturally safe and appropriate care, while advocating for greater understanding of the history and experiences of people living with dementia to ensure care aligns with their day-to-day routines. Finally, pharmacists can provide peer-support to other health care professionals and care staff to ensure optimal management of behavioural and psychological symptoms of dementia. The information and insights shared at the conference can serve as a valuable resource for pharmacists and other health care professionals and researchers working to improve the lives of those living with dementia.
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Marinelli R, Parker AG, Levinger I, Bourke M, Patten R, Woessner MN. Resistance training and combined resistance and aerobic training as a treatment of depression and anxiety symptoms in young people: A systematic review and meta-analysis. Early Interv Psychiatry 2024; 18:585-598. [PMID: 38710640 DOI: 10.1111/eip.13528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024]
Abstract
AIM To determine the treatment effect of resistance training in reducing symptoms of anxiety and depression in young people. METHODS We searched MEDLINE, PsychINFO, and PubMed for articles published in English from January 1980 to September 2023 for randomized controlled trials (RCT) that included at least 4 weeks of resistance training, with participants aged 26 years or younger with clinically elevated anxiety and depression symptoms. A random-effects meta-analysis was used to calculate a pooled effect size of resistance training pre-and post-intervention compared to control groups. The quality of evidence was assessed using the Cochrane risk-of-bias 2 (RoB 2) and Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria. RESULTS Ten RCTs involving 376 participants (209 females and 127 males) across educational, clinical, and community based setting were eligible for inclusion in the analysis. Resistance training was associated with a significant reduction in depressive (Hedge's g = -1.06, 95% CI -1.61 to -0.51, p < .001) and anxiety (Hedge's g = -1.02, 95% CI -1.50 to -0.54, p < .001) symptoms. Substantial heterogeneity was observed in the analysis of depression symptoms (I2 = 79%) and anxiety symptoms (I2 = 66%). Six trials had a low risk of bias, four trials showed some concerns. The GRADE analysis demonstrated a high level of certainty for depressive symptoms and a moderate level for anxiety symptoms. CONCLUSION Resistance training is an effective intervention in reducing depression and anxiety symptoms in young people, delivered across a range of settings. Future trials exploring the effect resistance training interventions with long-term follow up are warranted to understand the outcomes.
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Brockett CL, Stansen C, Bourke M, Pascoe M, Clements M, Parker AG. Factors that influence mental health and well-being of high-performance athletes from Olympic or Paralympic sport who have transitioned out of national-level or international-level sport: a mixed methods approach. BMJ Open Sport Exerc Med 2024; 10:e001991. [PMID: 38827245 PMCID: PMC11141181 DOI: 10.1136/bmjsem-2024-001991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/04/2024] Open
Abstract
Transitioning out of elite sports can be a challenging time for athletes. To illuminate the gaps and opportunities in existing support systems and better understand which initiatives may have the greatest benefit in supporting athletes to transition out of elite sport, this study examined the lived experience of retired elite Australian athletes. Using a sequential mixed-methods approach, quantitative data were collected via a self-report online survey, while qualitative data were collected via semistructured interviews. In total 102 retired high-performance athletes (M=27.35, SD=7.25 years) who competed in an Olympic or Paralympic recognised sport at the national and/or international-level participated in the online survey, providing data across domains of well-being and athletic retirement. Eleven survey respondents opted in for the semistructured interview (M=28.9, SD=6.9 years) providing in-depth responses on their retirement experiences. Using partial least squares structural equation modelling (PLS-SEM), latent variables were identified from the survey data and associations between retirement support, retirement difficulties, retirement experiences, well-being and mental health were determined. Interview data were thematically analysed. The structural model had good predictive validity for all nine latent variables, describing positive and negative associations of retirement experiences, mental health and well-being. Building an identity outside of sport, planning for retirement, and having adaptive coping strategies positively impacted retirement experiences. Feeling behind in a life stage and an abrupt loss of athletic identity had a negative impact on retirement experiences. Implications for sports policymakers are discussed, including support strategies that could better assist athletes in successfully transitioning from elite sports.
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Klamert L, Craike M, Bedi G, Kidd S, Pascoe MC, Parker AG. Underreporting of implementation strategies and barriers in physical activity interventions for young people at risk of problematic substance use: a brief report. Implement Sci Commun 2024; 5:45. [PMID: 38649968 PMCID: PMC11036629 DOI: 10.1186/s43058-024-00578-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/05/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Several studies have assessed whether physical activity interventions can reduce substance use in young people at risk of problematic substance use. This report identifies and describes the reporting of implementation characteristics within published studies of physical activity interventions for young people at risk of problematic substance use and provides recommendations for future reporting. METHODS Reported implementation strategies (including intervention manualization), barriers, implementation fidelity, and personnel acceptance were extracted from studies of physical activity interventions for young people aged 12-25 years at risk of problematic substance use that were included in a previous systematic review of intervention efficacy. RESULTS Implementation strategies were reported in less than half of the included studies (42.9%), implementation barriers in only 10.7% of studies, intervention fidelity in 21.4%, and personnel acceptance in a single study (3.6%). CONCLUSIONS Results indicate insufficient reporting of implementation strategies, barriers, fidelity, and personnel acceptance. Consideration of implementation characteristics is essential for implementing physical activity interventions in practice. Inadequate or limited reporting of these characteristics may contribute to delayed uptake and adoption of evidence-based interventions in clinical practice. Recommendations to improve the reporting of implementation information include integrating standards for reporting implementation characteristics into existing reporting guidelines, developing an international taxonomy of implementation strategies, and upskilling intervention researchers in the fundamentals of implementation science.
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Klamert L, Craike M, Bedi G, Kidd S, Pascoe MC, Parker AG. Behaviour change techniques in physical activity-focused interventions for young people at risk of problematic substance use: A systematic review and meta-analysis. Early Interv Psychiatry 2023; 17:1139-1153. [PMID: 37749782 DOI: 10.1111/eip.13467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/06/2023] [Accepted: 09/08/2023] [Indexed: 09/27/2023]
Abstract
AIM This systematic review investigates behaviour change techniques in interventions promoting physical activity for young people aged 12-25 years at heightened risk of problematic substance use, and the effect of these techniques on physical activity participation and substance use outcomes. METHODS Four databases (PsycINFO, CINAHL, SPORTDiscus and Medline) were searched between November 2020 and November 2022 for randomized and non-randomized controlled studies according to inclusion criteria. Meta-analyses were calculated using weighted, standardized averages of effect sizes (Hedges' g). RESULTS Twenty-eight studies were included, 14 studies in the meta-analysis (intervention n = 1328; control n = 845). Reported BCTs included behavioural instructions, social comparison and goal setting. There was a significant effect of behaviour change techniques on combined substance use outcomes, such as cravings and consumption, for interventions reporting multiple behaviour change techniques (g = -0.33, p < .001, 95% CI [-0.50,-0.16]) or one single behaviour change technique (g = -1.84, p < .001, 95% CI [-2.89,-0.8]). Limitations include unexplained variance and limited reporting of relevant behaviour change technique data in the included studies. CONCLUSION The results indicate that using behaviour change techniques in interventions that promote physical activity for young people has an effect on substance use. Further research needs to be completed comparing the impact of the number and type of behaviour change technique, and improved reporting of intervention content is required.
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Gao CX, Filia KM, Bedi G, Menssink JM, Brown E, Rickwood DJ, Parker AG, Hetrick SE, Herrman H, Hickie I, Telford N, McGorry PD, Cotton SM. Understanding the complexity, patterns, and correlates of alcohol and other substance use among young people seeking help for mental ill-health. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1457-1467. [PMID: 36914881 PMCID: PMC10460308 DOI: 10.1007/s00127-023-02444-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Use of alcohol and other substances is a multifaceted issue impacting young people across multiple life domains. This paper aims to elucidate patterns of substance use and associated demographic and clinical factors among young people seeking treatment for their mental health. METHODS Young people (12-25 years old) were recruited from five youth-specific primary mental health ("headspace") services in Australia. Self-reported substance use and harms in the past 3 months were measured using WHO-ASSIST. Network analyses were conducted to evaluate interrelationships between use and harms associated with different substances. Subgroups were then identified based on whether participants reported using high centrality substances, and associated demographic and clinical factors were assessed with multinomial logistic regression. RESULTS 1107 youth participated. 70% reported use of at least one substance in the past 3 months, with around 30% of those reporting related health, social, legal or financial problems. Network analysis highlighted substantial interconnections between use and harm indicators for all substances, with amphetamine-type stimulants (ATS) and cannabis being high central substances. Higher levels of substance use and harms were reported in subgroups with ATS or cannabis use and different risk factors were associated with these subgroups. CONCLUSIONS Findings highlight the importance of screening for substance use in youth primary mental healthcare settings, offering a key opportunity for early intervention. Clinicians should be aware of the inner connections of use and harms of different drugs and the role of cannabis and amphetamine use as a marker for more substance use profiles.
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Cotton SM, Sharmin S, Gao CX, Brown E, Menssink JM, Rickwood D, Bedi G, Hickie I, Hetrick SE, Parker AG, Herrman H, Telford N, McGorry PD, Filia KM. Prevalence and Correlates of Tobacco Use in Young People Presenting to Australian Primary Mental Health Services. Nicotine Tob Res 2023; 25:682-691. [PMID: 35665823 DOI: 10.1093/ntr/ntac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 12/20/2021] [Accepted: 02/07/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION In Australian youth primary mental health settings it is unclear as to the rates and correlates of tobacco use at service entry. AIMS AND METHODS We aimed to delineate the prevalence and correlates of recent tobacco use (eg, cigarettes, chewing tobacco, cigars, etc) in the past 3 months in young people at their first presentation to primary mental health services as a function of age. Cross-sectional self-report measures were collected using a tablet device from young people presenting to one of five Australian primary mental health (headspace) services. Logistic regression assessed correlates of past 3-month tobacco use in adolescents (12-17 years) and young adults (18-25 years). RESULTS Regular (at least monthly) tobacco use in the past 3 months was found in 23.4% (n = 247, N = 1055) of the sample. Increasing age (odds ratio [OR] =1.47 per year; 95% confidence interval [CI]: 1.15 to 1.89), male sex (OR = 1.98; 95% CI: 1.02 to 3.83), being in a relationship (OR = 1.96; 95% CI: 1.01 to 3.82), and poorer functioning (OR = 0.95 per unit Social and Occupational Functioning Assessment Scale increase; 95% CI: 0.91 to 0.99) predicted regular tobacco use in adolescents, but not in young adults. Living in a regional location (OR = 2.10; 95% CI: 1.40 to 3.13) and not studying (OR = 0.47; 95% CI: 0.31 to 0.73) predicted tobacco use in young adults. Having a diagnosed mental illness other than depression and/or anxiety predicted tobacco use in both groups (adolescents OR = 2.49; 95% CI: 1.26 to 4.94; young adults OR = 1.80; 95% CI: 1.13 to 2.89). CONCLUSIONS Nearly a quarter of young people with mental illness are using tobacco, supporting the need for early intervention approaches. Adapting treatment targets by age could improve the impact of interventions in adolescents versus young adults. Poor functioning and lack of engagement in education were associated with tobacco use in both age groups, respectively; however, more research is needed to determine the direction of these relationships. IMPLICATIONS Young people with mental illness have a high prevalence of recent tobacco use and this is evident when they first present to youth primary mental health services. Youth-oriented mental health settings may provide a unique window for tobacco use prevention and early intervention to reduce smoking in people with mental illness, a priority population. Age-specific targeted approaches might be needed in adolescents and young adults.
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Patten RK, McIlvenna LC, Moreno-Asso A, Hiam D, Stepto NK, Rosenbaum S, Parker AG. Efficacy of high-intensity interval training for improving mental health and health-related quality of life in women with polycystic ovary syndrome. Sci Rep 2023; 13:3025. [PMID: 36810865 PMCID: PMC9944288 DOI: 10.1038/s41598-023-29503-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023] Open
Abstract
Women with PCOS have substantially greater symptoms of depression and anxiety, and a lower health-related quality of life (HRQoL) compared to women without PCOS. The aim of this study was to determine if high-intensity interval training (HIIT) could provide greater improvements in mental health outcomes than standard moderate-intensity continuous training (MICT). Twenty-nine overweight women with PCOS aged 18-45 years were randomly assigned to 12 weeks of either MICT (60-75% HRpeak, N = 15) or HIIT (> 90% HRpeak, N = 14). Outcome measures included symptoms of depression, anxiety and stress (DASS-21), general HRQoL (SF-36) and PCOS specific HRQoL (PCOSQ) collected at baseline and post-intervention. Reductions in depression (Δ - 1.7, P = 0.005), anxiety (Δ - 3.4, P < 0.001) and stress (Δ - 2.4, P = 0.003) scores were observed in the HIIT group, while MICT only resulted in a reduction in stress scores (Δ - 2.9, P = 0.001). Reductions in anxiety scores were significantly higher in the HIIT group compared to the MICT group (β = - 2.24, P = 0.020). Both HIIT and MICT significantly improved multiple domain scores from the SF-36 and PCOSQ. This study highlights the potential of HIIT for improving mental health and HRQoL in overweight women with PCOS. HIIT may be a viable strategy to reduce symptoms of depression and anxiety in women with PCOS, however, large-scale studies are required to confirm these findings.Trial registration number: ACTRN12615000242527.
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Pankowiak A, Woessner MN, Parent S, Vertommen T, Eime R, Spaaij R, Harvey J, Parker AG. Psychological, Physical, and Sexual Violence Against Children in Australian Community Sport: Frequency, Perpetrator, and Victim Characteristics. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:4338-4365. [PMID: 35944902 DOI: 10.1177/08862605221114155] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Childhood sport participation is associated with physical, social, and mental health benefits, which are more likely to be realized if the sport environment is safe. However, our understanding of children's experience of psychological, physical, and sexual violence in community sport in Australia is limited. The aims of this study were to provide preliminary evidence on the extent of experiences of violence during childhood participation in Australian community sport and to identify common perpetrators of and risk factors for violence. The Violence Towards Athletes Questionnaire (VTAQ) was administered online to a convenience sample of Australian adults (>18 years), retrospectively reporting experiences of violence during childhood community sport. Frequencies of experience of violence were calculated and Chi-square tests were conducted to determine differences between genders. In total, there were 886 respondents included in the analysis. Most survey respondents were women (63%) and about a third were men (35%). About 82% of respondents experienced violence in sport as a child. Psychological violence was most prevalent (76%), followed by physical (66%) and sexual (38%) violence. Peers perpetrated the highest rates of psychological violence (69%), and the rates of physical and psychological violence by coaches (both >50%) were also high. Age, sexual orientation, disability, and hours of weekly sport participation as a child were all associated with childhood experience of violence in sport. The rates of interpersonal violence against children in sport were high. This novel data on perpetrators of the violence and the risk factors for experiencing violence provides further context to inform safeguarding strategies in sport. A national prevalence study is recommended to advance our understanding of the childhood experiences of violence in Australian sport.
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Dash S, Bourke M, Parker AG, Trott E, Pascoe MC. Mindfulness is associated with reduced barriers to exercise via decreasing psychological distress in help-seeking young adults: A cross-sectional brief report. Early Interv Psychiatry 2022; 16:1049-1054. [PMID: 34825493 DOI: 10.1111/eip.13249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 10/14/2021] [Accepted: 11/07/2021] [Indexed: 01/05/2023]
Abstract
AIM Mental illness is common among young people. Exercise has benefits for mental health; however, young people experience a range of barriers to engaging in physical activity, one of which is psychological distress. Mindfulness is a modifiable factor that can reduce distress and may, in turn, reduce perceived barriers to physical activity. The aim of this work was to explore associations between dispositional mindfulness, psychological distress and barriers to engaging in physical activity. METHODS We used cross-sectional survey data from young adults aged 15-25 years who attended youth mental health services (headspace centres). Demographic, mindfulness, exercise barriers and wellbeing data were collected. RESULTS Mediation analysis showed that greater dispositional mindfulness reduced perceived barriers to exercise via reductions in psychological distress among 88 help-seeking young Australians. CONCLUSION Interventions to increase dispositional mindfulness may be helpful in reducing psychological distress and lessening barriers to exercise engagement, therefore promoting mental health among young people experiencing mental health symptoms.
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Dash S, Bourke M, Parker AG, Dadswell K, Pascoe MC. Lifestyle behaviours and mental health and wellbeing of tertiary students during COVID-19 lockdown in Australia: A cross-sectional study. Compr Psychiatry 2022; 116:152324. [PMID: 35576672 PMCID: PMC9085438 DOI: 10.1016/j.comppsych.2022.152324] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Australia experienced significant COVID-19 lockdown restrictions throughout 2020 that had an impact on mental health and disrupted health-promoting lifestyle behaviours. Lockdowns may have exacerbated existing mental health concerns among tertiary students, who experience higher levels of mental health concerns compared to the wider community. This study aimed to investigate the association between modifiable lifestyle factors and wellbeing of students at a Melbourne-based tertiary education institution during COVID-19 lockdown. METHODS This quantitative, cross-sectional study was conducted across campuses in Melbourne and Sydney. Data was collected via online questionnaire during the 7th week of a second-wave lockdown. Descriptive statistics were calculated for demographic variables (n = 239). Linear regression models were estimated to determine multivariate associations between lifestyle variables and psychological distress. RESULTS Participants were on average 30.98 years old (SD = 9.78), predominantly female, domestic students, undergraduate, not the first member of their family to attend university and living out of family home. Mindfulness, diet quality, sleep quality and moderate-vigorous physical activity (MVPA) were all inversely correlated with psychological distress. Unadjusted and adjusted models show that mindfulness, sleep quality, and MVPA were all independently inversely related to psychological distress. Greater mindfulness, sleep quality and engagement in MVPA were associated with lower psychological distress during COVID-19 lockdowns. LIMITATIONS As this study is cross-sectional and we cannot rule out reverse causality. CONCLUSION This study highlights the potential for lifestyle focused mental-health promotion delivered through tertiary education institutions to support students in times of crisis as well as more generally.
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Allott K, Gao CX, Fisher C, Hetrick SE, Filia KM, Menssink JM, Herrman HE, Rickwood DJ, Parker AG, McGorry PD, Cotton SM. The Neuropsychological Symptoms Self-Report: psychometric properties in an adolescent and young adult mental health cohort. Child Adolesc Ment Health 2022; 27:111-121. [PMID: 33913237 DOI: 10.1111/camh.12473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Subjective cognitive symptoms are common in young people receiving mental health treatment and are associated with poorer outcomes. The aim of this study was to determine the psychometric properties of the Neuropsychological Symptoms Self-Report (NSSR), an eight-item measure recently developed to provide a snapshot of young people's perceived change in cognitive functioning in relation to mental health treatment. METHOD The sample included 633 youth aged 12-25 years (Mage = 18.2, 66.5% female, 88.6% Australian-born) who had sought mental health treatment in primary headspace services. At three-month follow-up, participants completed the NSSR and self-report measures of depression and anxiety. RESULTS Excellent internal consistency was found: Cronbach's alpha = 0.93. The NSSR had negative correlations with self-reported anxiety (r = -.33, p < .001) and depression (r = -.48, p < .001) symptoms, suggesting a link with affective symptoms, but still independence of constructs. Exploratory and confirmatory factor analyses supported a single-factor model. Item response theory (IRT) analysis suggested good model fit (homogeneity, data integrity, scalability, local independence and monotonicity) for all items. There was some evidence of measurement noninvariance (for item thresholds) by sex and age, but not diagnosis. IRT models also supported briefer six- and three-item versions of the NSSR. CONCLUSION In busy clinical practice, clinicians need a rapid and reliable method for determining whether cognitive symptoms are of concern and in need of further assessment and treatment. Study findings support the NSSR as a brief, psychometrically sound measure for assessing subjective cognitive functioning in adolescents and young adults receiving mental health treatment.
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Parker AG, Trott E, Bourke M, Klepac Pogrmilovic B, Dadswell K, Craike M, McLean SA, Dash S, Pascoe M. Young people's attitudes towards integrating physical activity as part of mental health treatment: A cross-sectional study in youth mental health services. Early Interv Psychiatry 2022; 16:518-526. [PMID: 34312996 DOI: 10.1111/eip.13189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/18/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Due to the significant burden associated with mental disorders that have their onset in youth, there is a critical need to improve treatments and treatment outcomes. Given the evidence for physical activity (PA) as an effective intervention for reducing depression and anxiety symptoms in young people, we examined young people's attitudes towards and acceptability of PA as part of mental health treatment, predictors of current engagement in PA and predictors of attitudes towards PA as a treatment option. METHODS Participants in this cross-sectional study were 88 young people (15-25 years) who were engaged in treatment at youth mental health services in Melbourne, Australia. RESULTS Young people's attitudes towards PA as a treatment option were generally positive. The acceptance of PA as a treatment option was predicted by fewer perceived barriers and more benefits to exercise, higher autonomous motivation and lower amotivation; whereas, the only significant predictor of current engagement in PA was autonomous motivation. DISCUSSION The integration of PA interventions within mental health treatment appears to be acceptable to young people; however, acceptance of PA as a treatment option is influenced by perceived barriers and benefits of PA and autonomous motivation. A focus on increasing autonomous motivation by enhancing the perceived value of PA and choosing preference-based, enjoyable activities may assist in addressing the complex range of factors that impact the ability of these young people to become more physically active. Addressing these factors may assist with implementing PA interventions within psychological treatments for mental disorders.
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Jarman HK, McLean SA, Griffiths S, Teague SJ, Rodgers RF, Paxton SJ, Austen E, Harris E, Steward T, Shatte A, Khanh-Dao Le L, Anwar T, Mihalopoulos C, Parker AG, Yager Z, Fuller-Tyszkiewicz M. Critical measurement issues in the assessment of social media influence on body image. Body Image 2022; 40:225-236. [PMID: 35032949 DOI: 10.1016/j.bodyim.2021.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023]
Abstract
Progress towards understanding how social media impacts body image hinges on the use of appropriate measurement tools and methodologies. This review provides an overview of common (qualitative, self-report survey, lab-based experiments) and emerging (momentary assessment, computational) methodological approaches to the exploration of the impact of social media on body image. The potential of these methodologies is detailed, with examples illustrating current use as well as opportunities for expansion. A key theme from our review is that each methodology has provided insights for the body image research field, yet is insufficient in isolation to fully capture the nuance and complexity of social media experiences. Thus, in consideration of gaps in methodology, we emphasise the need for big picture thinking that leverages and combines the strengths of each of these methodologies to yield a more comprehensive, nuanced, and robust picture of the positive and negative impacts of social media.
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Filia K, Menssink J, Gao CX, Rickwood D, Hamilton M, Hetrick SE, Parker AG, Herrman H, Hickie I, Sharmin S, McGorry PD, Cotton SM. Social inclusion, intersectionality, and profiles of vulnerable groups of young people seeking mental health support. Soc Psychiatry Psychiatr Epidemiol 2022; 57:245-254. [PMID: 34091699 DOI: 10.1007/s00127-021-02123-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/02/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND headspace centres provide enhanced primary mental healthcare for young people. A priority is to provide services for all young people irrespective of a range of social disadvantages or social exclusion. The aims of this study were to: (i) delineate extent of social inclusion across domains of housing, studying/employment, functioning, alcohol, and other drug use; and (ii) map profiles of young people deemed vulnerable to experiencing additional barriers to accessing services based on their social inclusion domains (e.g., those living in unstable housing, not in employment/education, and/or experiencing intersecting or multiple forms of disadvantage or difficulties), including detailing their clinical characteristics. METHODS Young people were recruited from five headspace centres. Data relevant to social inclusion were examined. Multivariate logistic regression models were used to determine overlap between vulnerable groups, functional, social, clinical, and behavioural factors. RESULTS 1107 young people participated, aged 12-25 years (M = 18.1 years, SD = 3.3), most living in stable housing (96.5%) and engaged in studying/employment (84.8%). Specific vulnerabilities were evident in young people with NEET status (15.2%); in unstable accommodation (3.5%); of culturally diverse backgrounds (CALD) (12.2%); living in regional areas (36.1%); and identifying as lesbian, gay, bisexual, transgender, intersex, queer/questioning, and asexual plus (LGBTIQA+; 28.2%). Higher levels of distress, substance use, functional impairment, and lower social support were reported by those who were NEET and/or in unstable housing. LGBTIQA+ status was associated with high distress, depressive symptoms, and suicidal ideation. CONCLUSIONS Most participants reported good social support, stable housing, and engagement in work or education. Those deemed vulnerable were likely to experience social exclusion across multiple domains and reported more mental health problems. The co-occurrence of mental ill-health and social exclusion highlights the importance of integrated mental healthcare.
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Bourke M, Patten RK, Dash S, Pascoe M, Craike M, Firth J, Bailey A, Jacka F, Parker AG. The Effect of Interventions That Target Multiple Modifiable Health Behaviors on Symptoms of Anxiety and Depression in Young People: A Meta-Analysis of Randomized Controlled Trials. J Adolesc Health 2022; 70:208-219. [PMID: 34580029 DOI: 10.1016/j.jadohealth.2021.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This meta-analysis aimed to determine the effect of interventions targeting multiple modifiable health behaviors (i.e., physical activity/sedentary behaviors, nutrition/diet, sleep, substance use) on depression and anxiety in young people. METHODS A search of electronic databases from inception until May 2020 was conducted. Randomized controlled trials (RCTs) that explicitly targeted at least two modifiable health behaviors, measured anxiety or depression at baseline and after intervention using a validated instrument, and included participants with an average age between 12 and 25 years were included. The effect of interventions was synthesized using random effects meta-analysis. RESULTS A total of 14 RCTs reporting on depression and six RCTs reporting on anxiety were included in the quantitative synthesis. Results showed that although interventions targeting multiple modifiable health behaviors did not produce significant reductions in symptoms of depression (g¯ = -.16, 95% confidence interval [CI] = [-.34, .02], 95% prediction interval [PI] = [-.80, .48], very low certainty evidence) or anxiety (g¯ = -.55, 95% CI = [-1.36, .26], 95% PI = [-3.48, 2.83], very low certainty evidence) across all young people, there was a significant difference in the effect of interventions on depression based on intervention type (Q = 8.37, df = 2, p = .012). Specifically, interventions targeting multiple modifiable health behaviors delivered to groups of young people with an elevated risk of depression had a favorable effect (g¯ = -.28, 95% CI = [-.52, -.05], 95% PI = [-1.04, .47]) on symptoms of depression compared with controls. CONCLUSIONS Although not universally effective, this meta-analysis establishes the potential efficacy of targeted interventions aiming to improve multiple modifiable health behaviors to address depression in young people at elevated risk of depression. More research is needed to understand the effect of such interventions on symptoms of anxiety in young people.
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Pascoe MC, Dash S, Klepac Pogrmilovic B, Patten RK, Parker AG. The engagement of tertiary students with an online mental health intervention during the coronavirus disease 2019 pandemic: A feasibility study. Digit Health 2022; 8:20552076221117746. [PMID: 36060613 PMCID: PMC9434656 DOI: 10.1177/20552076221117746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background We discuss the feasibility of a brief, online mental health promotion
programme for tertiary students and establish recommendations for future
programmes. Methods The programme ‘Student Elevenses’ was delivered at a tertiary education
institution. ‘Student Elevenses’ aimed to promote student wellbeing during
the coronavirus disease 2019 crisis, comprised of 10–15-min daily online
micro-interventions targeting six lifestyle areas for wellbeing, and was
delivered via video conference. Upon programme completion, all students were
invited to complete barriers to engagement survey, irrespective of whether
they had attended or heard of the programme. Descriptive statistics were
calculated for demographics, as well as feasibility and acceptability
outcomes including recruitment rates, attendance rates and reported barriers
to attendance. Open-ended questions were coded for themes. Results Less than 1% of those who consented to participate actually attended the
programme, with attendance ranging from 2 to 17 participants. Participants
were predominantly female (68%), domestic students (81%) and had a mean age
of 29.5 years. The barriers students reported included fixed time, online
format, a belief programme would not be helpful, preference for existing
supports and perceived impacts of coronavirus disease 2019. Students
recommended embedding support within policies/teaching, offering a range of
supports and involving students in design. Conclusion Barriers to mental health promotion via telehealth should be considered to
promote accessibility and acceptability for tertiary students. Future
programmes should consider reaching students through mandatory activities
(e.g. lectures, tutorials) and should include student consultation and
co-design to support the development of programmes that meet student needs
and preferences.
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Patten RK, Pascoe MC, Moreno-Asso A, Boyle RA, Stepto NK, Parker AG. Effectiveness of exercise interventions on mental health and health-related quality of life in women with polycystic ovary syndrome: a systematic review. BMC Public Health 2021; 21:2310. [PMID: 34930180 PMCID: PMC8690971 DOI: 10.1186/s12889-021-12280-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/22/2021] [Indexed: 12/19/2022] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is a complex condition, impacting cardio-metabolic and reproductive health, mental health and health-related quality of life. The physical health benefits of exercise for women with PCOS are well-established and exercise is increasingly being recognised as efficacious for improving psychological wellbeing. The aim of this review was to summarise the evidence regarding the effectiveness of exercise interventions on mental health outcomes in women with PCOS. Methods A systematic search of electronic databases was conducted in March of 2020. Trials that evaluated the effect of an exercise intervention on mental health or health-related quality of life outcomes in reproductive aged women with diagnosed PCOS were included. Methodological quality was assessed using the modified Downs and Black checklist. Primary outcomes included symptoms of depression and anxiety, and health-related quality of life. Results Fifteen articles from 11 trials were identified and deemed eligible for inclusion. Exercise demonstrated positive improvements in health-related quality of life in all of the included studies. Half of included studies also reported significant improvements in depression and anxiety symptoms. There was large variation in methodological quality of included studies and in the interventions utilised. Conclusions The available evidence indicates that exercise is effective for improving health-related quality of life and PCOS symptom distress. Exercise also shows some efficacy for improving symptoms and/or prevalence of depression and anxiety in women with PCOS. However, due to large heterogeneity of included studies, conclusions could not be made regarding the impact of exercise intervention characteristics. High-quality trials with well reported exercise intervention characteristics and outcomes are required in order to determine effective exercise protocols for women with PCOS and facilitate translation into practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12280-9.
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Nguyen D, Kleeman NJ, Yager Z, Parker AG, Shean MB, Jefferies W, Wilson-Evered E, Pucinischi CP, Pascoe MC. Identifying barriers and facilitators to implementing mindfulness-based programmes into schools: A mixed methods study. Appl Psychol Health Well Being 2021; 14:1172-1188. [PMID: 34907664 DOI: 10.1111/aphw.12329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022]
Abstract
Mindfulness-based initiatives have been shown to improve psychological wellbeing and increase academic engagement in school settings. The current study explored barriers and facilitators to the implementation of mindfulness-based (MB) programmes in schools. Ninety-five teachers completed an online survey, and six principals were interviewed, with questions for both informed by the Theoretical Domains Framework (TDF). Quantitative data was analysed via descriptive statistics and independent sample t tests. Qualitative interview data were analysed via thematic analysis. Teachers reported facilitators to successful MB programme implementation as self-efficacy and motivation, knowledge about MB programmes, acceptance of responsibility to deliver MB programmes and belief of negative consequences if MB programmes are not delivered. Principals reported organisational-level facilitators as having a school-wide positive education framework relevant to the school context, taking a long-term approach, school leaders supporting the initiatives and understanding the evidence behind MB programmes and empowering staff to engage in mindfulness. Individual-level facilitators included staff buy-in and commitment to practice and understanding mindfulness. Barriers included time, resources/money, staff buy-in and competing strategic priorities within the school. These findings are important for consideration by policymakers determining the way forward for more widespread implementation of MB programmes in Australia.
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Pascoe MC, Bailey AP, Craike M, Carter T, Patten RK, Stepto NK, Parker AG. Single Session and Short-Term Exercise for Mental Health Promotion in Tertiary Students: A Scoping Review. SPORTS MEDICINE - OPEN 2021; 7:72. [PMID: 34635969 PMCID: PMC8505587 DOI: 10.1186/s40798-021-00358-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/11/2021] [Indexed: 01/30/2023]
Abstract
Exercise can improve mental health; however many tertiary students do not reach recommended levels of weekly engagement. Short-term exercise may be more achievable for tertiary students to engage in to promote mental health, particularly during times of high stress. The current scoping review aimed to provide an overview of controlled trials testing the effect of short-term (single bout and up to 3 weeks) exercise across mental health domains, both at rest and in response to an experimentally manipulated laboratory stress task, in tertiary students. The search was conducted using 'Evidence Finder,' a database of published and systematic reviews and controlled trials of interventions in the youth mental health field. A total of 14 trials meet inclusion criteria, six measured mental health symptoms in response to an experimentally manipulated laboratory stress task and the remaining eight measured mental health symptoms. We found that short-term exercise interventions appeared to reduce anxiety like symptoms and anxiety sensitivity and buffered against a drop in mood following an experimentally manipulated laboratory stress task. There was limited available evidence testing the impacts of exercise on depression like symptoms and other mental health mental health domains, suggesting further work is required. Universities should consider implementing methods to increase student knowledge about the relationship between physical exercise and mental health and student access to exercise facilities.
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Pascoe MC, Bailey AP, Craike M, Carter T, Patten RK, Stepto NK, Parker AG. Poor reporting of physical activity and exercise interventions in youth mental health trials: A brief report. Early Interv Psychiatry 2021; 15:1414-1422. [PMID: 32924318 PMCID: PMC8451843 DOI: 10.1111/eip.13045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/03/2020] [Accepted: 08/30/2020] [Indexed: 12/11/2022]
Abstract
AIM To describe the quality and completeness of the description and reporting of physical activity and exercise interventions delivered to young people to promote mental health or treat mental illness. METHODS We conducted a series of scoping reviews identifying 64 controlled trials of physical activity and exercise interventions delivered to young people. We extracted: intervention characteristics, personnel and delivery format, the intensity, duration, frequency and type of physical activity or exercise. RESULTS There was limited reporting of intervention details across studies; 52% did not provide information to confidently assess intervention intensity, 29% did not state who delivered the intervention, and 44% did not specify the intervention delivery format. CONCLUSIONS We recommend that authors adhere to the CONSORT reporting requirements and its intervention reporting extensions, (a) the Template for Intervention Description and Replication, (b) Consensus for Exercise Reporting Template and (c) as part of this, detail the frequency, intensity, time and type of physical activity recommendations and prescriptions. Without this, future trials are unable to replicate and extend previous work to support or disconfirm existing knowledge, leading to research waste and diminishing translation and implementation potential.
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Woessner MN, Tacey A, Levinger-Limor A, Parker AG, Levinger P, Levinger I. The Evolution of Technology and Physical Inactivity: The Good, the Bad, and the Way Forward. Front Public Health 2021; 9:655491. [PMID: 34123989 PMCID: PMC8193221 DOI: 10.3389/fpubh.2021.655491] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/05/2021] [Indexed: 12/29/2022] Open
Abstract
Since the beginning of time people explored and developed new technologies to make their activities of daily living less labour intense, more efficient and, consequently, more sedentary. In addition, technological advances in medicine throughout history have led to a substantial increase in life expectancy. However, the combination of increased sedentary behaviour and increased life-expectancy resulted in a sharp increase in overweight and obesity related chronic conditions and illness. Although people may live longer, they are doing so with poorer physical function and a reduced quality of life. In this review we explore how technological advances have influenced people's sedentary behaviour and, through the lens of the affective-reflective theory (ART), we propose a means by which technology could be repurposed to encourage greater engagement in physical activity.
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Carter T, Pascoe M, Bastounis A, Morres ID, Callaghan P, Parker AG. The effect of physical activity on anxiety in children and young people: a systematic review and meta-analysis. J Affect Disord 2021; 285:10-21. [PMID: 33618056 DOI: 10.1016/j.jad.2021.02.026] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND There is emerging evidence that physical activity can have beneficial effects on anxiety. A comprehensive synthesis of the evidence of the anxiolytic effects of physical activity from randomised controlled trials (RCTs) in children and young people (CYP) is warranted. METHODS A search of 13 databases was conducted to identify RCTs testing the effects of physical activity on anxiety symptoms in children and young people (up to 25 years). Screening, data extraction and risk of bias assessment (using the Cochrane Collaboration tool for assessing risk of bias) were independently undertaken by two study authors. The primary analysis used a random effects model to compare the effect of physical activity interventions to no intervention or minimal intervention control conditions on state anxiety, assessed using validated, self-report measures. RESULTS Of the 3590 articles retrieved, 22 RCTs were included, with nine included in the primary meta-analysis. The overall standardised mean difference was 0.54 (95% CI -0.796, -0.28), representing a moderate improvement in state anxiety, compared to no intervention or minimal intervention control conditions. Physical activity was also found to produce significantly superior effects on state anxiety when compared to a time and attention-controlled group. LIMITATIONS The studies are of low quality overall, and there are a limited number of studies included in the meta-analyses therefore limiting the precision of results. CONCLUSIONS Physical activity may be a useful approach to addressing anxiety symptoms in children and young people, however, further trials of clinical populations are required to determine the effectiveness of physical activity as a treatment of anxiety disorders.
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Allott K, Gao C, Hetrick SE, Filia KM, Menssink JM, Fisher C, Hickie IB, Herrman HE, Rickwood DJ, Parker AG, Mcgorry PD, Cotton SM. Subjective cognitive functioning in relation to changes in levels of depression and anxiety in youth over three months of treatment - CORRIGENDUM. BJPsych Open 2020; 6:e110. [PMID: 32924901 PMCID: PMC7576658 DOI: 10.1192/bjo.2020.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Allott K, Gao C, Hetrick SE, Filia KM, Menssink JM, Fisher C, Hickie IB, Herrman HE, Rickwood DJ, Parker AG, Mcgorry PD, Cotton SM. Subjective cognitive functioning in relation to changes in levels of depression and anxiety in youth over 3 months of treatment. BJPsych Open 2020; 6:e84. [PMID: 32753079 PMCID: PMC7453798 DOI: 10.1192/bjo.2020.68] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Subjective cognitive difficulties are common in mental illness and have a negative impact on role functioning. Little is understood about subjective cognition and the longitudinal relationship with depression and anxiety symptoms in young people. AIMS To examine the relationship between changes in levels of depression and anxiety and changes in subjective cognitive functioning over 3 months in help-seeking youth. METHOD This was a cohort study of 656 youth aged 12-25 years attending Australian headspace primary mental health services. Subjective changes in cognitive functioning (rated as better, same, worse) reported after 3 months of treatment was assessed using the Neuropsychological Symptom Self-Report. Multivariate multinomial logistic regression analysis was conducted to evaluate the impact of baseline levels of and changes in depression (nine-item Patient Health Questionnaire; PHQ9) and anxiety symptoms (seven-item Generalised Anxiety Disorder scale; GAD7) on changes in subjective cognitive function at follow-up while controlling for covariates. RESULTS With a one-point reduction in PHQ9 at follow-up, there was an estimated 11-18% increase in ratings of better subjective cognitive functioning at follow-up, relative to stable cognitive functioning. A one-point increase in PHQ9 from baseline to follow-up was associated with 7-14% increase in ratings of worse subjective cognitive functioning over 3 months, relative to stable cognitive functioning. A similar attenuated pattern of findings was observed for the GAD7. CONCLUSIONS A clear association exists between subjective cognitive functioning outcomes and changes in self-reported severity of affective symptoms in young people over the first 3 months of treatment. Understanding the timing and mechanisms of these associations is needed to tailor treatment.
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