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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Kelly Allott
- Orygen, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - Caroline X Gao
- Orygen, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Caroline Fisher
- Department of Psychology, Royal Melbourne Hospital, Melbourne Health, Parkville, Vic., Australia.,The Melbourne Clinic, Richmond, Vic., Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Kate M Filia
- Orygen, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - Jana M Menssink
- Orygen, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - Helen E Herrman
- Orygen, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - Debra J Rickwood
- headspace National Youth Mental Health Foundation, Melbourne, Vic., Australia.,Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Alexandra G Parker
- Orygen, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia.,Institute for Health and Sport, Victoria University, Melbourne, Vic., Australia
| | - Patrick D McGorry
- Orygen, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - Sue M Cotton
- Orygen, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
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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: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [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: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Kelly Allott
- Orygen, Australia; and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Caroline Gao
- Orygen; Centre for Youth Mental Health, The University of Melbourne; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, University of Auckland, New Zealand
| | - Kate M Filia
- Orygen; and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Jana M Menssink
- Orygen; and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Caroline Fisher
- Department of Psychology, Royal Melbourne Hospital, Melbourne Health; and The Melbourne Clinic, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Australia
| | - Helen E Herrman
- Orygen; and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Debra J Rickwood
- headspace National Youth Mental Health Foundation; and Faculty of Health, University of Canberra, Australia
| | - Alexandra G Parker
- Orygen; Centre for Youth Mental Health, The University of Melbourne; and Institute for Health and Sport, Victoria University, Australia
| | - Patrick D Mcgorry
- Orygen; and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Sue M Cotton
- Orygen; and Centre for Youth Mental Health, The University of Melbourne, Australia
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Chopra P, Herrman HE. The long-term outcomes and unmet needs of a cohort of former long-stay patients in Melbourne, Australia. Community Ment Health J 2011; 47:531-41. [PMID: 20931282 DOI: 10.1007/s10597-010-9351-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 09/16/2010] [Indexed: 11/26/2022]
Abstract
Former long-stay patients with psychotic disorders have significant unmet needs. This study assessed the long-term outcomes for the original cohort of 18 residents of the Footbridge Community Care Unit (CCU), a residential psychiatric rehabilitation unit at St Vincent's Mental Health Melbourne. A review of case records and interviews were conducted for each member of the cohort 8 years after admission to the CCU. Members of the cohort were living in a variety of settings after discharge from the CCU. Despite significant gains during the period of residential rehabilitation in the CCU after hospital discharge, by the time of follow-up individuals were in general leading restricted lives characterised by a lack of stable residential and social supports. Most reported positively on the support provided in the CCU although later experiences of moving repeatedly from one setting to another were adverse. Five key unmet needs were identified: promotion of independence; stability in accommodation; stability in social networks; consistency of care; and addressing the theme of loss. A longitudinal perspective in management that focuses on stability in residential care is required for long-stay patients.
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Affiliation(s)
- Prem Chopra
- Centre for International Mental Health, School of Population Health, The University of Melbourne, Parkville, VIC, Australia.
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Gunn JM, Palmer VJ, Dowrick CF, Herrman HE, Griffiths FE, Kokanovic R, Blashki GA, Hegarty KL, Johnson CL, Potiriadis M, May CR. Embedding effective depression care: using theory for primary care organisational and systems change. Implement Sci 2010; 5:62. [PMID: 20687962 PMCID: PMC2925331 DOI: 10.1186/1748-5908-5-62] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 08/06/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression and related disorders represent a significant part of general practitioners (GPs) daily work. Implementing the evidence about what works for depression care into routine practice presents a challenge for researchers and service designers. The emerging consensus is that the transfer of efficacious interventions into routine practice is strongly linked to how well the interventions are based upon theory and take into account the contextual factors of the setting into which they are to be transferred. We set out to develop a conceptual framework to guide change and the implementation of best practice depression care in the primary care setting. METHODS We used a mixed method, observational approach to gather data about routine depression care in a range of primary care settings via: audit of electronic health records; observation of routine clinical care; and structured, facilitated whole of organisation meetings. Audit data were summarised using simple descriptive statistics. Observational data were collected using field notes. Organisational meetings were audio taped and transcribed. All the data sets were grouped, by organisation, and considered as a whole case. Normalisation Process Theory (NPT) was identified as an analytical theory to guide the conceptual framework development. RESULTS Five privately owned primary care organisations (general practices) and one community health centre took part over the course of 18 months. We successfully developed a conceptual framework for implementing an effective model of depression care based on the four constructs of NPT: coherence, which proposes that depression work requires the conceptualisation of boundaries of who is depressed and who is not depressed and techniques for dealing with diffuseness; cognitive participation, which proposes that depression work requires engagement with a shared set of techniques that deal with depression as a health problem; collective action, which proposes that agreement is reached about how care is organised; and reflexive monitoring, which proposes that depression work requires agreement about how depression work will be monitored at the patient and practice level. We describe how these constructs can be used to guide the design and implementation of effective depression care in a way that can take account of contextual differences. CONCLUSIONS Ideas about what is required for an effective model and system of depression care in primary care need to be accompanied by theoretically informed frameworks that consider how these can be implemented. The conceptual framework we have presented can be used to guide organisational and system change to develop common language around each construct between policy makers, service users, professionals, and researchers. This shared understanding across groups is fundamental to the effective implementation of change in primary care for depression.
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Affiliation(s)
- Jane M Gunn
- Primary Care Research Unit, The Department of General Practice, School of Medicine, The University of Melbourne, Australia
| | - Victoria J Palmer
- Primary Care Research Unit, The Department of General Practice, School of Medicine, The University of Melbourne, Australia
| | - Christopher F Dowrick
- Department of Primary Care, School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool, UK
| | - Helen E Herrman
- Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Frances E Griffiths
- Centre for Primary Health Care Studies, Warwick Medical School, University of Warwick, UK
| | - Renata Kokanovic
- Department of Sociology, School of Political and Social Enquiry, Monash University, Australia
| | - Grant A Blashki
- Nossal Institute for Global Health, The University of Melbourne, Australia
| | - Kelsey L Hegarty
- Primary Care Research Unit, The Department of General Practice, School of Medicine, The University of Melbourne, Australia
| | - Caroline L Johnson
- Primary Care Research Unit, The Department of General Practice, School of Medicine, The University of Melbourne, Australia
| | - Maria Potiriadis
- Primary Care Research Unit, The Department of General Practice, School of Medicine, The University of Melbourne, Australia
| | - Carl R May
- Institute of Health and Society, Newcastle University, UK
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Gunn JM, Gilchrist GP, Chondros P, Ramp M, Hegarty KL, Blashki GA, Pond DC, Kyrios M, Herrman HE. Who is identified when screening for depression is undertaken in general practice? Baseline findings from the Diagnosis, Management and Outcomes of Depression in Primary Care (diamond) longitudinal study. Med J Aust 2008; 188:S119-25. [PMID: 18558911 DOI: 10.5694/j.1326-5377.2008.tb01874.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 04/26/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To report the baseline characteristics of the Diagnosis, Management and Outcomes of Depression in Primary Care (diamond) study cohort and discuss the implications for depression care in general practice. DESIGN A prospective longitudinal study beginning in January 2005. PARTICIPANTS AND SETTING Adult patients with depressive symptoms identified via screening with the Center for Epidemiologic Studies Depression Scale (CES-D > or = 16) in 30 randomly selected Victorian general practices. MAIN OUTCOME MEASURE Depression status on the Patient Health Questionnaire (PHQ). RESULTS 789 patients form the cohort (71% women). At baseline, 47% were married, 21% lived alone, 36% received a pension or benefit, 15% were unable to work, 23% reported hazardous drinking, 32% were smokers, 39% used antidepressants and 19% used sedatives. 27% satisfied criteria for current major depressive syndrome (MDS) on the PHQ, while 52% had "persistent" depressive symptoms, and 22% had "transient" depressive symptoms, lasting at most a few weeks. Of those satisfying criteria for MDS, 49% were also classified with an anxiety syndrome, 40% reported childhood sexual abuse, 57% reported childhood physical abuse, 42% had at some time been afraid of their partner, and 72% reported a chronic physical condition; 84% were receiving mental health care (either taking antidepressants or seeing a health practitioner specifically for mental health care) compared with 66% of those with persistent depressive symptoms and 57% with transient depressive symptoms. CONCLUSION This method of screening for depressive symptoms in general practice identifies a group of patients with substantial multiple comorbidities -- psychiatric, physical and social problems coexist with depressive symptoms, raising challenges for the management of depression in general practice.
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Affiliation(s)
- Jane M Gunn
- Primary Care Research Unit, Department of General Practice, University of Melbourne, Melbourne, VIC, Australia.
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Herrman HE. Review: targeted, multicomponent programmes, delivered by health care professionals most effective at reducing risk factors for depression. Evidence-Based Mental Health 2004; 7:44. [PMID: 15107340 DOI: 10.1136/ebmh.7.2.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Helen E Herrman
- Department of Psychiatry, University of Melbourne and St Vincent's, Health Melbourne, Melbourne, Victoria, Australia
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Clarke DM, Mackinnon AJ, Smith GC, McKenzie DP, Herrman HE. Dimensions of psychopathology in the medically ill. A latent trait analysis. Psychosomatics 2000; 41:418-25. [PMID: 11015628 DOI: 10.1176/appi.psy.41.5.418] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors examined the latent structure of psychiatric symptoms occurring in patients with medical illness. Symptom data were collected from 312 hospitalized medically ill patients using the Monash Interview for Liaison Psychiatry and subjected to latent trait analysis. A model with 5 dimensions provided an acceptable fit to the data. Dimensions were characterized as demoralization, anhedonia, autonomic anxiety, somatic symptoms, and grief. The demoralization dimension was similar to the concept of demoralization described by Frank and to the "giving up-given up complex" described by Engel. The concepts of demoralization, grief, and anhedonia may be useful in increasing understanding of the minor depressions in people with medical illness and in increasing the specificity of psychological and pharmacological treatments for these disorders.
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Affiliation(s)
- D M Clarke
- Department of Psychological Medicine, Monash University, Clayton, Victoria, Australia.
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Schofield HL, Bloch S, Nankervis J, Murphy B, Singh BS, Herrman HE. Health and well-being of women family carers: a comparative study with a generic focus. Aust N Z J Public Health 1999; 23:585-9. [PMID: 10641347 DOI: 10.1111/j.1467-842x.1999.tb01541.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine differences between women family carers of people with chronic illnesses or disabilities and a group of women 'non-carers' in self-reported physical health, psychological well-being, life satisfaction, social support and feelings of overload. METHOD Using a computer-assisted telephone interviewing system, a random survey of more than 26,000 households was conducted in Victoria to identify and then interview a representative sample of family carers of people with disabilities or chronic illnesses. The women in the sample (n = 857) were then compared with a sample of women with 'usual family responsibilities' (n = 219) in terms of physical and emotional states. RESULTS We found higher rates of self-reported ill-health and use of medication, more negative effect, and less life satisfaction and perceived social support, among carers than among women in the comparison group. Even though the latter were more likely to be caring for one or more children, compared with the carers they reported less overload. Irrespective of carers status, women without partners expressed less life satisfaction, and more social isolation and negative effect. CONCLUSIONS AND IMPLICATIONS The poorer health status and emotional well-being of carers compared with non-carers among women, and associations between overload, social isolation, negative effect and health problems within carers, point to a number of practical interventions such as promoting an awareness in GPs and other health professionals of the impact of caregiving on the health of their patients; informing them about relevant community services; and encouraging appropriate referrals.
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Affiliation(s)
- H L Schofield
- Department of Psychiatry, University of Melbourne, Victoria
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Clarke DM, Smith GC, Herrman HE, McKenzie DP. Monash Interview for Liaison Psychiatry (MILP). Development, reliability, and procedural validity. Psychosomatics 1998; 39:318-28. [PMID: 9691701 DOI: 10.1016/s0033-3182(98)71320-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Monash Interview for Liaison Psychiatry (MILP) is a structured interview designed for use with patients who have physical and psychiatric comorbidity. Linked to a computerized diagnostic algorithm, the MILP is able to establish diagnoses according to DSM-III-R, International Classification of Diseases--10th Edition (ICD-10), and DSM-IV criteria, as well as a range of other criteria relevant to consultation-liaison psychiatry. Interrater reliability was assessed with 54 joint interviews, in which the mean kappa for agreement of items was 0.83 and of diagnoses was 0.68. Comparative procedural validity was tested against DSM-III-R decision-tree diagnoses, ICD-10 checklist diagnoses, and Structured Clinical Interview for DSM-III-R interview diagnoses on another sample of 54 patients. Mean kappas for these comparisons were 0.61, 0.56, and 0.31, respectively. As predicted, the MILP more fully covered the spectrum of somatizing disorders, compared with the other methods for establishing diagnoses.
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Affiliation(s)
- D M Clarke
- Monash University Department of Psychological Medicine, Monash Medical Centre, Melbourne, Australia.
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Abstract
BACKGROUND Past research and instrument development in caregiving have focused on specific aspects of caregiving or specific disability groups. This paper reports the scale characteristics of a new generic instrument developed to assess the experience of caregiving, and the social and emotional well-being of caregivers and a comparison group of 'non-caregivers'. METHODS Using computer-assisted telephone technology, a random survey of 26000 households was conducted in Victoria, Australia to identify and interview 976 caregivers of people who were aged or had a long-term illness or disability of any kind, and 219 non-caregivers. Both groups were re-interviewed after 15 months. Scales administered on each occasion to caregivers and non-caregivers included life satisfaction, positive and negative affect, social support and overload; and to caregivers, caring role satisfaction, resentment and anger, and, in relation to the care recipient, measures of help provided and needed, severity of disability and behaviour problems. RESULTS On each occasion and with each sample all scales demonstrated a satisfactory reliability. With a subsample of caregiver-care-recipient dyads (N = 67), caregiver reports of severity of disability, level of helped needed and provided were validated externally by clinician assessments. CONCLUSIONS A comprehensive instrument to assess the experience of caregiving was developed. It is relevant to a broad range of ages, levels and types of disability and care provided; and, in assessing health and well-being, to both caregivers and non-caregivers. Scales, including both positive and negative dimensions, have demonstrated good internal consistency on two occasions. The instrument is potentially useful in a range of research and practical settings.
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Affiliation(s)
- H L Schofield
- Department of Psychiatry, University of Melbourne, Victoria, Australia
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Abstract
Research on family caregiving has been based largely on small samples, often drawn from support organisations or services, and has tended to focus on particular disability groups. Our study was population-based and included all ages and disabilities. As the first stage in a longitudinal research and health promotion program for informal caregivers, a statewide random survey of over 26,000 households was conducted by telephone: 78 per cent of self-identified carers (N = 976) agreed to participate in a one-hour interview. This paper presents a sociodemographic profile of Australian caregivers. Four types of relationship between carers and care recipients (adult offspring, spouses, parents and other relatives and friends) provide the framework for results. Group differences were observed on most characteristics: for example, age, living arrangements, work status and duration of care. Care recipient characteristics, including difficult behaviours and need for assistance, are also reported, as well as use of and need for community services. What the findings reflected most was the heterogeneity of both caregivers and care recipients and the diversity of caregiving roles and circumstances.
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Affiliation(s)
- H L Schofield
- Department of Psychiatry, University of Melbourne, Vic
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Affiliation(s)
- H E Herrman
- University of Melbourne Department of Psychiatry St. Vincent's Hospital, VIC
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Abstract
OBJECTIVES To examine psychiatric morbidity, including substance use disorders, and service use in young people with experience of homelessness. DESIGN A cross-sectional study of 34 new residents in a supported accommodation program in Melbourne. Current and lifetime psychiatric diagnoses were made using the Structured Clinical Interview for the Diagnostic and statistical manual of mental disorders, third edition, revised (DSM-III-R). Use of psychiatric and related services was also assessed. RESULTS Of the 21 women and 13 men (mean age, 18.1 years; standard deviation, 2.2 years), 50% had a current major DSM-III-R diagnosis, and 82% had a lifetime DSM-III-R diagnosis. The most common diagnoses were alcohol dependence, depressive disorders and cannabis dependence. Co-morbidity was common. Few of the young people had sought or received any treatment for depressive or substance use disorders. CONCLUSIONS Young people with experience of homelessness have a high prevalence of depressive disorders and substance use disorders, particularly alcohol and cannabis dependence. Despite this they have a low rate of service use. These findings suggest a need for closer interaction between mental health professionals and other agencies in the planning and provision of services to young homeless people.
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Affiliation(s)
- J J Reilly
- Department of Psychiatry, University of Melbourne, St Vincent's Hospital, Vic
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Abstract
This paper describes the institution of a clinical database in the consultation-liaison psychiatry service of an Australian general hospital psychiatry unit. One of the problems faced was that many researchers and clinicians in Australia use the ICD-9 rather than the DSM-III-R classification system. Nevertheless, it was possible to use the DSM-III-R-based MICRO-CARES clinical database management system in this project. The data obtained during the first 12 months of its use are presented. Despite differences in the patient demographic characteristics, the data obtained are within the ranges described for North American and European sites. The local benefits of such a clinical database are described, and it is argued that such a database is also necessary for interhospital and international collaborative studies and comparisons.
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Affiliation(s)
- G C Smith
- Monash University Department of Psychological Medicine, Monash Medical Centre, Melbourne, Australia
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16
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Abstract
Consultation-liaison (C-L) psychiatry as a service entity has developed slowly and to a variable extent in Australia despite the presence of factors conducive to its development. These include a compulsory national health insurance system and a favorable disposition to the biopsychosocial model and to psychoanalytic ideas. C-L psychiatry, however, does enjoy a high profile in many undergraduate medical and postgraduate psychiatry teaching programs. Research on C-L psychiatry is emerging, complementing a strong history of research in psychosomatic medicine. An Australian and New Zealand C-L psychiatry interest group is being formed. Collaboration with the MICRO-CARES Consortium and the European Consultation-Liaison Workgroup is proving to be a great stimulus.
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Affiliation(s)
- G C Smith
- Monash University Department of Psychological Medicine, Monash Medical Centre, Clayton, Victoria, Australia
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Abstract
OBJECTIVE Self-administered questionnaires are frequently used in studies of hospitalized physically ill patients to identify and measure psychiatric morbidity. This study examines the validity of some commonly used questionnaires in this context. METHOD One hundred and seventy-nine patients in a general hospital completed the GHQ, HAD, BDI and STAI and were interviewed using the SCID-R. The findings were evaluated against DSM-III-R diagnoses using the QROC curve. RESULTS Thirty-eight percent of patients obtained one or more DSM-III-R diagnoses; 25 percent mood disorder, 12 percent anxiety disorder, 11 percent drug abuse or dependence, 2 percent a somatic syndrome. Eleven percent had more than one diagnosis. As screening instruments for general psychiatric morbidity there were no statistically significant differences between versions of the GHQ and the HAD. With respect to identifying depression, the GHQ tended to perform better than the other instruments. CONCLUSIONS The questionnaires identified general morbidity and depression satisfactorily but anxiety and drug abuse and dependence syndromes poorly. The results also support the notion that the DSM-III-R classification has a number of deficiencies when used in this population.
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Affiliation(s)
- D M Clarke
- Monash University Department of Psychological Medicine, Monash Medical Centre, Melbourne, Australia
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Abstract
This article describes three recently established community-based crisis services for people with acute psychiatric illness. Data were obtained from local information systems developed in the early phase of service operation. Patterns of service were found to vary among the teams in terms of the frequency of contact with the client, the period of contact with the client and the overall numbers of contacts. Such diversification of services reflects, at least in part, the differences in the service networks within which the new services were Such diversification of services is inevitable and creative, and the evaluation of these services must consider not only the short-term impact of crisis services, but also the impact of the network of care services on longer term outcomes for the client.
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Affiliation(s)
- S J Finch
- Psychiatric Epidemiology and Services Evaluation Unit, Health Department Victoria
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19
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Abstract
Trained clinicians interviewed 346 people who were representative of those aged 15 to 60 years staying in crisis accommodation centres for the homeless and cheap single-room accommodations in inner Melbourne. The interviewers used a standardised diagnostic instrument, the structured clinical interview for DSM III-R. (Diagnostic and statistical manual of mental disorders - revised), to diagnose a range of severe mental disorders, including psychotic, affective, and substance-related disorders. Almost half the people interviewed received diagnoses of current disorders and over 70% received diagnoses of lifetime disorders. The prevalences of lifetime and current disorders in all categories were as high in young as in older men. Only small numbers of women were seen. The relatively high prevalence of disorder in younger men may be related to selective factors in the survey, to a cohort effect, or to recovery or death of older men with a history of mental disorder. From a practical point of view the important issue is the effect of varying systems of mental health care, and of welfare and housing policies, on the course and outcome of the various disorders, and on the likelihood of individuals living impoverished and disaffiliated lives.
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Affiliation(s)
- H E Herrman
- Monash University Department of Psychological Medicine, Royal Park Hospital, Parkville, VIC
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Copolov DL, McGorry PD, Keks N, Minas IH, Herrman HE, Singh BS. Origins and establishment of the schizophrenia research programme at Royal Park Psychiatric Hospital. Aust N Z J Psychiatry 1989; 23:443-51. [PMID: 2610645 DOI: 10.3109/00048678909062611] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This paper documents the initial phase of a new research direction which began in 1984 at Royal Park Hospital. Attention is focussed on the place of the university and the research institute in the psychiatric hospital and on the perceived need for concerted research on the major psychoses in Australia. The focal point of the Royal Park research programme, the Aubrey Lewis Clinical Research Unit, has been open since October 1984. The development of the unit's research activities during the initial few years of its existence required an awareness of specific scientific, administrative and political issues. These are discussed in detail in order to convey something of the process, as well as the content of such development, and in an attempt to provide some assistance to others undertaking similar developments.
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Affiliation(s)
- D L Copolov
- NH & MRC Schizophrenia Research Unit, Royal Park Hospital, Parkville, Victoria
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Abstract
Six hundred people diagnosed as schizophrenic by the specialist psychiatric services in Oxfordshire, between 1971 and 1973, were identified from the Oxford Psychiatric Case Register (OPCR). The person records of deaths and hospital discharges held by the Oxford Record Linkage Study (ORLS) wee used to examine the following items of information for members of this group: details of discharges from an surgical operations performed in Oxfordshire non-psychiatric hospitals in a 6-year period before and a 4-year period after the date of first inclusion in the OPCR, and details of deaths in a 4-year period after the date of first inclusion in the OPCR. The numbers of deaths, discharges and operations so observed in the study group were compared in age, sex and major diagnostic groups with the expected numbers derived from rates prevailing in the Oxfordshire population over the same periods. Observed deaths were twice as numerous as expected in both sexes, and the numbers of general hospital discharges were also higher than expected. Ischaemic heart disease was the commonest cause of death in both sexes, but did not account for the excessive numbers of hospital discharges. Trauma and poisoning accounted for the excess both of deaths in younger members of the study group and of general hospital discharges overall. Social and environmental difficulties associated with the diagnosis schizophrenia are likely to have contributed more than any inherent biological disadvantage to this excess.
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Schofield HL, Herrman HE, Bloch S, Howe A, Singh B. A profile of Australian family caregivers: diversity of roles and circumstances. Aust N Z J Public Health 1977. [DOI: 10.1111/j.1467-842x.1977.tb00967.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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