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Pacella BJ, Cowlishaw S, Gibbs L, Bryant RA, Brady K, Gallagher C, Molyneaux R, Gibson K, Block K, Harms L, Forbes D, O'Donnell ML. Trajectory of adjustment difficulties following disaster: 10-year longitudinal cohort study. BJPsych Open 2024; 10:e57. [PMID: 38433588 PMCID: PMC10951843 DOI: 10.1192/bjo.2024.3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/19/2023] [Accepted: 01/02/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Although much is known about psychopathology such as post-traumatic stress disorder (PTSD) and depression following bushfire (also known as wildfire), little is known about prevalence, trajectory and impacts for those experiencing general adjustment difficulties following exposure to these now-common events. AIMS This was an exploratory analysis of a large cohort study that examined the prevalence, trajectory and risk factors of probable adjustment disorder over a 10-year period following bushfire exposure. METHOD The Beyond Bushfires study assessed individuals exposed to a large and deadly bushfire across three time points spanning 10 years. Self-report survey data from participants from areas with moderate and high levels of fire-affectedness were analysed: n = 802 participants at Wave 1 (3-4 years post-fires), n = 596 at Wave 2 (5 years post-fires) and n = 436 at Wave 3 (10 years post-fires). Surveys indexed fire-related experiences and post-fire stressors, and comprised the six-item Kessler Psychological Distress Scale (probable adjustment disorder index), four-item Posttraumatic Stress Disorder Checklist (probable fire-related PTSD) and nine-item Patient Health Questionnaire (probable major depressive episode). RESULTS Prevalence of probable adjustment disorder was 16% (Wave 1), 15% (Wave 2) and 19% (Wave 3). Probable adjustment disorder at 3-4 years post-fires predicted a five-fold increase in risk for escalating to severe psychiatric disorder (i.e. probable fire-related PTSD/major depressive episode) at 10 years post-fires, and was associated with post-fire income and relationship stressors. CONCLUSIONS Adjustment difficulties are prevalent post-disaster, many of which are maintained and exacerbated over time, resulting in increased risk for later disorder and adaptation difficulties. Psychosocial interventions supporting survivors with adjustment difficulties may prevent progression to more severe disorder.
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Affiliation(s)
- Belinda J. Pacella
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Sean Cowlishaw
- Turner Institute for Brain and Mental Health, Monash School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Lisa Gibbs
- Child and Community Wellbeing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Kate Brady
- Child and Community Wellbeing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Colin Gallagher
- Centre for Transformative Innovation, Faculty of Business and Law, Swinburne University of Technology, Melbourne, Australia
| | - Robyn Molyneaux
- Child and Community Wellbeing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Kari Gibson
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Karen Block
- Child and Community Wellbeing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Louise Harms
- Department of Social Work, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - David Forbes
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Meaghan L. O'Donnell
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
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Forbes D, LeardMann CA, Lawrence-Wood E, Villalobos J, Madden K, Gutierrez IA, Cowlishaw S, Baur J, Adler AB. Three-Item Dimensions of Anger Reactions Scale. JAMA Netw Open 2024; 7:e2354741. [PMID: 38315485 PMCID: PMC10844994 DOI: 10.1001/jamanetworkopen.2023.54741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/21/2023] [Accepted: 12/13/2023] [Indexed: 02/07/2024] Open
Abstract
Importance Problematic anger is prevalent and associated with adjustment difficulties in military populations. To facilitate measurement of problematic anger, a very brief valid measure is needed. Objective To reduce the Dimensions of Anger Reactions 5-item (DAR-5) scale to a very brief measure. Design, Setting, and Participants This cross-sectional study used survey data collected between 2014 and 2016 in the Australian Transition and Well-Being Research Programme and US Millennium Cohort Study. Participants were service members who were actively serving or had transitioned out of the military (separated). Statistical analyses were performed from September 2021 to June 2023. Main Outcomes and Measures The DAR-5 was reduced to the 3 experiential items: frequency, intensity, and duration (the DAR-3). Psychometrics for the DAR-3 and DAR-5 were compared in terms of standardized Cronbach α, positive screening result, mean, and SD. Analyses were stratified by Australian and US military service status cohorts (active duty and separated). Results A total of 71 010 participants were included from Australia and the US. Of 10 900 Australian participants (8145 active duty participants [74.7%]; 2755 separated participants [25.3%]), 5893 (55.2%) were aged 40 years or older and 8774 (80.5%) were male; of 60 110 US participants (24 706 active duty participants [41.1%]; 35 404 separated participants [58.9%]), 28 804 (47.9%) were aged 30 to 39 years and 43 475 (72.3%) were male. The DAR-3 demonstrated good internal consistency in the active duty (Australia: mean [SD] score, 4.97 [2.5]; α = 0.90; US: mean [SD] score, 5.04 [2.6]; α = 0.87) and separated (Australia: mean [SD] score, 6.53 [3.4]; α = 0.92; US: mean [SD] score, 6.05 [3.2]; α = 0.91) samples. The cutoff score of 8 or greater on the DAR-3 had optimal sensitivity and specificity across all samples. DAR-3 and DAR-5 were associated with posttraumatic stress disorder (PTSD), depression, aggression, and relationship conflict. While the scales did not significantly differ in their associations with PTSD, depression, and relationship conflict, the magnitude of association for aggression was significantly lower in US samples using the DAR-3 (eg, US active duty sample: DAR-5 OR, 9.96; 95% CI, 9.01-11.00; DAR-3 OR, 8.36; 95% CI, 7.58-9.22). Conclusions and Relevance In this cross-sectional study of a very brief measure of anger, each item contributed to the overall strength of the measure without losing psychometric strength compared with the DAR-5. The consistency of these findings across military and veteran samples in Australian and US populations demonstrated the psychometric robustness of the DAR-3.
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Affiliation(s)
- David Forbes
- Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia
| | - Cynthia A. LeardMann
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, San Diego, California
| | - Ellie Lawrence-Wood
- Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia
| | - Javier Villalobos
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, San Diego, California
| | - Kelsey Madden
- Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia
| | - Ian A. Gutierrez
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Sean Cowlishaw
- Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia
| | - Jenelle Baur
- Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia
| | - Amy B. Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
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Cowlishaw S, O'Dwyer C, Bowd C, Sadler N, O'Donnell M, Forbes D, Howard A. Pandemic impacts and experiences after disaster in Australia: qualitative study of compound impacts following the Black Summer bushfires. BJPsych Open 2024; 10:e43. [PMID: 38305026 PMCID: PMC10897690 DOI: 10.1192/bjo.2023.648] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The first cases of the COVID-19 pandemic in Australia were recorded in January 2020, which was during the 'Black Summer' bushfires of 2019-20 and prior to additional disasters in some regions. Few studies have considered the compound impact of disasters and the pandemic. AIMS To improve understanding of the impact on mental health and well-being of the pandemic in disaster-affected communities. METHOD We conducted semi-structured interviews (n = 18) with community members and online focus groups (n = 31) with help providers from three regions of rural Australia affected by bushfires and the pandemic. RESULTS Six themes were produced: (a) 'Pulling together, pulling apart', describing experiences after bushfires and prior to impacts of the pandemic; (b) 'Disruption of the 'normal response', encompassing changes to post-disaster recovery processes attributed to the pandemic; (c) 'Escalating tensions and division in the community', describing impacts on relationships; (d) 'Everywhere you turn you get a slap in the face', acknowledging impacts of bureaucratic 'red tape'; (e) 'There are layers of trauma', highlighting intersecting traumas and pre-existing vulnerabilities; and (f) 'Where does the help come from when we can't do it?', encompassing difficulties accessing services and impacts on the helping workforce. CONCLUSIONS This study furthers our understanding of compound disasters and situates pandemic impacts in relation to processes of adjustment and recovery from bushfires. It highlights the need for long-term approaches to resilience and recovery, investment in social infrastructure, multi-component approaches to workforce issues, and strategies to increase mental health support and pathways across services.
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Affiliation(s)
- S. Cowlishaw
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - C. O'Dwyer
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - C. Bowd
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - N. Sadler
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - M. O'Donnell
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - D. Forbes
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - A. Howard
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
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Lohmann S, Cowlishaw S, Ney L, O’Donnell M, Felmingham K. The Trauma and Mental Health Impacts of Coercive Control: A Systematic Review and Meta-Analysis. Trauma Violence Abuse 2024; 25:630-647. [PMID: 37052388 PMCID: PMC10666508 DOI: 10.1177/15248380231162972] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Coercive control is an under researched type of intimate partner violence (IPV). The aims of this review were to (a) synthesize all available evidence regarding associations with coercive control and mental health outcomes including post-traumatic stress disorder (PTSD), complex PTSD, and depression; and (b) compare these with associations involving broader categories of psychological IPV. Primary studies which measured associations of coercive control with PTSD, complex PTSD, depression, or other mental health symptoms, were identified via a systematic search of electronic databases (PsycINFO, Medline, CINAHL, Scopus). Eligible studies involved observational designs and reported associations between coercive control and mental health outcomes, among participants who were at least 18 years old. Studies were published in peer-reviewed journals and English language. Random-effects meta-analyses were used to synthesize correlational data from eligible studies. The search identified 68 studies while data from 45 studies could be included in the meta-analyses. These indicated moderate associations involving coercive control and PTSD (r = .32; 95% confidence interval [.28, .37]) and depression (r = .27; [.22, .31]). These associations were comparable to those involving psychological IPV and PTSD (r = .34; [.25, .42]) and depression (r = .33; [.26, .40]). Only one study reported on the relationship between coercive control and complex PTSD and meta-analyses could not be performed. This review indicated that coercive control exposure is moderately associated with both PTSD and depression. This highlights that mental health care is needed for those exposed to coercive control, including trauma-informed psychological interventions.
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Affiliation(s)
- Susanne Lohmann
- The University of Melbourne, Melbourne School of Psychological Sceinces, Melbourne, VIC, Australia
| | - Sean Cowlishaw
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Luke Ney
- Queensland University of Technology, School of Psychology & Counselling, Brisbane, Queensland, Australia
| | - Meaghan O’Donnell
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Kim Felmingham
- The University of Melbourne, Melbourne School of Psychological Sceinces, Melbourne, VIC, Australia
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Cowlishaw S, Gibson K, Alexander S, Howard A, Agathos J, Strauven S, Chisholm K, Fredrickson J, Pham L, Lau W, O’Donnell ML. Improving mental health following multiple disasters in Australia: a randomized controlled trial of the Skills for Life Adjustment and Resilience (SOLAR) programme. Eur J Psychotraumatol 2023; 14:2284032. [PMID: 38073550 PMCID: PMC10993813 DOI: 10.1080/20008066.2023.2284032] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/20/2023] [Indexed: 12/18/2023] Open
Abstract
Background: The mental health impacts of climate change-related disasters are significant. However, access to mental health services is often limited by the availability of trained clinicians. Although building local community capability for the mental health response is often prioritised in policy settings, the lack of evidence-based programs is problematic. The aim of this study was to test the efficacy of the Skills for Life Adjustment and Resilience programme (SOLAR) delivered by trained local community members following compound disasters (drought, wildfires, pandemic-related lockdowns) in Australia.Method: Thirty-six community members were trained to deliver the SOLAR programme, a skills-based, trauma informed, psychosocial programme. Sixty-six people with anxiety, depression and/or posttraumatic stress symptoms, and impairment were randomised into the SOLAR programme or a Self-Help condition. They were assessed pre, post and two months following the interventions. The SOLAR programme was delivered across five 1-hourly sessions (either face to face or virtually). Those in the Self-Help condition received weekly emails with self-help information including links to online educational videos.Results: Multigroup analyses indicated that participants in the SOLAR condition experienced significantly lower levels of anxiety and depression, and PTSD symptom severity between pre - and post-intervention (T1 to T2), relative to the Self-Help condition, while controlling for scores at intake. These differences were not statistically different at follow-up. The SOLAR programme was associated with large effect size improvements in posttraumatic stress symptoms over time.Conclusion: The SOLAR programme was effective in improving anxiety, depression and posttraumatic stress symptoms over time. However, by follow-up the size of the effect was similar to an active self-help condition. Given the ongoing stressors in the community associated with compounding disasters it may be that booster sessions would have been useful to sustain programme impact.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12621000283875..
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Affiliation(s)
- S. Cowlishaw
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - K. Gibson
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - S. Alexander
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - A. Howard
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - J. Agathos
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - S. Strauven
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - K. Chisholm
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - J. Fredrickson
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - L. Pham
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - W. Lau
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - M. L. O’Donnell
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
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Thomas S, Cowlishaw S, Francis J, van Schalkwyk MCI, Daube M, Pitt H, McCarthy S, McGee D, Petticrew M, Rwafa-Ponela T, Minja A, Fell G. Global public health action is needed to counter the commercial gambling industry. Health Promot Int 2023; 38:daad110. [PMID: 37738551 DOI: 10.1093/heapro/daad110] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
Affiliation(s)
- Samantha Thomas
- Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, Australia
| | - Sean Cowlishaw
- Turner Institute for Brain and Mental Health, Monash School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Joel Francis
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - May C I van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Hannah Pitt
- Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, Australia
| | - Simone McCarthy
- Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, Australia
| | | | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Teurai Rwafa-Ponela
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Greg Fell
- Director of Public Health, Sheffield City Council, Sheffield, UK
- Vice President UK Association of Directors of Public Health, UK
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Dell L, Casetta C, Benassi H, Cowlishaw S, Agathos J, O'Donnell M, Crane M, Lewis V, Pacella B, Terhaag S, Morton D, McFarlane A, Bryant R, Forbes D. Mental health across the early years in the military. Psychol Med 2023; 53:3683-3691. [PMID: 35197132 PMCID: PMC10277765 DOI: 10.1017/s0033291722000332] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/20/2021] [Accepted: 01/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The mental health impact of the initial years of military service is an under-researched area. This study is the first to explore mental health trajectories and associated predictors in military members across the first 3-4 years of their career to provide evidence to inform early interventions. METHODS This prospective cohort study surveyed Australian Defence personnel (n = 5329) at four time-points across their early military career. Core outcomes were psychological distress (K10+) and posttraumatic stress symptoms [four-item PTSD Checklist (PCL-4)] with intra-individual, organizational and event-related trajectory predictors. Latent class growth analyses (LCGAs) identified subgroups within the sample that followed similar longitudinal trajectories for these outcomes, while conditional LCGAs examined the variables that influenced patterns of mental health. RESULTS Three clear trajectories emerged for psychological distress: resilient (84.0%), worsening (9.6%) and recovery (6.5%). Four trajectories emerged for post-traumatic stress, including resilient (82.5%), recovery (9.6%), worsening (5.8%) and chronic subthreshold (2.3%) trajectories. Across both outcomes, prior trauma exposure alongside modifiable factors, such as maladaptive coping styles, and increased anger and sleep difficulties were associated with the worsening and chronic subthreshold trajectories, whilst members in the resilient trajectories were more likely to be male, report increased social support from family/friends and Australian Defence Force (ADF) sources, and use adaptive coping styles. CONCLUSIONS The emergence of symptoms of mental health problems occurs early in the military lifecycle for a significant proportion of individuals. Modifiable factors associated with wellbeing identified in this study are ideal targets for intervention, and should be embedded and consolidated throughout the military career.
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Affiliation(s)
- Lisa Dell
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville VIC, Melbourne 3053, Australia
| | - Carolina Casetta
- Department of Defence, Joint Health Command, Canberra, Australia
| | - Helen Benassi
- Department of Defence, Joint Health Command, Canberra, Australia
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville VIC, Melbourne 3053, Australia
| | - James Agathos
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville VIC, Melbourne 3053, Australia
| | - Meaghan O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville VIC, Melbourne 3053, Australia
| | - Monique Crane
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park NSW, Sydney 2109, Australia
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, La Trobe University, Bundoora VIC, Melbourne 3086, Australia
| | - Belinda Pacella
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville VIC, Melbourne 3053, Australia
| | - Sonia Terhaag
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville VIC, Melbourne 3053, Australia
| | - David Morton
- Department of Defence, Joint Health Command, Canberra, Australia
| | - Alexander McFarlane
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide SA 5005, Australia
| | - Richard Bryant
- Faculty of Science, School of Psychology, University of New South Wales, Sydney NSW 2052, Australia
| | - David Forbes
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville VIC, Melbourne 3053, Australia
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Metcalf O, Roebuck G, Lawrence-Wood E, Sadler N, Baur J, Van Hooff M, Forbes D, O'Donnell M, Hodson S, Benassi H, Varker T, Battersby M, McFarlane AC, Cowlishaw S. Gambling problems predict suicidality in recently transitioned military veterans. Aust N Z J Public Health 2023:100038. [PMID: 37055278 DOI: 10.1016/j.anzjph.2023.100038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVE This study investigated associations between gambling problems and suicidality in Australian veterans. METHODS Data drawn from n = 3,511 Australian Defence Force veterans who had recently transitioned to civilian life. Gambling problems were assessed using the Problem Gambling Severity Index (PGSI) and suicidal ideation and behaviour were assessed using items adapted from the National Survey of Mental Health and Wellbeing. RESULTS At-risk gambling and problem gambling were associated with increased odds of suicidal ideation [at-risk gambling: odds ratio (OR), 1.93; 95% confidence interval (CI), 1.47‒2.53; problem gambling: OR, 2.75; 95% CI 1.86‒4.06] and suicide planning or attempts (at-risk gambling: OR, 2.07; 95% CI, 1.39‒3.06; problem gambling: OR 4.22, 95% CI, 2.61‒6.81). The association with total scores on the PGSI and any suicidality was substantially reduced and became non-significant when controlling for the effects of depressive symptoms, but not financial hardship or social support. CONCLUSIONS Gambling problems and harms are important risk factors for suicide in veterans, and should be recognised in veteran-specific suicide prevention policies and programs, along with co-occurring mental health problems. IMPLICATIONS FOR PUBLIC HEALTH A comprehensive public health approach to reducing gambling harm should feature in suicide prevention efforts in veteran and military populations.
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Affiliation(s)
- Olivia Metcalf
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne.
| | - Greg Roebuck
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne; The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, and Barwon Health, Geelong, Victoria, Australia
| | - Ellie Lawrence-Wood
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne
| | - Nicole Sadler
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne
| | - Jenelle Baur
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne
| | - Miranda Van Hooff
- Military and Emergency Services Health Australia, The Hospital Research Foundation, Adelaide
| | - David Forbes
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne
| | - Meaghan O'Donnell
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne
| | - Stephanie Hodson
- Open Arms - Veteran & Families Counselling, Department of Veterans' Affairs, Canberra
| | - Helen Benassi
- Joint Health Command, Joint Capabilities Group, Australian Department of Defence
| | - Tracey Varker
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne
| | - Malcolm Battersby
- College of Medicine and Public Health, Flinders University, Adelaide
| | - Alexander C McFarlane
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne
| | - Sean Cowlishaw
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne; Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
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Pitt H, McCarthy S, Thomas SL, Randle M, Marko S, Cowlishaw S, Kairouz S, Daube M. Older adults' perceptions of the risks associated with contemporary gambling environments: Implications for public health policy and practice. Front Sociol 2023; 8:1061872. [PMID: 37006633 PMCID: PMC10060892 DOI: 10.3389/fsoc.2023.1061872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/20/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Rapid changes in the Australian gambling environment have amplified the risks for gamblers and pose significant threats to public health. Technological advances, saturation of marketing, and the embedding of gambling in sport have all contributed to significant changes in the gambling risk environment. Older adults have witnessed the changes to the way gambling is provided and promoted in public spaces, but little is known about how these changes have shaped the way they conceptualize the risks associated with gambling. METHOD Guided by critical qualitative inquiry, semi structured interviews were conducted with 40 Australian adults aged 55 years and older, who had gambled at least once in the last 12 months. Reflexive thematic analysis was used to interpret the data. RESULTS Participants discussed gambling environments in Australia and how they had changed through the proliferation of gambling products, environments, and opportunities; the risks posed through the embedding of gambling in community and media environments; the role of technology in gambling environments; and the role of marketing and promotions in the changing gambling environments. Participants recognized that these factors had contributed to gambling environments becoming increasingly risky over time. However, despite the perception of increased risk, many participants had engaged with new gambling technologies, products, and environments. DISCUSSION This research supports the adoption of public health responses that include consideration of the environmental, commercial, and political factors that may contribute to risky gambling environments.
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Affiliation(s)
- Hannah Pitt
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Simone McCarthy
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Samantha L. Thomas
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Melanie Randle
- Faculty of Business and Law, University of Wollongong, Wollongong, NSW, Australia
| | - Sarah Marko
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Sean Cowlishaw
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Sylvia Kairouz
- Department of Sociology and Anthropology, Concordia University, Montreal, QC, Canada
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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10
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McCarthy S, Thomas S, Pitt H, Marko S, Randle M, Cowlishaw S, Kairouz S, Daube M. Young women's engagement with gambling: A critical qualitative inquiry of risk conceptualisations and motivations to gamble. Health Promot J Austr 2023; 34:129-137. [PMID: 36002940 PMCID: PMC10087406 DOI: 10.1002/hpja.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Younger women's engagement with gambling has changed over recent decades due to a range of socio-cultural, environmental and commercial factors. However, younger women's distinct lived experiences with gambling have rarely been considered. The following critical qualitative inquiry explored factors that influenced younger women's engagement with gambling and their perceptions of gambling risks. METHODS Semi-structured interviews were conducted with 41 Australian women aged 18-40 years. Participants were asked questions relating to their reasons for gambling, and the perceived risks associated with gambling. Reflexive thematic analysis was used to interpret the data. RESULTS Five themes were constructed from the data. First, women reported that they gambled to escape their everyday lives, with some women reporting gambling within their own homes. Second, women reported gambling for financial reasons, particularly to change their life circumstances and outcomes. Third, gambling was used by women as a way to connect with social network members. Fourth, gambling was an incidental activity that was an extension of non-gambling leisure activities. Finally, lower risk perceptions of participants' own gambling risk contributed to their engagement and continuation of gambling. CONCLUSION Public health and health promotion initiatives should recognise that young women's gambling practices are diverse, and address the full range of socio-cultural, environmental and commercial factors that may influence younger women's engagement with gambling.
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Affiliation(s)
- Simone McCarthy
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Vic., Australia
| | - Samantha Thomas
- Institute for Health Transformation, Deakin University, Geelong, Vic., Australia
| | - Hannah Pitt
- Institute for Health Transformation, Deakin University, Geelong, Vic., Australia
| | - Sarah Marko
- Institute for Health Transformation, Deakin University, Geelong, Vic., Australia
| | - Melanie Randle
- Faculty of Business and Law, University of Wollongong, Wollongong, NSW, Australia
| | - Sean Cowlishaw
- Department of Psychiatry, The University of Melbourne, Melbourne, Vic., Australia
| | - Sylvia Kairouz
- Department of Sociology and Anthropology, Concordia University, Montreal, QC, Canada
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Thomas SL, Pitt H, Randle M, Cowlishaw S, Rintoul A, Kairouz S, Daube M. Convenient consumption: a critical qualitative inquiry into the gambling practices of younger women in Australia. Health Promot Int 2022; 37:6956908. [PMID: 36547399 PMCID: PMC9773969 DOI: 10.1093/heapro/daac153] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
There are a range of stereotypes and assumptions associated with women's gambling behaviours. While researchers have demonstrated that the practices associated with women's gambling are changing and becoming increasingly normalized, there is a limited understanding of how younger women ascribe meanings to these practices. This study explored the gambling practices of younger women. Forty-one women (20-40 years) participated in qualitative telephone interviews. Participants were asked open-ended questions about personal engagement in gambling, including experiences of gambling, gambling engagement, and experiences with different gambling products and environments. Data interpretation was guided by reflexive thematic analysis. Three themes were constructed from the data: (i) gambling infrastructures, including both products and the embedding of gambling in community environments, contributed to the convenient and regular consumption of gambling, with gambling easy to access and engage with; (ii) social networks and intergenerational gambling practices impacted the perceived social value and competencies related to gambling; and (iii) technology facilitated new gambling practices, routinizing gambling behaviours through automation and building perceived competencies with a range of gambling products. Gambling regulation and public health responses to gambling often focus on either individual behaviours or product characteristics. This study suggests that this focus is too narrow and excludes important influences on younger women's gambling practices, which include the infrastructure that supports the provision and consumption of gambling products. Public health research, policy and practice must consider the full range of determinants that may contribute to the initiation and continuation of gambling in younger women.
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Affiliation(s)
| | - Hannah Pitt
- Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Melanie Randle
- Faculty of Business and Law, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sean Cowlishaw
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Angela Rintoul
- Health Innovation and Transformation Centre, Federation University, Ballarat, Victoria, Australia
| | - Sylvia Kairouz
- Department of Sociology and Anthropology, Concordia University, Montreal, Quebec, Canada
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Subiaco, Western Australia, Australia
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12
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Dowling N, Merkouris S, Lubman D, Thomas S, Bowden-Jones H, Cowlishaw S. Pharmacological interventions for the treatment of disordered and problem gambling. Cochrane Database Syst Rev 2022; 9:CD008936. [PMID: 36130734 PMCID: PMC9492444 DOI: 10.1002/14651858.cd008936.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/05/2023]
Abstract
BACKGROUND Pharmacological interventions for disordered and problem gambling have been employed in clinical practice. Despite the availability of several reviews of the efficacy of pharmacological interventions for disordered or problem gambling, few have employed systematic search strategies or compared different categories of pharmacological interventions. Systematic reviews of high-quality evidence are therefore essential to provide guidance regarding the efficacy of different pharmacological interventions for disordered or problem gambling. OBJECTIVES The primary aims of the review were to: (1) examine the efficacy of major categories of pharmacological-only interventions (antidepressants, opioid antagonists, mood stabilisers, atypical antipsychotics) for disordered or problem gambling, relative to placebo control conditions; and (2) examine the efficacy of these major categories relative to each other. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase, and PsycINFO (all years to 11 January 2022). SELECTION CRITERIA We included randomised trials evaluating a pharmacological intervention for the treatment of disordered or problem gambling. Eligible control conditions included placebo control groups or comparisons with another category of pharmacological intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures, including systematic extraction of included study characteristics and results and risk of bias assessment. Our primary outcome was reduction in gambling symptom severity. Our secondary outcomes were reduction in gambling expenditure, gambling frequency, time spent gambling, depressive symptoms, anxiety symptoms, and functional impairment; and responder status. We evaluated treatment effects for continuous and dichotomous outcomes using standardised mean difference (SMD) and risk ratios (RR), respectively, employing random-effects meta-analyses. A minimum of two independent treatment effects were required for a meta-analysis to be conducted (with only meta-analytic findings reported in this abstract). MAIN RESULTS We included 17 studies in the review (n = 1193 randomised) that reported outcome data scheduled for end of treatment. Length of treatment ranged from 7 to 96 weeks. Antidepressants: Six studies (n = 268) evaluated antidepressants, with very low to low certainty evidence suggesting that antidepressants were no more effective than placebo at post-treatment: gambling symptom severity (SMD -0.32, 95% CI -0.74 to 0.09, n = 225), gambling expenditure (SMD -0.27, 95% CI -0.60 to 0.06, n = 144), depressive symptoms (SMD -0.19, 95% CI -0.60 to 0.23, n = 90), functional impairment (SMD -0.15, 95% CI -0.53 to 0.22, n = 110), and responder status (RR 1.24, 95% CI 0.93 to 1.66, n = 268). Opioid antagonists: Four studies (n = 562) evaluated opioid antagonists, with very low to low certainty evidence showing a medium beneficial effect of treatment on gambling symptom severity relative to placebo at post-treatment (SMD -0.46, 95% CI -0.74 to -0.19, n = 259), but no difference between groups in responder status (RR 1.65, 95% CI 0.86 to 3.14, n = 562). Mood stabilisers: Two studies (n = 71) evaluated mood stabilisers (including anticonvulsants), with very low certainty evidence suggesting that mood stabilisers were no more effective than placebo at post-treatment: gambling symptom severity (SMD -0.92, 95% CI -2.24 to 0.39, n = 71), depressive symptoms (SMD -0.15, 95% CI -1.14 to 0.83, n = 71), and anxiety symptoms (SMD -0.17, 95% CI -0.64 to 0.30, n = 71). Atypical antipsychotics:Two studies (n = 63) evaluated the atypical antipsychotic olanzapine, with very low certainty evidence showing a medium beneficial effect of treatment on gambling symptom severity relative to placebo at post-treatment (SMD -0.59, 95% CI -1.10 to -0.08, n = 63). Comparative effectiveness: Two studies (n = 62) compared antidepressants with opioid antagonists, with very low certainty evidence indicating that antidepressants were no more effective than opioid antagonists on depressive symptoms (SMD 0.22, 95% CI -0.29 to 0.72, n = 62) or anxiety symptoms (SMD 0.21, 95% CI -0.29 to 0.72, n = 62) at post-treatment. Two studies (n = 58) compared antidepressants with mood stabilisers (including anticonvulsants), with very low certainty evidence indicating that antidepressants were no more effective than mood stabilisers on depressive symptoms (SMD 0.02, 95% CI -0.53 to 0.56, n = 58) or anxiety symptoms (SMD 0.16, 95% CI -0.39 to 0.70, n = 58) at post-treatment. Tolerability and adverse events: Several common adverse effects were reported by participants receiving antidepressants (e.g. headaches, nausea, diarrhoea/gastrointestinal issues) and opioid antagonists (e.g. nausea, dry mouth, constipation). There was little consistency in the types of adverse effects experienced by participants receiving mood stabilisers (e.g. tiredness, headaches, concentration difficulties) or atypical antipsychotics (e.g. pneumonia, sedation, increased hypomania). Discontinuation of treatment due to these adverse events was highest for opioid antagonists (10% to 32%), followed by antidepressants (4% to 31%), atypical antipsychotics (14%), and mood stabilisers (13%). AUTHORS' CONCLUSIONS This review provides preliminary support for the use of opioid antagonists (naltrexone, nalmefene) and atypical antipsychotics (olanzapine) to produce short-term improvements in gambling symptom severity, although a lack of available evidence precludes a conclusion regarding the degree to which these pharmacological agents can improve other gambling or psychological functioning indices. In contrast, the findings are inconclusive with regard to the effects of mood stabilisers (including anticonvulsants) in the treatment of disordered or problem gambling, and there is limited evidence to support the efficacy of antidepressants. However, these conclusions are based on very low to low certainty evidence characterised by a small number of included studies, high risk of bias, modest pooled sample sizes, imprecise estimates, moderate between-study heterogeneity, and exclusion of participants with psychiatric comorbidities. Moreover, there were insufficient studies to conduct meta-analyses on many outcome measures; to compare efficacy across and within major categories of interventions; to explore dosage effects; or to examine effects beyond post-treatment. These limitations suggest that, despite recommendations related to the administration of opioid antagonists in the treatment of disordered or problem gambling, pharmacological interventions should be administered with caution and with careful consideration of patient needs. A larger and more methodologically rigorous evidence base with longer-term evaluation periods is required before definitive conclusions can be drawn about the effectiveness and durability of pharmacological treatments for disordered or problem gambling.
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Affiliation(s)
- Nicki Dowling
- School of Psychology, Deakin University, Geelong, Australia
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, Australia
| | | | - Dan Lubman
- Turning Point, Eastern Health, Melbourne, Australia
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Shane Thomas
- School of Health, Federation University, Melbourne, Australia
- Research School of Population Health, Australian National University, Melbourne, Australia
- Peking University, Beijing, China
| | - Henrietta Bowden-Jones
- National Problem Gambling Clinic UK, Faculty of Brain Sciences, UCL, London, UK
- Department of Psychiatry, Cambridge University, Cambridge, UK
| | - Sean Cowlishaw
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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13
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Scantlebury A, Adamson J, Salisbury C, Brant H, Anderson H, Baxter H, Bloor K, Cowlishaw S, Doran T, Gaughan J, Gibson A, Gutacker N, Leggett H, Purdy S, Voss S, Benger JR. Do general practitioners working in or alongside the emergency department improve clinical outcomes or experience? A mixed-methods study. BMJ Open 2022; 12:e063495. [PMID: 36127084 PMCID: PMC9490584 DOI: 10.1136/bmjopen-2022-063495] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To examine the effect of general practitioners (GPs) working in or alongside the emergency department (GPED) on patient outcomes and experience, and the associated impacts of implementation on the workforce. DESIGN Mixed-methods study: interviews with service leaders and NHS managers; in-depth case studies (n=10) and retrospective observational analysis of routinely collected national data. We used normalisation process theory to map our findings to the theory's four main constructs of coherence, cognitive participation, collective action and reflexive monitoring. SETTING AND PARTICIPANTS Data were collected from 64 EDs in England. Case site data included: non-participant observation of 142 clinical encounters; 467 semistructured interviews with policy-makers, service leaders, clinical staff, patients and carers. Retrospective observational analysis used routinely collected Hospital Episode Statistics alongside information on GPED service hours from 40 hospitals for which complete data were available. RESULTS There was disagreement at individual, stakeholder and organisational levels regarding the purpose and potential impact of GPED (coherence). Participants criticised policy development and implementation, and staff engagement was hindered by tensions between ED and GP staff (cognitive participation). Patient 'streaming' processes, staffing and resource constraints influenced whether GPED became embedded in routine practice. Concerns that GPED may increase ED attendance influenced staff views. Our quantitative analysis showed no detectable impact on attendance (collective action). Stakeholders disagreed whether GPED was successful, due to variations in GPED model, site-specific patient mix and governance arrangements. Following statistical adjustment for multiple testing, we found no impact on: ED reattendances within 7 days, patients discharged within 4 hours of arrival, patients leaving the ED without being seen; inpatient admissions; non-urgent ED attendances and 30-day mortality (reflexive monitoring). CONCLUSIONS We found a high degree of variability between hospital sites, but no overall evidence that GPED increases the efficient operation of EDs or improves clinical outcomes, patient or staff experience. TRIAL REGISTRATION NUMBER ISCRTN5178022.
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Affiliation(s)
| | - Joy Adamson
- Department of Health Sciences, University of York, York, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Heather Brant
- School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Helen Anderson
- Department of Health Sciences, University of York, York, UK
| | - Helen Baxter
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Karen Bloor
- Department of Health Sciences, University of York, York, UK
| | - Sean Cowlishaw
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
| | - James Gaughan
- Department of Health Sciences, University of York, York, UK
| | - Andy Gibson
- School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Nils Gutacker
- Centre for Health Economics, University of York, York, UK
| | | | - Sarah Purdy
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sarah Voss
- School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Jonathan Richard Benger
- School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, UK
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14
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Varker T, Arjmand HA, Metcalf O, Cowlishaw S, O'Donnell M, Forbes D, McFarlane A, Bryant RA, Hopwood M, Phelps A, Hinton M. Using an ecological momentary assessment protocol to understand problem anger in veterans. J Behav Ther Exp Psychiatry 2022; 76:101746. [PMID: 35738692 DOI: 10.1016/j.jbtep.2022.101746] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 11/13/2020] [Revised: 03/07/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Problem anger is highly destructive, and is one of the most commonly reported issues in military and veteran populations. The goal of this study was to use ecological momentary assessment (EMA) to explore and characterize moment-to-moment experiences of problem anger in a sample of Australian veterans. METHODS Sixty veterans with problem anger (measured on the Dimensions of Anger Reactions Scale) completed measures of anger and anger rumination, before and after a 10-day EMA period which assessed the frequency, intensity, and expression of momentary anger experiences. RESULTS Findings showed that 75% of respondents indicated some level of anger during EMA monitoring. In 25% of cases, anger was reported as severe. Moreover, anger was expressed verbally in 43% of cases, and expressed physically in 27% of cases. While anger fluctuated frequently during the day, more severe anger was more likely to be reported in the late afternoon/early evening. Problem anger symptoms decreased significantly over time, from pre-EMA to post EMA (p < .001). LIMITATIONS The generalizability of findings is limited to a predominantly male sample, with low levels of risk of harm or violence. The study was also limited in the selection of outcome variables assessed and the lack of a control group; other momentary factors could influence experience of problem anger and provide further explanation of study results. CONCLUSIONS EMA is a valuable assessment tool for individuals with problem anger, and the potential for EMA as an intervention needs to be explored further.
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Affiliation(s)
- Tracey Varker
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia.
| | - Hussain-Abdulah Arjmand
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Olivia Metcalf
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Sean Cowlishaw
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Meaghan O'Donnell
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - David Forbes
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Alexander McFarlane
- Adelaide Medical School, The University of Adelaide, South Australia, Australia
| | - Richard A Bryant
- School of Psychology, The University of New South Wales, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Australia
| | - Andrea Phelps
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Mark Hinton
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
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15
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Iverson KM, Dardis CM, Cowlishaw S, Webermann AR, Shayani DR, Dichter ME, Mitchell KS, Mattocks KM, Gerber MR, Portnoy GR. Effects of Intimate Partner Violence During COVID-19 and Pandemic-Related Stress on the Mental and Physical Health of Women Veterans. J Gen Intern Med 2022; 37:724-733. [PMID: 36042090 PMCID: PMC9427167 DOI: 10.1007/s11606-022-07589-z] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about women veterans' intimate partner violence (IPV) experiences during the COVID-19 pandemic or the impacts of pandemic-related stress on their mental and physical health. OBJECTIVES To identify IPV experiences among women veterans prior to and during the pandemic, pandemic-related stressors, and examine their respective contributions to mental and physical health. DESIGN National sample of women veterans drawn from a larger web-based longitudinal study. Relationships between recent IPV and pandemic-related stressors were tested with linear regressions, controlling for pre-pandemic IPV and mental and physical health symptoms, demographic, and military-related covariates. PARTICIPANTS One hundred forty-two women veterans (Mage=58.8 years). MAIN MEASURES We assessed IPV (CTS-2), PTSD (PCL-5), depression (CESD), anxiety (DASS-A), physical health (PHQ-15), and physical health-related quality of life (SF-12) prior to the pandemic (June 2016-December 2016/January 2017) and during the pandemic study period (March 2020-December 2020/January 2021). We assessed pandemic-related stressors (EPII) during the pandemic study period. KEY RESULTS Over a third (38.7%) of participants experienced IPV during the pandemic study period (psychological: 35.9%, physical: 9.9%, sexual: 4.2%). Overall rates, frequency, and severity of IPV experience did not significantly differ between the pre-pandemic and pandemic study periods. Few participants tested positive for COVID-19 (4.2%); however, most participants reported experiencing pandemic-related stressors across life domains (e.g., social activities: 88%, physical health: 80.3%, emotional health: 68.3%). IPV during the pandemic and pandemic-related stressors were both associated with greater PTSD and depressive symptoms. Pandemic-related stressors were associated with worse anxiety and physical health symptoms. Neither IPV during the pandemic nor pandemic-related stressors were associated with physical health-related quality of life. CONCLUSIONS IPV experiences during the pandemic were common among women veterans, as were pandemic-related stressors. Although IPV did not increase in the context of COVID-19, IPV experiences during the pandemic and pandemic-related stressors were linked with poorer mental and physical health.
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Affiliation(s)
- Katherine M Iverson
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
| | | | - Sean Cowlishaw
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | | | - Danielle R Shayani
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Melissa E Dichter
- VA Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- School of Social Work, Temple University, Philadelphia, PA, USA
| | - Karen S Mitchell
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Megan R Gerber
- Division of General Medicine, Albany Medical College, Albany, NY, USA
- Albany Stratton VA Medical Center, Albany, NY, USA
| | - Galina R Portnoy
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
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16
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Cowlishaw S, Freijah I, Kartal D, Sbisa A, Mulligan A, Notarianni M, Couineau AL, Forbes D, O’Donnell M, Phelps A, Iverson KM, Heber A, O’Dwyer C, Smith P, Hosseiny F. Intimate Partner Violence (IPV) in Military and Veteran Populations: A Systematic Review of Population-Based Surveys and Population Screening Studies. IJERPH 2022; 19:ijerph19148853. [PMID: 35886702 PMCID: PMC9316917 DOI: 10.3390/ijerph19148853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 12/23/2022]
Abstract
Intimate partner violence (IPV) may be a major concern in military and veteran populations, and the aims of this systematic review were to (1) provide best available estimates of overall prevalence based on studies that are most representative of relevant populations, and (2) contextualise these via examination of IPV types, impacts, and context. An electronic search of PsycINFO, CINHAL, PubMed, and the Cochrane Library databases identified studies utilising population-based designs or population screening strategies to estimate prevalence of IPV perpetration or victimisation reported by active duty (AD) military personnel or veterans. Random effects meta-analyses were used for quantitative analyses and were supplemented by narrative syntheses of heterogeneous data. Thirty-one studies involving 172,790 participants were included in meta-analyses. These indicated around 13% of all AD personnel and veterans reported any recent IPV perpetration, and around 21% reported any recent victimisation. There were higher rates of IPV perpetration in studies of veterans and health service settings, but no discernible differences were found according to gender, era of service, or country of origin. Psychological IPV was the most common form identified, while there were few studies of IPV impacts, or coercive and controlling behaviours. The findings demonstrate that IPV perpetration and victimisation occur commonly among AD personnel and veterans and highlight a strong need for responses across military and veteran-specific settings. However, there are gaps in understanding of impacts and context for IPV, including coercive and controlling behaviours, which are priority considerations for future research and policy.
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Affiliation(s)
- Sean Cowlishaw
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
- Correspondence:
| | - Isabella Freijah
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
| | - Dzenana Kartal
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
| | - Alyssa Sbisa
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
| | - Ashlee Mulligan
- Atlas Institute for Veterans and Families, Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada; (A.M.); (M.N.); (P.S.); (F.H.)
| | - MaryAnn Notarianni
- Atlas Institute for Veterans and Families, Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada; (A.M.); (M.N.); (P.S.); (F.H.)
| | - Anne-Laure Couineau
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
| | - David Forbes
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
| | - Meaghan O’Donnell
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
| | - Andrea Phelps
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
| | - Katherine M. Iverson
- Women’s Health Sciences Division, National Center for PTSD, Veterans Affairs Boston Healthcare System, 150 South Huntington Street, Boston, MA 02130, USA;
- Department of Psychiatry, Boston University School of Medicine, 72 E Concord Street, Boston, MA 02118, USA
| | - Alexandra Heber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada;
- Veterans Affairs Canada, Charlottetown, PE C1A 8M9, Canada
| | - Carol O’Dwyer
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
| | - Patrick Smith
- Atlas Institute for Veterans and Families, Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada; (A.M.); (M.N.); (P.S.); (F.H.)
| | - Fardous Hosseiny
- Atlas Institute for Veterans and Families, Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada; (A.M.); (M.N.); (P.S.); (F.H.)
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Varker T, Cowlishaw S, Baur J, McFarlane AC, Lawrence-Wood E, Metcalf O, Van Hooff M, Sadler N, O'Donnell ML, Hodson S, Benassi H, Forbes D. Problem anger in veterans and military personnel: Prevalence, predictors, and associated harms of suicide and violence. J Psychiatr Res 2022; 151:57-64. [PMID: 35453092 DOI: 10.1016/j.jpsychires.2022.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Received: 09/19/2021] [Revised: 03/06/2022] [Accepted: 04/04/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Problem anger is increasingly identified as an important issue, and may be associated with suicidality and violence. This study investigates the relationship between problem anger, suicidality, and violence amongst veterans and military personnel. METHODS Cross-sectional survey data from n = 12,806 military personnel and veterans were subject to analyses. These considered the weighted prevalence of problem anger, while further analyses of veterans (n = 4326) considered risk factors and co-occurrence with other psychiatric conditions. Path analyses examined inter-relationships involving anger, violence and suicidality. RESULTS There were 30.7% of veterans and 16.4% of military personnel that reported past month problem anger, while 14.9% of veterans and 7.4% of military personnel reported physical violence. There were higher levels of suicidality among veterans (30.3%), than military personnel (14.3%). Logistic regression models indicated that PTSD was the strongest risk factor for problem anger (PCL-5, OR = 21.68), while there were small but substantial increases in anger rates associated with depression (OR = 15.62) and alcohol dependence (OR = 6.55). Path models indicated that problem anger had an influence on suicide attempts, occurring primarily through suicidal ideation, and an influence on violence. Influences of problem anger on suicidal ideation and violence remained significant when controlling for co-occurring mental health problems. CONCLUSIONS Problem anger, violence, and suicidality are common and inter-related issues among military personnel and veterans. Problem anger is a unique correlate of suicidality, supporting the need for anger to be included as part of violence and suicide risk assessment, and clinician training.
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Affiliation(s)
- Tracey Varker
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Australia.
| | - Sean Cowlishaw
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Australia
| | - Jenelle Baur
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Australia
| | | | - Ellie Lawrence-Wood
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Australia
| | - Olivia Metcalf
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Australia
| | - Miranda Van Hooff
- Military and Emergency Services Health Australia, The Hospital Research Foundation Group, The University of Adelaide, The University of South Australia, Adelaide, South Australia, Australia
| | - Nicole Sadler
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Australia
| | - Meaghan L O'Donnell
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Australia
| | - Stephanie Hodson
- Open Arms - Veteran & Families Counselling, Department of Veterans' Affairs, Canberra, Australia
| | - Helen Benassi
- Joint Health Command, Joint Capabilities Group, Australian Department of Defence, Australia
| | - David Forbes
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Australia
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McCarthy S, Thomas S, Marko S, Pitt H, Randle M, Cowlishaw S. Women's perceptions of strategies to address the normalisation of gambling and gambling-related harm. Aust N Z J Public Health 2022; 46:821-828. [PMID: 35735793 DOI: 10.1111/1753-6405.13264] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/01/2022] [Accepted: 04/01/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Research has demonstrated that gambling is becoming increasingly normalised for women. As limited research has sought to understand women's perspectives on this issue, we sought women's opinions about the factors that may contribute to the normalisation of gambling for women, and the strategies that may counter this normalisation. METHODS Semi-structured interviews were conducted with 41 women in young and middle adulthood, aged 20-40 years. RESULTS Participants suggested that gambling was normal for women because gambling environments had been designed to appeal to women, newer technologies had removed the stigma of attending physical venues, and the growing equality and independence of women. To de-normalise gambling, women suggested addressing the influential role of marketing, designing new public education strategies, addressing the availability and accessibility of gambling, and restricting engagement with gambling products. CONCLUSION This study highlighted women's perceptions of strategies to address the normalisation of gambling and the importance of providing risk information paired with broader policy reform and prevention initiatives to address the range of determinants that normalise gambling for women. IMPLICATIONS FOR PUBLIC HEALTH Involving women in advocacy and understanding their perspectives is important in developing relevant public health responses to the normalisation of gambling for women.
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Affiliation(s)
- Simone McCarthy
- Institute for Health Transformation, Faculty of Health, Deakin University, Victoria
| | - Samantha Thomas
- Institute for Health Transformation, Faculty of Health, Deakin University, Victoria
| | - Sarah Marko
- Institute for Health Transformation, Faculty of Health, Deakin University, Victoria
| | - Hannah Pitt
- Institute for Health Transformation, Faculty of Health, Deakin University, Victoria
| | - Melanie Randle
- Faculty of Business and Law, University of Wollongong, New South Wales
| | - Sean Cowlishaw
- Department of Psychiatry, The University of Melbourne, Victoria
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Pitt H, Thomas SL, Randle M, Cowlishaw S, Arnot G, Kairouz S, Daube M. Young people in Australia discuss strategies for preventing the normalisation of gambling and reducing gambling harm. BMC Public Health 2022; 22:956. [PMID: 35549692 PMCID: PMC9098214 DOI: 10.1186/s12889-022-13201-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background The normalisation of gambling for young people has received considerable recent attention in the public health literature, particularly given the proliferation of gambling marketing aligned with sport. A range of studies and reports into the health and wellbeing of young people have recommended that they should be consulted and engaged in developing public health policy and prevention strategies. There are, however, very few opportunities for young people to have a say about gambling issues, with little consideration of their voices in public health recommendations related to gambling. This study aimed to address this gap by documenting young people’s perceptions about strategies that could be used to counter the normalisation of gambling and prevent gambling related harm. Methods This study took a critical qualitative inquiry approach, which acknowledges the role of power and social injustice in health issues. Qualitative interviews, using a constructivist approach, were conducted with 54 young people (11–17 years) in Australia. Reflexive thematic analysis was used to interpret the data. Results Five overall strategies were constructed from the data. 1) Reducing the accessibility and availability of gambling products; 2) Changing gambling infrastructure to help reduce the risks associated with gambling engagement; 3) Untangling the relationship between gambling and sport; 4) Restrictions on advertising; and 5) Counter-framing in commercial messages about gambling. Conclusions This study demonstrates that young people have important insights and provide recommendations for addressing factors that may contribute to the normalisation of gambling, including strategies to prevent gambling related harm. Young people hold similar views to public health experts about strategies aimed at de-normalising gambling in their local communities and have strong opinions about the need for gambling to be removed from sport.
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Affiliation(s)
- Hannah Pitt
- Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia.
| | - Samantha L Thomas
- Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Melanie Randle
- Faculty of Business and Law, University of Wollongong, Wollongong, Australia
| | - Sean Cowlishaw
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Grace Arnot
- Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Sylvia Kairouz
- Gambling Studies, Concordia University, Montreal, Canada
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Perth, Australia
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Sawyer S, Cowlishaw S, Kendrick K, Boyle M, Dicker B, Lord B. A systematic review of incidence, prevalence, and trends in health outcomes for Australian and New Zealand paramedics. PREHOSP EMERG CARE 2022; 27:398-412. [PMID: 35394892 DOI: 10.1080/10903127.2022.2064019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Introduction: The paramedic role carries inherent risk to practitioner health, due to a combination of work characteristics and the employment practices of different organisations. Emerging evidence suggests that paramedics worldwide may face a range of negative health outcomes. The purpose of this paper was to systematically review the literature of paramedic health outcomes in the Australian and New Zealand context.Methods: A systematic search of key databases and grey literature was conducted to identify all available studies reporting on quantitative health outcomes for paramedics working in Australia or New Zealand. The review was conducted using the JBI methodology for prevalence studies, and uses a narrative synthesis approach to reporting.Results: There were k = 20 studies that met inclusion criteria, and most used Australian samples. Results indicated between 57.3-66.5% of paramedics studied were classified as overweight or obese, while up to 80% reported poor sleep, and 55.6% reported fatigue. Incidence rates per 100,000 FTE included 26.62 for completed suicide, 5.46 for drug-caused death, and 9.3 for workplace fatalities. The most recent incidence per 1,000 FTE for injury compensation claims was 141.4.Conclusions: Australian and New Zealand paramedics demonstrate poor health according to several metrics. Our sample demonstrated considerably worse health than the general population or similar occupations. There is little trend data available, so it was difficult to ascertain if rates are changing. The range of health outcomes studied was limited, and correlations between different health outcomes were rarely considered by authors. Data relating to specific rates for gender and sexuality, location of work, and First Nations status or ethnicity was often not available.Systematic review registration number (PROSPERO): CRD42021232196.
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Cowlishaw S, Sbisa A, Freijah I, Kartal D, Mulligan A, Notarianni M, Iverson K, Couineau AL, Forbes D, O’Donnell M, Phelps A, Smith P, Hosseiny F. Health Service Interventions for Intimate Partner Violence among Military Personnel and Veterans: A Framework and Scoping Review. Int J Environ Res Public Health 2022; 19:ijerph19063551. [PMID: 35329239 PMCID: PMC8955703 DOI: 10.3390/ijerph19063551] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023]
Abstract
IPV is a significant concern among active duty (AD) military personnel or veterans, and there is a need for initiatives to address violence perpetrated by such personnel, and IPV victimisation in military and veteran-specific contexts. The aim of this paper was to provide an overview of major IPV intervention approaches and evidence in military and veteran-specific health services. A scoping review was conducted involving a systematic search of all available published studies describing IPV interventions in military and veteran-specific health services. Findings were synthesised narratively, and in relation to a conceptual framework that distinguishes across prevention, response, and recovery-oriented strategies. The search identified 19 studies, all from the U.S., and only three comprised randomised trials. Initiatives addressed both IPV perpetration and victimisation, with varied interventions targeting the latter, including training programs, case identification and risk assessment strategies, and psychosocial interventions. Most initiatives were classified as responses to IPV, with one example of indicated prevention. The findings highlight an important role for specific health services in addressing IPV among AD personnel and veterans, and signal intervention components that should be considered. The limited amount of empirical evidence indicates that benefits of interventions remain unclear, and highlights the need for targeted research.
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Affiliation(s)
- Sean Cowlishaw
- Phoenix Australia–Centre for Post-traumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (A.S.); (I.F.); (D.K.); (A.-L.C.); (D.F.); (M.O.); (A.P.)
- Correspondence:
| | - Alyssa Sbisa
- Phoenix Australia–Centre for Post-traumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (A.S.); (I.F.); (D.K.); (A.-L.C.); (D.F.); (M.O.); (A.P.)
| | - Isabella Freijah
- Phoenix Australia–Centre for Post-traumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (A.S.); (I.F.); (D.K.); (A.-L.C.); (D.F.); (M.O.); (A.P.)
| | - Dzenana Kartal
- Phoenix Australia–Centre for Post-traumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (A.S.); (I.F.); (D.K.); (A.-L.C.); (D.F.); (M.O.); (A.P.)
| | - Ashlee Mulligan
- Centre of Excellence on Post-Traumatic Stress Disorder and Related Mental Health Conditions, 1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada; (A.M.); (M.N.); (P.S.); (F.H.)
| | - MaryAnn Notarianni
- Centre of Excellence on Post-Traumatic Stress Disorder and Related Mental Health Conditions, 1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada; (A.M.); (M.N.); (P.S.); (F.H.)
| | - Katherine Iverson
- Women’s Health Sciences Division of the National Center for PTSD, Veterans Affairs Boston Healthcare System, 150 South Huntington Street, Boston, MA 02130, USA;
- Department of Psychiatry, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Anne-Laure Couineau
- Phoenix Australia–Centre for Post-traumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (A.S.); (I.F.); (D.K.); (A.-L.C.); (D.F.); (M.O.); (A.P.)
| | - David Forbes
- Phoenix Australia–Centre for Post-traumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (A.S.); (I.F.); (D.K.); (A.-L.C.); (D.F.); (M.O.); (A.P.)
| | - Meaghan O’Donnell
- Phoenix Australia–Centre for Post-traumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (A.S.); (I.F.); (D.K.); (A.-L.C.); (D.F.); (M.O.); (A.P.)
| | - Andrea Phelps
- Phoenix Australia–Centre for Post-traumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (A.S.); (I.F.); (D.K.); (A.-L.C.); (D.F.); (M.O.); (A.P.)
| | - Patrick Smith
- Centre of Excellence on Post-Traumatic Stress Disorder and Related Mental Health Conditions, 1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada; (A.M.); (M.N.); (P.S.); (F.H.)
| | - Fardous Hosseiny
- Centre of Excellence on Post-Traumatic Stress Disorder and Related Mental Health Conditions, 1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada; (A.M.); (M.N.); (P.S.); (F.H.)
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Cowlishaw S, Metcalf O, Little J, Hinton M, Forbes D, Varker T, Agathos J, Bryant RA, McFarlane AC, Hopwood M, Phelps AJ, Howard A, Cooper J, Dell L, O'Donnell ML. Cross-lagged analyses of anger and PTSD symptoms among veterans in treatment. Psychol Trauma 2022; 14:336-345. [PMID: 34435811 DOI: 10.1037/tra0001084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Anger is a salient feature of posttraumatic mental health which is linked to posttraumatic stress disorder (PTSD) and may have implications for treatment. However, the nature of associations involving anger and PTSD remains unclear. The aim of the present study was to examine bidirectional influences involving anger and International Classification of Diseases (ICD)-11 PTSD symptom clusters over time among treatment-seeking veterans. METHOD Current or ex-serving members (n = 742; 92.4% male) who participated in an accredited outpatient PTSD treatment program were administered measures of PTSD symptoms (PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th edition [PCL-5]) and anger (Dimensions of Anger Reactions Scale-5 [DAR-5]) at treatment intake, discharge, and three-month follow-up. Bidirectional influences were assessed using cross-lagged panel analyses. RESULTS The majority of participants (78%) exhibited significant anger problems at intake. Cross-lagged analyses showed anger was associated with relative increases in PTSD symptoms of intrusive reexperiencing and avoidance at posttreatment, whereas no reverse effects of any PTSD symptoms on anger were observed. Anger continued to influence changes in heightened sense of threat and avoidance symptoms at three-months posttreatment. CONCLUSIONS Anger influences change in specific PTSD symptoms over time among military veterans in treatment and may interfere with treatments for PTSD. Veterans who present to clinical services with anger problems may benefit from anger interventions prior to commencing trauma-focused treatment. The findings have additional implications for conceptual models of the relationship between anger and PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Sean Cowlishaw
- Phoenix Australia Center for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne
| | - Olivia Metcalf
- Phoenix Australia Center for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne
| | - Jonathon Little
- Phoenix Australia Center for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne
| | - Mark Hinton
- Phoenix Australia Center for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne
| | - David Forbes
- Phoenix Australia Center for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne
| | - Tracey Varker
- Phoenix Australia Center for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne
| | - James Agathos
- Phoenix Australia Center for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne
| | | | | | | | - Andrea J Phelps
- Phoenix Australia Center for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne
| | - Alexandra Howard
- Phoenix Australia Center for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne
| | - John Cooper
- Phoenix Australia Center for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne
| | - Lisa Dell
- Phoenix Australia Center for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne
| | - Meaghan L O'Donnell
- Phoenix Australia Center for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne
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Metcalf O, Little J, Cowlishaw S, Varker T, Arjmand HA, O'Donnell M, Phelps A, Hinton M, Bryant R, Hopwood M, McFarlane A, Forbes D. Modelling the relationship between poor sleep and problem anger in veterans: A dynamic structural equation modelling approach. J Psychosom Res 2021; 150:110615. [PMID: 34525413 DOI: 10.1016/j.jpsychores.2021.110615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 03/29/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Problem anger and poor sleep are common, particularly in military and veteran populations, but the nature of the relationship is poorly understood, and treatment approaches would benefit from improved understanding of how these constructs interact. Ecological momentary assessment (EMA) is suitable for monitoring day-to-day fluctuations in symptoms, and modelling dynamic relationships between variables. METHODS This study aimed to examine these fluctuations and relationships involving sleep quality and anger experiences among veterans. A sample of n = 60 veterans with problem anger as assessed by the recommended cut off on the Dimensions of Anger Reactions 5 scale (DAR-5) completed daily assessments of sleep quality and four times daily assessments of anger frequency, over a 10-day period. RESULTS A Dynamic Structural Equation Model (DESM) estimated and revealed a unidirectional relationship across daily measurements, in that previous night poor sleep quality was associated with more frequent anger on the next day (φASi Estimate -0.791, one-tailed p = .075), but not the reverse. CONCLUSIONS These are the first longitudinal, naturalistic findings in relation to anger and sleep in a sample self-identifying with significant anger problems. The observed patterns point to the need for further research on mechanisms underpinning this relationship, and raises potential for early intervention for problem anger to include a focus on improving sleep quality.
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Affiliation(s)
- Olivia Metcalf
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia.
| | - Jonathon Little
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Sean Cowlishaw
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Tracey Varker
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Hussain-Abdulah Arjmand
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Meaghan O'Donnell
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Andrea Phelps
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Mark Hinton
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Richard Bryant
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Malcolm Hopwood
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Alexander McFarlane
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - David Forbes
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
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Terhaag S, Phelps A, Howard A, O'Donnell M, Cowlishaw S. A Longitudinal Exploration of Self-Reported Hearing Loss, Tinnitus, and Posttraumatic Stress Disorder Treatment Outcomes in Australian Veterans. Psychosom Med 2021; 83:863-869. [PMID: 34267087 DOI: 10.1097/psy.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/20/2022]
Abstract
OBJECTIVE Tinnitus, hearing loss, and posttraumatic stress disorder (PTSD) are common conditions among veterans. Shared underlying symptoms, such as hypervigilance and heightened sense of threat, may interfere with talk-based psychological treatments. The aim was to investigate the prevalence and risk factors for self-reported tinnitus and hearing loss among Australian treatment-seeking veterans, as well as links with PTSD symptoms and quality of life (QOL) after treatment. METHODS Australian veterans participating in hospital-based PTSD treatment (n = 523) completed self-report measures of subjective hearing impairment, service-related factors, PTSD symptoms, and QOL at treatment intake and discharge, as well as 3- and 9-month follow-ups. Univariate analyses of covariance modeled symptom change over time. RESULTS More than half of veterans on PTSD treatment self-reported doctor-diagnosed hearing loss or tinnitus, whereas 43% reported both. However, 75% reported subjective mild to moderate hearing impairment, and only 1% reported severe impairment. Service-related factors, such as longer length of service and exposure to explosions, were risk factors for having any hearing condition. After controlling for intake scores, there were no significant differences on PTSD or QOL outcomes over time between those with and without hearing conditions. CONCLUSIONS Although self-reported tinnitus and hearing loss are prevalent among veterans, those with severe hearing impairments are unlikely to be represented in this context. There is a need for psychological treatments that are accessible to patients with severe hearing impairments, which should be examined routinely among military members accessing psychological treatments.
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Affiliation(s)
- Sonia Terhaag
- From the Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
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25
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Hinton M, O'Donnell M, Cowlishaw S, Kartal D, Metcalf O, Varker T, McFarlane AC, Hopwood M, Bryant RA, Forbes D, Howard A, Lau W, Cooper J, Phelps AJ. Defining post-traumatic stress disorder recovery in veterans: Benchmarking symptom change against functioning indicators. Stress Health 2021; 37:547-556. [PMID: 33336551 DOI: 10.1002/smi.3019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/07/2020] [Accepted: 12/11/2020] [Indexed: 11/08/2022]
Abstract
Improved metrics of Post-traumatic stress disorder (PTSD) treatment response that extend beyond a focus on symptom reduction to incorporate meaningful, patient-centred indicators of functioning are needed in veteran populations. The aim of this study was to extend previous research by investigating whether indicators of functioning can successfully distinguish against symptom response categories derived from the Post-Traumatic Stress Disorder Checklist (PCL-5) pre- and post- PTSD treatment. Participants were 472 veterans receiving hospital-based treatment for PTSD. In addition to the PCL-5, measures included quality of life, social relationships, physical health and psychological distress. Four mutually exclusive, progressive response categories were used to define treatment response including: No Response, Response, Response and Below Threshold, and Remission. PTSD symptom reductions were associated with corresponding improvements in broader indicators of functioning. However, it was only when the magnitude of symptom reduction placed the individual in the 'Response and Below Threshold' category that improvement on functioning measures achieved levels indicative of a good end state. Traditional metrics of treatment 'response' in PTSD treatment do not necessarily indicate recovery on important functioning indicators. Only when an individual both responds to treatment and drops below threshold for probable disorder are they likely to report having meaningful levels of functioning.
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Affiliation(s)
- Mark Hinton
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Meaghan O'Donnell
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Sean Cowlishaw
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia.,Bristol Medical School, University of Bristol, Bristol, UK
| | - Dzenana Kartal
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Olivia Metcalf
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Tracey Varker
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Alexander C McFarlane
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Kensington, Australia
| | - David Forbes
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Alexandra Howard
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Winnie Lau
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - John Cooper
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Andrea J Phelps
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
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26
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Kartal D, Arjmand HA, Varker T, Cowlishaw S, O'Donnell M, Phelps A, Howard A, Hopwood M, McFarlane A, Bryant RA, Forbes D, Cooper J, Hinton M. Cross-Lagged Relationships Between Insomnia and Posttraumatic Stress Disorder in Treatment-Receiving Veterans. Behav Ther 2021; 52:982-994. [PMID: 34134836 DOI: 10.1016/j.beth.2020.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Received: 06/15/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 01/13/2023]
Abstract
Insomnia is a risk factor for the development of posttraumatic stress disorder (PTSD) while it is also plausible that PTSD symptoms can maintain insomnia symptoms. The present study examined longitudinal bidirectional relationships between insomnia and PTSD symptoms in treatment-seeking veterans. Participants were 693 ex-serving members of the Australian Defence Force who participated in an accredited, hospital-based outpatient PTSD program. Participants completed self-reported assessments of PTSD and insomnia symptoms at four time points: intake, discharge, 3-month, and 9-months posttreatment follow-up. Cross-lagged pathway analyses indicated significant bi-directional pathways between insomnia symptoms and PTSD symptoms at most time points. A final cross-lagged model between insomnia symptoms and the PTSD symptom clusters indicated that the PTSD symptom paths on insomnia symptoms, between intake and discharge, were attributable to reexperiencing PTSD symptoms. In contrast, across posttreatment follow-up time points there were significant paths of insomnia symptoms on all PTSD symptom clusters except from insomnia at 3-months to avoidance symptom at 9-months. PTSD symptoms and insomnia symptoms have bidirectional associations over time that may lead to the mutual maintenance or exacerbation of each condition following PTSD treatment. Where residual insomnia symptoms are present post-treatment, a sleep-focussed intervention is indicated and a sequenced approach to treatment recommended.
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Affiliation(s)
- Dzenana Kartal
- Phoenix Australia-Centre for Posttraumatic Mental Health and University of Melbourne.
| | | | - Tracey Varker
- Phoenix Australia-Centre for Posttraumatic Mental Health and University of Melbourne
| | - Sean Cowlishaw
- Phoenix Australia-Centre for Posttraumatic Mental Health and University of Melbourne
| | - Meaghan O'Donnell
- Phoenix Australia-Centre for Posttraumatic Mental Health and University of Melbourne
| | - Andrea Phelps
- Phoenix Australia-Centre for Posttraumatic Mental Health and University of Melbourne
| | - Alexandra Howard
- Phoenix Australia-Centre for Posttraumatic Mental Health and University of Melbourne
| | | | | | | | - David Forbes
- Phoenix Australia-Centre for Posttraumatic Mental Health and University of Melbourne
| | - John Cooper
- Phoenix Australia-Centre for Posttraumatic Mental Health and University of Melbourne
| | - Mark Hinton
- Phoenix Australia-Centre for Posttraumatic Mental Health and University of Melbourne
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Scantlebury A, Brant H, Anderson H, Leggett H, Salisbury C, Cowlishaw S, Voss S, Benger JR, Adamson J. Potential impacts of general practitioners working in or alongside emergency departments in England: initial qualitative findings from a national mixed-methods evaluation. BMJ Open 2021; 11:e045453. [PMID: 34031113 PMCID: PMC8149439 DOI: 10.1136/bmjopen-2020-045453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the potential impacts of introducing General Practitioners into Emergency Departments (GPED) from the perspectives of service leaders, health professionals and patients. These 'expectations of impact' can be used to generate hypotheses that will inform future implementations and evaluations of GPED. DESIGN Qualitative study consisting of 228 semistructured interviews. SETTING 10 acute National Health Service (NHS) hospitals and the wider healthcare system in England. Interviews were undertaken face to face or via telephone. Data were analysed thematically. PARTICIPANTS 124 health professionals and 94 patients and carers. 10 service leaders representing a range of national organisations and government departments across England (eg, NHS England and Department of Health) were also interviewed. RESULTS A range of GPED models are being implemented across the NHS due to different interpretations of national policy and variation in local context. This has resulted in stakeholders and organisations interpreting the aims of GPED differently and anticipating a range of potential impacts. Participants expected GPED to affect the following areas: ED performance indicators; patient outcome and experience; service access; staffing and workforce experience; and resources. Across these 'domains of influence', arguments for positive, negative and no effect of GPED were proposed. CONCLUSIONS Evaluating whether GPED has been successful will be challenging. However, despite uncertainty surrounding the direction of effect, there was agreement across all stakeholder groups on the areas that GPED would influence. As a result, we propose eight domains of influence that will inform our subsequent mixed-methods evaluation of GPED. TRIAL REGISTRATION NUMBER ISRCTN51780222.
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Affiliation(s)
- Arabella Scantlebury
- York Trials Unit, Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Heather Brant
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | - Helen Anderson
- York Trials Unit, Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Heather Leggett
- York Trials Unit, Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Chris Salisbury
- School of Social and community medicine, University of Bristol, Bristol, UK
| | - Sean Cowlishaw
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Voss
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | - Jonathan Richard Benger
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
- Academic Department of Emergency Care, NHS Bristol North Somerset and South Gloucestershire Clinical Commissioning Group, Bristol, UK
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, North Yorkshire, UK
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Pitt H, Thomas SL, Cowlishaw S, Randle M, Balandin S. "I always walked out with an empty purse." Older adults' engagement with electronic gambling machines in Victoria, Australia. Health Promot J Austr 2021; 33:533-541. [PMID: 33982863 DOI: 10.1002/hpja.500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 11/10/2022] Open
Abstract
ISSUE ADDRESSED Older adults are at an increased risk of experiencing gambling harm, which may be due to their use of high-intensity gambling products such as electronic gambling machines (EGMs). However, little research has explored the motivations behind older adults' engagement with EGMs, their understanding of the structural characteristics of EGMs, or their perceptions of risk associated with EGM gambling. This paper aims to address this gap in the literature. METHODS Focus groups were conducted in Melbourne, Australia with n = 126 adults aged 55+, who had attended a club or pub in the last 12 months. Topics included EGM attitudes and behaviours, structural characteristics of EGMs, and the potential risks associated with EGM gambling. Thematic analysis was used to interpret the data. RESULTS For most participants, EGM gambling was secondary to their participation in other activities available within venues. Participants identified structural characteristics of EGMs; however, there were some misconceptions about how EGMs operated, including how or why machines paid out. Most participants perceived that they were not at risk of gambling harm because they engaged in "responsible" gambling practices such as setting limits. CONCLUSIONS Older adults often engaged in EGM gambling because of its availability in community-based venues. Older adults' perception that they are implementing responsible gambling practices may be increasing their susceptibility to harm. SO WHAT?: There is a need to reduce the availability and accessibility of EGMs in community settings and develop public education programs that are tailored to the needs of older adults.
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Affiliation(s)
- Hannah Pitt
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Samantha L Thomas
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia.,Department of Anthropology, Goldsmiths, University of London, London, UK
| | - Sean Cowlishaw
- Department of Psychiatry, University of Melbourne and Phoenix Australia Centre for Posttraumatic Mental Health, Melbourne, Australia
| | - Melanie Randle
- School of Management, Operations and Marketing, Faculty of Business, University of Wollongong, Wollongong, Australia
| | - Susan Balandin
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
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Howard A, Agathos JA, Phelps A, Cowlishaw S, Terhaag S, Arjmand HA, Armstrong R, Berle D, Steel Z, Brewer D, Human B, Herwig A, Wigg C, Kemp P, Wellauer R, O'Donnell ML. Prevalence and treatment implications of ICD-11 complex PTSD in Australian treatment-seeking current and ex-serving military members. Eur J Psychotraumatol 2021; 12:1844441. [PMID: 34025910 PMCID: PMC8128128 DOI: 10.1080/20008198.2020.1844441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/11/2022] Open
Abstract
Background: Despite growing support for the distinction between posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as separate diagnoses within the ICD-11 psychiatric taxonomy, the prevalence and treatment implications of CPTSD among current and ex-serving military members have not been established. Objective: The study aims were to a) establish the prevalence of provisional ICD-11 CPTSD diagnosis relative to PTSD in an Australian sample of treatment-seeking current and ex-serving military members, and b) examine the implications of CPTSD diagnosis for intake profile and treatment response. Methods: The study analysed data collected routinely from Australian-accredited treatment programmes for military-related PTSD. Participants were 480 current and ex-serving military members in this programmes who received a provisional ICD-11 diagnosis of PTSD or CPTSD at intake using proxy measures. Measures of PTSD symptoms, disturbances in self-organisation, psychological distress, mental health and social relationships were considered at treatment intake, discharge, and 3-month follow-up. Results: Among participants with a provisional ICD-11 diagnosis, 78.2% were classified as having CPTSD, while 21.8% were classified as having PTSD. When compared to ICD-11 PTSD, participants with CPTSD reported greater symptom severity and psychological distress at intake, and lower scores on relationship and mental health dimensions of the quality of life measure. These relative differences persisted at each post-treatment assessment. Decreases in PTSD symptoms between intake and discharge were similar across PTSD (d RM = -0.81) and CPTSD (d RM = -0.76) groups, and there were no significant post-treatment differences between groups when controlling for initial scores. Conclusions: CPTSD is common among treatment-seeking current and ex-serving military members, and is associated with initially higher levels of psychiatric severity, which persist over time. Participants with CPTSD were equally responsive to PTSD treatment; however, the tendency for those with CPTSD to remain highly symptomatic post-treatment suggests additional treatment components should be considered.
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Affiliation(s)
- Alexandra Howard
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - James A Agathos
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Andrea Phelps
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sonia Terhaag
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Hussein-Abdullah Arjmand
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Renee Armstrong
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - David Berle
- Discipline of Clinical Psychology, University of Technology Sydney, Sydney, Australia
| | - Zachary Steel
- Discipline of Clinical Psychology, University of Technology Sydney, Sydney, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia.,St John of God Mental Health Services, Richmond Hospital, Sydney, Australia
| | | | | | | | - Christopher Wigg
- Veteran Mental Health Rehabilitation Unit, The Jamie Larcombe Centre, Adelaide, Australia
| | - Paul Kemp
- Veteran Mental Health Rehabilitation Unit, The Jamie Larcombe Centre, Adelaide, Australia
| | | | - Meaghan L O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
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Cowlishaw S, Metcalf O, Varker T, Stone C, Molyneaux R, Gibbs L, Block K, Harms L, MacDougall C, Gallagher HC, Bryant R, Lawrence-Wood E, Kellett C, O'Donnell M, Forbes D. Anger Dimensions and Mental Health Following a Disaster: Distribution and Implications After a Major Bushfire. J Trauma Stress 2021; 34:46-55. [PMID: 33136348 DOI: 10.1002/jts.22616] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 04/23/2020] [Revised: 08/11/2020] [Accepted: 09/19/2020] [Indexed: 11/07/2022]
Abstract
Anger is an important dimension of affect and a prominent feature of posttraumatic mental health, but it is commonly overlooked in postdisaster settings. We aimed to examine the distribution and implications of significant anger problems in the aftermath of a natural disaster, via analyses of Beyond Bushfires survey data from 736 residents of rural communities 5 years after the 2009 Black Saturday bushfires in Victoria, Australia. Assessments included the five-item Dimensions of Anger Reaction (DAR-5) scale along with measures of PTSD, depression, and significant mental illness, and indicators of life satisfaction, suicidality, hostile aggressive behavior, and violence exposure. The results indicated that approximately 10% of respondents from areas highly affected by the bushfires scored above the provisional cutoff criteria for significant anger problems on the DAR-5, which was a more than 3-fold increase, OR = 3.26, relative to respondents from areas of low-to-moderate bushfire impact. The rates were higher among women, younger participants, and those who were unemployed, and co-occurred commonly, although not exclusively, with other postdisaster mental health problems. Anger problems were also associated with lower life satisfaction, β = -.31, an 8-fold increase in suicidal ideation, OR = 8.68, and a nearly 13-fold increase in hostile aggressive behavior, OR = 12.98. There were associations with anger problems and violence exposure, which were reduced when controlling for covariates, including probable PTSD. The findings provide evidence indicating that anger is a significant issue for postdisaster mental health and should be considered routinely alongside other posttraumatic mental health issues.
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Affiliation(s)
- Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol United Kingdom
| | - Olivia Metcalf
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Tracey Varker
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Caleb Stone
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Robyn Molyneaux
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Lisa Gibbs
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Karen Block
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Louise Harms
- Department of Social Work, The University of Melbourne, Melbourne, Australia
| | - Colin MacDougall
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - H Colin Gallagher
- Centre for Transformative Innovation, Swinburne University of Technology, Melbourne, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Ellie Lawrence-Wood
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Connie Kellett
- Victorian Department of Justice and Community Safety, Melbourne, Australia
| | - Meaghan O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - David Forbes
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
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Gibson K, Little J, Cowlishaw S, Ipitoa Toromon T, Forbes D, O'Donnell M. Piloting a scalable, post-trauma psychosocial intervention in Tuvalu: the Skills for Life Adjustment and Resilience (SOLAR) program. Eur J Psychotraumatol 2021; 12:1948253. [PMID: 34394857 PMCID: PMC8354170 DOI: 10.1080/20008198.2021.1948253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The Skills for Life Adjustment and Resilience (SOLAR) programme is a brief, scalable, psychosocial skill-building programme designed to reduce distress and adjustment difficulties following disaster. OBJECTIVES We tested the feasibility, acceptability, efficacy and safety of a culturally adapted version of SOLAR in two remote, cyclone-affected communities in the Pacific Island nation of Tuvalu. METHOD This pilot adopted a quasi-experimental, control design involving 99 participants. SOLAR was administered to the treatment group (n = 49) by local, non-specialist facilitators (i.e. 'Coaches') in a massed, group format across 5 consecutive days. The control group (n = 50) had access to Usual Care (UC). We compared group differences (post-intervention vs. post-control) with psychological distress being the primary outcome. We also examined whether changes were maintained at 6-month follow-up. RESULTS Large, statistically significant group differences in psychological distress were observed after controlling for baseline scores in favour of the SOLAR group. Mean group outcomes were consistently lower at 6-month follow-up than at baseline. SOLAR was found to be acceptable and safe, and programme feedback from participants and Coaches was overwhelmingly positive. CONCLUSIONS Findings contribute to emerging evidence that SOLAR is a flexible, culturally adaptable and scalable intervention that can support individual recovery and adjustment in the aftermath of disaster. RCTs to strengthen evidence of SOLAR's efficacy are warranted.
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Affiliation(s)
- Kari Gibson
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Jonathon Little
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Teawa Ipitoa Toromon
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - David Forbes
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Meaghan O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
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32
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Cowlishaw S, Metcalf O, Lawrence-Wood E, Little J, Sbisa A, Deans C, O'Donnell M, Sadler N, Van Hooff M, Crozier M, Battersby M, Forbes D, McFarlane AC. Gambling problems among military personnel after deployment. J Psychiatr Res 2020; 131:47-53. [PMID: 32920277 DOI: 10.1016/j.jpsychires.2020.07.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/18/2020] [Accepted: 07/25/2020] [Indexed: 12/01/2022]
Abstract
Military and veteran populations may exhibit heightened vulnerability to gambling problems; however, there is scant relevant evidence outside the US, and few studies of transition periods, including return from operational deployment. The aim of this study was thus to highlight the extent, risk-factors, and implications of gambling problems among current members of the Australian Defence Force (ADF) following deployment to the Middle East Area of Operations (MEAO). It involved analyses of data from n = 1324 ADF personnel who deployed between 2010 and 2012, and completed surveys within four months of returning to Australia. The Problem Gambling Severity Index (PGSI) identified Problem Gambling (PG: PGSI ≥5) and At-Risk Gambling (ARG: PGSI 1-4), alongside measures of Depression (PHQ-9), Posttraumatic Stress Disorder (PCL-C), alcohol use problems (AUDIT), distress (K10), and post-deployment stressors. Analyses indicated that 7.7% of personnel reported at least some gambling problems post-deployment, including 2.0% that were distinguished by PG, and 5.7% indicating ARG. These figures were comparable to conditions including probable depression and alcohol dependence, while levels of any gambling problems were high relative to harmful drinking. Higher levels were observed among personnel who were aged 18-24, reported 0-4 years of military service, served in the Army, and comprised Non-Commissioned Officers/Other Ranks. There were strong associations with gambling problems and various indicators of mental health and wellbeing, and self-reported post-deployment difficulties. The findings indicate that gambling problems are salient concerns for some Australian military personnel post-deployment, and highlight the need for increased recognition and responses to these problems.
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Affiliation(s)
- Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia; Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom.
| | - Olivia Metcalf
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Ellie Lawrence-Wood
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Jonathon Little
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Alyssa Sbisa
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Carolyn Deans
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Meaghan O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Nicole Sadler
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Miranda Van Hooff
- Australian Centre for Excellence in Posttraumatic Stress, The Road Home, The Hospital Research Foundation, Australia
| | - Matilda Crozier
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Malcolm Battersby
- College of Medicine and Public Health, Flinders University, Australia
| | - David Forbes
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Alexander C McFarlane
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia; University of Adelaide, Adelaide, Australia
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33
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Cheng HY, McGuinness LA, Elbers RG, MacArthur GJ, Taylor A, McAleenan A, Dawson S, López-López JA, Higgins JPT, Cowlishaw S, Lingford-Hughes A, Hickman M, Kessler D. Treatment interventions to maintain abstinence from alcohol in primary care: systematic review and network meta-analysis. BMJ 2020; 371:m3934. [PMID: 33239318 PMCID: PMC7687021 DOI: 10.1136/bmj.m3934] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the most effective interventions in recently detoxified, alcohol dependent patients for implementation in primary care. DESIGN Systematic review and network meta-analysis. DATA SOURCES Medline, Embase, PsycINFO, Cochrane CENTRAL, ClinicalTrials.gov, and the World Health Organization's International Clinical Trials Registry Platform. STUDY SELECTION Randomised controlled trials comparing two or more interventions that could be used in primary care. The population was patients with alcohol dependency diagnosed by standardised clinical tools and who became detoxified within four weeks. DATA EXTRACTION Outcomes of interest were continuous abstinence from alcohol (effectiveness) and all cause dropouts (as a proxy for acceptability) at least 12 weeks after start of intervention. RESULTS 64 trials (43 interventions) were included. The median probability of abstinence across placebo arms was 25%. Compared with placebo, the only intervention associated with increased probability of abstinence and moderate certainty evidence was acamprosate (odds ratio 1.86, 95% confidence interval 1.49 to 2.33, corresponding to an absolute probability of 38%). Of the 62 included trials that reported all cause dropouts, interventions associated with a reduced number of dropouts compared with placebo (probability 50%) and moderate certainty of evidence were acamprosate (0.73, 0.62 to 0.86; 42%), naltrexone (0.70, 0.50 to 0.98; 41%), and acamprosate-naltrexone (0.30, 0.13 to 0.67; 17%). Acamprosate was the only intervention associated with moderate confidence in the evidence of effectiveness and acceptability up to 12 months. It is uncertain whether other interventions can help maintain abstinence and reduce dropouts because of low confidence in the evidence. CONCLUSIONS Evidence is lacking for benefit from interventions that could be implemented in primary care settings for alcohol abstinence, other than for acamprosate. More evidence from high quality randomised controlled trials is needed, as are strategies using combined interventions (combinations of drug interventions or drug and psychosocial interventions) to improve treatment of alcohol dependency in primary care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016049779.
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Affiliation(s)
- Hung-Yuan Cheng
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Luke A McGuinness
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Roy G Elbers
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Georgina J MacArthur
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Abigail Taylor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alexandra McAleenan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - José A López-López
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Basic Psychology and Methodology, University of Murcia, Spain
| | - Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Sean Cowlishaw
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Anne Lingford-Hughes
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - David Kessler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
- National Institute for Health Research School for Primary Care Research, University of Bristol, Bristol, UK
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Nursey J, Sbisa A, Knight H, Ralph N, Cowlishaw S, Forbes D, O’Donnell M, Hinton M, Cooper J, Hopwood M, McFarlane A, Herring S, Fitzgerald P. Exploring Theta Burst Stimulation for Post-traumatic Stress Disorder in Australian Veterans—A Pilot Study. Mil Med 2020; 185:e1770-e1778. [DOI: 10.1093/milmed/usaa149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/04/2020] [Accepted: 06/01/2020] [Indexed: 12/20/2022] Open
Abstract
Abstract
Introduction
Post-traumatic stress disorder (PTSD) is a severe and debilitating condition affecting a significant proportion of the veteran community. A substantial number of veterans with PTSD fail to benefit from trauma-focused psychological therapies or pharmacotherapy or are left with residual symptoms, and therefore, investigation of new and innovative treatment is required. Theta Burst Stimulation (TBS) is a novel form of Repetitive Transcranial Magnetic Stimulation, which has been shown to improve depression symptoms and associated cognitive deficits. The current pilot study aimed to explore the acceptability, safety, and tolerability of intermittent TBS (iTBS) as a treatment for PTSD in Australian veterans.
Materials and Methods
This study employed a case series, repeated-measures design. Eight Australian Defence Force veterans with PTSD received 20 bilateral iTBS treatments (1 session per day, 5 days per week over a 4-week period) and were assessed on a range of mental health and neuropsychological measures, including the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and Hamilton Depression Rating Scale (HAM-D), at pretreatment, post-treatment, and a 3-month follow-up.
Results
Treatment was generally welltolerated, with reported side-effects including mild to moderate site-specific cranial pain and headaches during stimulation, which were relieved with the use of low dose analgesics. No serious side effects or adverse events were reported. Participants exhibited reductions in both PTSD and depression symptom severity (the repeated-measures effect size [dRM] for the CAPS-5 was −1.78, and the HAM-D was −1.16 post-treatment), as well as improvements in working memory and processing speed. Although significance cannot be inferred, these preliminary estimates of effect size indicate change over time.
Conclusions
Bilateral iTBS appears to be welltolerated by Australian veterans. Within this repeated-measures case series, iTBS treatment shows promise in reducing both PTSD and mood symptoms, as well as improving cognitive difficulties associated with these disorders. Large-scale randomized controlled trials of this promising treatment are warranted.
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Affiliation(s)
- Jane Nursey
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - Alyssa Sbisa
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - Holly Knight
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - Naomi Ralph
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - Sean Cowlishaw
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - David Forbes
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - Meaghan O’Donnell
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - Mark Hinton
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - John Cooper
- Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - Malcolm Hopwood
- University of Melbourne Professorial Psychiatry Unit, Albert Road Clinic, 31 Albert Road, Melbourne, Victoria 3004, Australia
| | - Alexander McFarlane
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Sally Herring
- Epworth Centre for Innovation in Mental Health (ECIMH), 888 Toorak Rd, Camberwell, Victoria 3124, Australia
| | - Paul Fitzgerald
- Epworth Centre for Innovation in Mental Health (ECIMH), 888 Toorak Rd, Camberwell, Victoria 3124, Australia
- Monash Alfred Psychiatry Research Centre, Monash University, Central Clinical School and the Alfred, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia
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Cowlishaw S, Little J, Sbisa A, McFarlane A, Van Hooff M, Lawrence-Wood E, O'Donnell M, Hinton M, Sadler N, Savic A, Forbes D, Metcalf O. Prevalence and implications of gambling problems among firefighters. Addict Behav 2020; 105:106326. [PMID: 32004832 DOI: 10.1016/j.addbeh.2020.106326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/13/2020] [Accepted: 01/17/2020] [Indexed: 12/12/2022]
Abstract
Firefighting is a high-risk occupation that accounts for vulnerability to a range of mental health problems and addictive behaviours. However, no research has addressed whether this vulnerability extends to gambling problems, and the aim of this study was thus to provide new data on frequency and implications of such problems in this occupational context. The sample consisted of n = 566 career and retained firefighters who participated in a cross-sectional survey of an Australian metropolitan fire service. The Problem Gambling Severity Index (PGSI) was used to operationalise both clinically significant levels of problem gambling (PGSI ≥ 5), and 'at-risk' gambling (PGSI 1-4); alongside measures of major depression (PHQ-9), anxiety (GAD-7), Posttraumatic Stress Disorder (PCL-5) and alcohol problems (AUDIT), as well as other addictive behaviours, wellbeing and psychosocial issues. Results indicated 12.3% of firefighters that reported any gambling problems across a continuum of severity (PGSI ≥ 1), including 2.3% that were problems gamblers, and 10.0% reporting at-risk gambling. The weighted prevalence of problem gambling was comparable to other significant mental health conditions including depression and PTSD, while the rate of any gambling problems was high relative to other addictive behaviours. Gambling problems were associated with poor mental health and wellbeing, but not psychosocial indicators (e.g., financial difficulties). The findings suggest that gambling problems across a spectrum of severity may be significant yet hidden issues among emergency service workers, and thus require increased recognition and responses at the organisational level.
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Shang F, Kaniasty K, Cowlishaw S, Wade D, Ma H, Forbes D. The impact of received social support on posttraumatic growth after disaster: The importance of both support quantity and quality. Psychol Trauma 2020; 14:1134-1141. [PMID: 31894990 DOI: 10.1037/tra0000541] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Few studies have investigated the relationship between received social support (actual help received) and posttraumatic growth (PTG), and these studies focused only on the quantity of support received. This study examined the joint implications of both the quantity and quality of postdisaster received social support for PTG. METHOD Data were collected from Lushan earthquake (China, in 2013) survivors at 7 (n = 199) and 31 (n = 161) months after the earthquake. The main effects of quantity and quality of received support, and the interaction between support quantity and support quality, were examined using hierarchical multiple regression analyses controlling for the extent of disaster exposure, postdisaster negative life events, and sociodemographic factors. RESULTS Neither quantity nor quality of received social support exerted significant main effects on PTG. However, the influence of the amount of received social support on PTG was moderated by the quality of received social support. Among survivors who appraised the postdisaster social support they received as higher in quality, greater amounts of received support were associated with more subsequent PTG. Among those survivors who appraised the postdisaster social support they received as lower in quality, greater quantity of received support was associated with lower levels of reported PTG. CONCLUSION This study calls attention to the importance of enhancing the quality of help provided to disaster survivors because simply "more" support is not necessarily better. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Fanhong Shang
- Phoenix Australia - Centre for Posttraumatic Mental Health
| | | | - Sean Cowlishaw
- Phoenix Australia - Centre for Posttraumatic Mental Health
| | - Darryl Wade
- Phoenix Australia - Centre for Posttraumatic Mental Health
| | - Hong Ma
- Department of Public Mental Health
| | - David Forbes
- Phoenix Australia - Centre for Posttraumatic Mental Health
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O'Donnell ML, Lau W, Fredrickson J, Gibson K, Bryant RA, Bisson J, Burke S, Busuttil W, Coghlan A, Creamer M, Gray D, Greenberg N, McDermott B, McFarlane AC, Monson CM, Phelps A, Ruzek JI, Schnurr PP, Ugsang J, Watson P, Whitton S, Williams R, Cowlishaw S, Forbes D. An Open Label Pilot Study of a Brief Psychosocial Intervention for Disaster and Trauma Survivors. Front Psychiatry 2020; 11:483. [PMID: 32670099 PMCID: PMC7332836 DOI: 10.3389/fpsyt.2020.00483] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/12/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In the aftermath of disaster, a large proportion of people will develop psychosocial difficulties that impair recovery, but for which presentations do not meet threshold criteria for disorder. Although these adjustment problems can cause high distress and impairment, and often have a trajectory towards mental health disorder, few evidence-based interventions are available to facilitate recovery. OBJECTIVE This paper describes the development and pilot testing of an internationally developed, brief, and scalable psychosocial intervention that targets distress and poor adjustment following disaster and trauma. METHOD The Skills fOr Life Adjustment and Resilience (SOLAR) program was developed by an international collaboration of trauma and disaster mental health experts through an iterative expert consensus process. The resulting five session, skills-based intervention, deliverable by community-based or frontline health or disaster workers with little or no formal mental health training (known as coaches), was piloted with 15 Australian bushfire survivors using a pre-post with follow up, mixed-methods design study. RESULTS Findings from this pilot demonstrated that the SOLAR program was safe and feasible for non-mental health frontline workers (coaches) to deliver locally after two days of training. Participants' attendance rates and feedback about the program indicated that the program was acceptable. Pre-post quantitative analysis demonstrated reductions in psychological distress, posttraumatic stress symptoms, and impairment. CONCLUSIONS This study provides preliminary evidence that the delivery of the SOLAR program after disaster by trained, frontline workers with little or no mental health experience is feasible, acceptable, safe, and beneficial in reducing psychological symptoms and impairment among disaster survivors. Randomized controlled trials of the SOLAR program are required to advance evidence of its efficacy.
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Affiliation(s)
- Meaghan Louise O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Winnie Lau
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Julia Fredrickson
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Kari Gibson
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Richard Allan Bryant
- School of Psychology, University of New South Wales, UNSW Sydney, Kensington, NSW, Australia
| | - Jonathan Bisson
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, United Kingdom
| | - Susie Burke
- Australian Psychological Society, Melbourne, VIC, Australia
| | - Walter Busuttil
- Department of Psychiatry, Combat Stress, UK, Leatherhead, United Kingdom
| | | | - Mark Creamer
- Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Debbie Gray
- Mental Health Promotion and Illness Prevention, Addiction Mental Health - Alberta Health Services, Calgary, AB, Canada
| | - Neil Greenberg
- Academic Department of Military Mental Health, King's College London, London, United Kingdom
| | - Brett McDermott
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | - Alexander C McFarlane
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, SA, Australia
| | - Candice M Monson
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Andrea Phelps
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Josef I Ruzek
- National Center for PTSD, Dissemination and Training Division, US Department of Veterans Affairs, Palto Alto, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, CA, United States
| | - Paula P Schnurr
- National Center for PTSD, Executive Division, US Department of Veterans Affairs, White River Junction, VT, United States.,Department of Psychiatry, Geisel School of Medicine, Dartmouth, Hanover, NH, United States
| | | | - Patricia Watson
- National Center for PTSD, Dissemination and Training Division, US Department of Veterans Affairs, Palto Alto, CA, United States
| | - Shona Whitton
- Australian Red Cross, North Melbourne, VIC, Australia
| | - Richard Williams
- Welsh Institute for Health and Social Care, University of South Wales, Wales, United Kingdom
| | - Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia.,Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David Forbes
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
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Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) refers to an anxiety or trauma- and stressor-related disorder that is linked to personal or vicarious exposure to traumatic events. PTSD is associated with a range of adverse individual outcomes (e.g. poor health, suicidality) and significant interpersonal problems which include difficulties in intimate and family relationships. A range of couple- and family-based treatments have been suggested as appropriate interventions for families impacted by PTSD. OBJECTIVES The objectives of this review were to: (1) assess the effects of couple and family therapies for adult PTSD, relative to 'no treatment' conditions, 'standard care', and structured or non-specific individual or group psychological therapies; (2) examine the clinical characteristics of studies that influence the relative effects of these therapies; and (3) critically evaluate methodological characteristics of studies that may bias the research findings. SEARCH METHODS We searched MEDLINE (1950- ), Embase (1980- ) and PsycINFO (1967- ) via the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) to 2014, then directly via Ovid after this date. We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library. We conducted supplementary searches of PTSDPubs (all available years) (this database is formerly known as PILOTS (Published International Literature on Traumatic Stress)). We manually searched the early editions of key journals and screened the reference lists and bibliographies of included studies to identify other relevant research. We also contacted the authors of included trials for unpublished information. Studies have been incorporated from searches to 3 March 2018. SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs) of couple or family therapies for PTSD in adult samples. The review considered any type of therapy that was intended to treat intact couples or families where at least one adult family member met criteria for PTSD. It was required that participants were diagnosed with PTSD according to recognised classification systems. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures prescribed by Cochrane. Three review authors screened all titles and abstracts and two authors independently extracted data from each study deemed eligible and assessed the risk of bias for each study. We used odds ratios (OR) to summarise the effects of interventions for dichotomous outcomes, and standardised mean differences (SMD) to summarise post-treatment between-group differences on continuous measures. MAIN RESULTS We included four trials in the review. Two studies examined the effects of cognitive behavioural conjoint/couple's therapy (CBCT) relative to a wait list control condition, although one of these studies only reported outcomes in relation to relationship satisfaction. One study examined the effects of structural approach therapy (SAT) relative to a PTSD family education (PFE) programme; and one examined the effects of adjunct behavioural family therapy (BFT) but failed to report any outcome variables in sufficient detail - we did not include it in the meta-analysis. One trial with 40 couples (80 participants) showed that CBCT was more effective than wait list control in reducing PTSD severity (SMD -1.12, 95% CI -1.79 to -0.45; low-quality evidence), anxiety (SMD -0.93, 95% CI -1.58 to -0.27; very low-quality evidence) and depression (SMD -0.66, 95% CI -1.30 to -0.02; very low-quality evidence) at post-treatment for the primary patient with PTSD. Data from two studies indicated that treatment and control groups did not differ significantly according to relationship satisfaction (SMD 1.07, 95% CI -0.17 to 2.31; very low-quality evidence); and one study showed no significant differences regarding depression (SMD 0.28, 95% CI -0.35 to 0.90; very low-quality evidence) or anxiety symptoms (SMD 0.15, 95% CI -0.47 to 0.77; very low-quality evidence) for the partner of the patient with PTSD. One trial with 57 couples (114 participants) showed that SAT was more effective than PFE in reducing PTSD severity for the primary patient (SMD -1.32, 95% CI -1.90 to -0.74; low-quality evidence) at post-treatment. There was no evidence of differences on the other outcomes, including relationship satisfaction (SMD 0.01, 95% CI -0.51 to 0.53; very low-quality evidence), depression (SMD 0.21, 95% CI -0.31 to 0.73; very low-quality evidence) and anxiety (SMD -0.16, 95% CI -0.68 to 0.36; very low-quality evidence) for intimate partners; and depression (SMD -0.28, 95% CI -0.81 to 0.24; very low-quality evidence) or anxiety (SMD -0.34, 95% CI -0.87 to 0.18; very low-quality evidence) for the primary patient. Two studies reported on adverse events and dropout rates, and no significant differences between groups were observed. Two studies were classified as having a 'low' or 'unclear' risk of bias in most domains, except for performance bias that was rated 'high'. Two studies had significant amounts of missing information resulting in 'unclear' risk of bias. There were too few studies available to conduct subgroup analyses. AUTHORS' CONCLUSIONS There are few trials of couple-based therapies for PTSD and evidence is insufficient to determine whether these offer substantive benefits when delivered alone or in addition to psychological interventions. Preliminary RCTs suggest, however, that couple-based therapies for PTSD may be potentially beneficial for reducing PTSD symptoms, and there is a need for additional trials of both adjunctive and stand-alone interventions with couples or families which target reduced PTSD symptoms, mental health problems of family members and dyadic measures of relationship quality.
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Affiliation(s)
- Aino Suomi
- Australian Catholic UniversityInstitute of Child Protection StudiesCanberraAustralia
- The University of MelbourneMelbourne Graduate School of EducationMelbourneAustralia
| | - Lynette Evans
- La Trobe UniversitySchool of Psychological Studies, Faculty of Science, Technology and EngineeringMelbourneAustralia
| | - Bryan Rodgers
- The Australian National UniversitySchool of Demography, ANU College of Arts and Social SciencesCanberraAustralia
| | - Stephanie Taplin
- Australian Catholic UniversityInstitute of Child Protection StudiesCanberraAustralia
| | - Sean Cowlishaw
- The University of MelbournePhoenix Australia Centre for Posttraumatic Mental Health, Department of PsychiatryMelbourneAustralia
- University of BristolBristol Medical SchoolBristolUK
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Lotzin A, Buth S, Sehner S, Hiller P, Martens MS, Read J, Härter M, Cowlishaw S, Schäfer I. Learning How to Ask - Does a one-day training increase trauma inquiry in routine substance use disorder practice? Results of a cluster-randomized controlled trial. J Subst Abuse Treat 2019; 107:8-16. [PMID: 31757266 DOI: 10.1016/j.jsat.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 08/02/2019] [Accepted: 08/06/2019] [Indexed: 11/30/2022]
Abstract
AIMS To examine the effectiveness of a one-day skills training program for increasing trauma inquiry in routine substance use disorder treatment. DESIGN Cluster-randomized two-armed controlled trial, with 12 substance use disorder (SUD) organizations operating 25 counseling centers, randomly assigned to training in trauma inquiry (13 counseling centers of 8 SUD organizations) or no training (12 counseling centers of 4 SUD organizations). SETTING SUD counseling centers in Northern Germany. CASES N = 5204 SUD counseling services. INTERVENTION The professionals assigned to the intervention group received a one-day training in trauma inquiry plus a 1.5-hour refresher session 3 months later. Professionals in the control group received no training. MEASURES Over a 12-month period, professionals documented for each counseling service whether they asked the client about four traumatic events: physical abuse, emotional abuse, sexual abuse and neglect. ANALYSIS Primary outcomes were rates of asking about physical abuse, sexual abuse, emotional abuse and neglect in the 6 months after training. These were compared across conditions, while adjusting for baseline probabilities in the 6 months before training, using mixed-effects logistic regression. FINDINGS In the 6 months after training, the rate of asking about physical abuse was 18% higher in the SUD counseling services of trained professionals, relative to services of untrained professionals (OR = 1.18, 95% CI = [1.01-1.37, p = .035]). No effect was found for asking about sexual abuse, emotional abuse and neglect. CONCLUSION A one-day training program in trauma inquiry, combined with a brief refresher session, was effective in increasing inquiries about physical abuse in routine counseling practice. The training was ineffective in increasing inquiries about sexual abuse, emotional abuse and neglect. The effectiveness of a one-day training of trauma inquiry might be increased by a longer training, or by combining it with additional elements, such as ongoing supervision.
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Affiliation(s)
- Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Sven Buth
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Susanne Sehner
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Philipp Hiller
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Marcus-Sebastian Martens
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - John Read
- School of Psychology, University of East London, Water Lane, London E15 4LZ, UK
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia; Population Health Sciences, University of Bristol, Beacon House, Queens Road, Bristol BS8 1QU, UK
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Abstract
INTRODUCTION There are several brief screening tools for gambling that possess promising psychometric properties, but have uncertain utility in generalist healthcare environments which prioritize prevention and brief interventions. This study describes an examination of the National Opinion Research Centre Diagnostic and Statistical Manual of Mental Disorders Screen for Gambling Problems (NODS-CLiP), in comparison with the Problem Gambling Severity Index (PGSI), when used to operationalize gambling problems across a spectrum of severity. METHODS Data were obtained from 1058 primary care attendees recruited from 11 practices in England who completed various measures including the NODS-CLiP and PGSI. The performance of the former was defined by estimates of sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs), when PGSI indicators of problem gambling (5+) and any gambling problems (1+), respectively, were reference standards. RESULTS The NODS-CLiP demonstrated perfect sensitivity for problem gambling, along with high specificity and a NPV, but a low PPV. There was much lower sensitivity when the indicator of any gambling problems was the reference standard, with capture rates indicating only 20% of patients exhibiting low to moderate severity gambling problems (PGSI 1-4) were identified by the NODS-CLiP. CONCLUSIONS The NODS-CLiP performs well when identifying severe cases of problem gambling, but lacks sensitivity for less severe problems and may be unsuitable for settings which prioritize prevention and brief interventions. There is a need for screening measures which are sensitive across the full spectrum of risk and severity, and can support initiatives for improving identification and responses to gambling problems in healthcare settings such as primary care.
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Affiliation(s)
- Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia (SC); Centre for Academic Primary Care, Bristol Medical School, University of Bristol, UK (SC, DK); Department of Health Sciences, University of York, UK (JM)
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Terhaag S, Cowlishaw S, Steel Z, Brewer D, Howard A, Armstrong R, Human B, Forbes D, Phelps A. Psychiatric comorbidity for veterans with posttraumatic stress disorder (PTSD): A latent profile analysis and implications for treatment. ACTA ACUST UNITED AC 2019; 14:831-839. [DOI: 10.1037/tra0000520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cowlishaw S, Merkouris SS, Dowling NA, Rodda S, Suomi A, Thomas SL. Locating gambling problems across a continuum of severity: Rasch analysis of the Quinte Longitudinal Study (QLS). Addict Behav 2019; 92:32-37. [PMID: 30579115 DOI: 10.1016/j.addbeh.2018.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 11/28/2022]
Abstract
Addressing gambling problems across a continuum requires understanding of low severity problems, as well as severe levels of problem gambling or disorder. The aims of this study were thus to derive a map of how problematic gambling behaviours and harms are situated across a continuum, and identify the best available indicators of low severity problems to inform assessment and secondary prevention. This involved the Rasch analyses of baseline data from the Quinte Longitudinal Study (QLS); a community-based survey involving random-digit dialling of numbers around Belleville, Canada. Participants were n = 1305 adults with non-zero scores across 26-items from: the Problem Gambling Severity Index (PGSI); the NORC DSM Screen for Gambling Problems (NODS); and the Problem and Pathological Gambling Measure (PPGM). Results indicated that item-level measures except chasing losses provided fit to the Rasch model, and most were clustered within a narrow region of the continuum which resembled addictive disorders. At the most severe end were mainly items about harms, while there were few items representing low severity levels (feeling guilty, betting more than one can afford, attempts to reduce gambling, gambling more than intended). There was Differential Item Functioning (DIF) for several indicators of low severity problems. The findings suggest that measures remain closely aligned with psychiatric models and are suited for discriminating across severe levels of problem gambling or addictive disorder. Although cognitive-affective and behavioural indicators comprise the best available indicators of low severity symptoms, there is an urgent need for improvements in conceptualisation and measurement.
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Affiliation(s)
- S Cowlishaw
- Department of Psychiatry, The University of Melbourne, Australia; Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom.
| | - S S Merkouris
- School of Psychology, Deakin University, Geelong, Australia
| | - N A Dowling
- School of Psychology, Deakin University, Geelong, Australia.; Melbourne Graduate School of Education, The University of Melbourne, Australia
| | - S Rodda
- School of Population Health, University of Auckland, New Zealand
| | - A Suomi
- Melbourne Graduate School of Education, The University of Melbourne, Australia
| | - S L Thomas
- School of Population Health Sciences, Deakin University, Australia
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Shang F, Kaniasty K, Cowlishaw S, Wade D, Ma H, Forbes D. Social support following a natural disaster: A longitudinal study of survivors of the 2013 Lushan earthquake in China. Psychiatry Res 2019; 273:641-646. [PMID: 31207846 DOI: 10.1016/j.psychres.2019.01.085] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/26/2019] [Accepted: 01/26/2019] [Indexed: 10/27/2022]
Abstract
The idea that social support post-disaster is beneficial to survivors' mental health is widely accepted by both researchers and practitioners. However previous social support studies are mainly focused on perceived social support, and the limited received social support studies have produced mixed results. In this study we modelled the influence of both quantity and quality of received social support on long-term mental health outcomes in a longitudinal study of 2013 Lushan earthquake survivors in China. Survivors were invited to complete a questionnaire interview 7 months after the earthquake and were followed up 31 months later (n = 161). Hierarchical regression analyses that controlled for disaster exposure variables showed that greater quality of social support received 7 months after disaster predicted lower levels of posttraumatic stress symptoms and psychological distress two years later, however quantity of received social support was not significant in predicting these two outcomes. These results remained robust when controlled for gender, negative life events and family financial status. The findings of this study suggest that what appears to be critical in the process of supporting disaster survivors is the quality, not necessarily the quantity, of support provided.
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Affiliation(s)
- Fanhong Shang
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Krzysztof Kaniasty
- Department of Psychology, Indiana University of Pennsylvania, Indiana, Pennsylvania, USA; Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Sean Cowlishaw
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Darryl Wade
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Hong Ma
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders, 51 Huayuanbei Road, Haidian District, Beijing 100191, China.
| | - David Forbes
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
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Thomas SL, Bestman A, Pitt H, Cassidy R, McCarthy S, Nyemcsok C, Cowlishaw S, Daube M. Young people's awareness of the timing and placement of gambling advertising on traditional and social media platforms: a study of 11-16-year-olds in Australia. Harm Reduct J 2018; 15:51. [PMID: 30340584 PMCID: PMC6194705 DOI: 10.1186/s12954-018-0254-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/07/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Research has demonstrated that the promotion of gambling, particularly within sport, may have a significant impact on positively shaping young people's attitudes towards gambling. While some governments have implemented restrictions to limit young people's exposure to gambling advertising, few studies have investigated where young people recall seeing gambling advertising, and whether they perceive that advertising restrictions have gone far enough in reducing exposure to these promotions. METHOD Mixed methods, interviewer-assisted surveys were conducted with n = 111 young people aged 11-16 years, who were self-reported fans of basketball in Victoria, Australia. Interviews were conducted at basketball stadiums between May and July 2018. The study assessed media viewing patterns; recall and awareness of the timing, placement, and content of gambling advertising; the impact of gambling advertising restrictions; and attitudes towards sporting organisations' roles in the promotion of gambling. RESULTS The majority of young people recalled seeing gambling advertising on television (n = 101, 91.0%), with most recalling advertising within sporting matches or games (n = 79, 71.2%). Most young people recalled seeing gambling advertising in the early evening before 8:30 pm (n = 75, 67.6%). Just over half of young people described seeing gambling advertisements on social media (n = 61, 55.0%), and over a third (n = 40, 36.0%) recalled gambling advertising on YouTube, predominantly before watching sporting or gaming videos. The majority stated that they continued to watch sport after 8:30 pm (n = 93, 83.7%), which is when restrictions on advertising in live sport in Australia end. The majority (n = 88, 79.3%) stated that there were too many gambling advertisements in sport. Three quarters believed that sporting codes should do more to prevent young people from being exposed to advertising for gambling in sport (n = 84, 75.7%). CONCLUSIONS There is now a clear body evidence that current regulatory systems for gambling advertising are ineffective, with further restrictions urgently needed across a range of media channels to prevent exposure to promotions that may encourage young people's interest and involvement in gambling.
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Affiliation(s)
- Samantha L Thomas
- Centre for Population Health Research, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia.
| | - Amy Bestman
- Centre for Population Health Research, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Hannah Pitt
- Centre for Population Health Research, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Rebecca Cassidy
- Department of Anthropology, Goldsmiths, University of London, London, UK
| | - Simone McCarthy
- Centre for Population Health Research, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Christian Nyemcsok
- Centre for Population Health Research, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Sean Cowlishaw
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Bentley, Australia
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Morton K, Voss S, Adamson J, Baxter H, Bloor K, Brandling J, Cowlishaw S, Doran T, Gibson A, Gutacker N, Liu D, Purdy S, Roy P, Salisbury C, Scantlebury A, Vaittinen A, Watson R, Benger JR. General practitioners and emergency departments (GPED)-efficient models of care: a mixed-methods study protocol. BMJ Open 2018; 8:e024012. [PMID: 30287675 PMCID: PMC6194458 DOI: 10.1136/bmjopen-2018-024012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Pressure continues to grow on emergency departments in the UK and throughout the world, with declining performance and adverse effects on patient outcome, safety and experience. One proposed solution is to locate general practitioners to work in or alongside the emergency department (GPED). Several GPED models have been introduced, however, evidence of effectiveness is weak. This study aims to evaluate the impact of GPED on patient care, the primary care and acute hospital team and the wider urgent care system. METHODS AND ANALYSIS The study will be divided into three work packages (WPs). WP-A; Mapping and Taxonomy: mapping, description and classification of current models of GPED in all emergency departments in England and interviews with key informants to examine the hypotheses that underpin GPED. WP-B; Quantitative Analysis of National Data: measurement of the effectiveness, costs and consequences of the GPED models identified in WP-A, compared with a no-GPED model, using retrospective analysis of Hospital Episode Statistics Data. WP-C; Case Studies: detailed case studies of different GPED models using a mixture of qualitative and quantitative methods including: non-participant observation of clinical care, semistructured interviews with staff, patients and carers; workforce surveys with emergency department staff and analysis of available local routinely collected hospital data. Prospective case study sites will be identified by completing telephone interviews with sites awarded capital funding by the UK government to implement GPED initiatives. The study has a strong patient and public involvement group that has contributed to study design and materials, and which will be closely involved in data interpretation and dissemination. ETHICS AND DISSEMINATION The study has been approved by the National Health Service East Midlands-Leicester South Research Ethics Committee: 17/EM/0312. The results of the study will be disseminated through peer-reviewed journals, conferences and a planned programme of knowledge mobilisation. TRIAL REGISTRATION NUMBER ISRCTN51780222.
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Affiliation(s)
- Katherine Morton
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | - Sarah Voss
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | - Joy Adamson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Baxter
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Karen Bloor
- Department of Health Sciences, University of York, York, UK
| | - Janet Brandling
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | - Sean Cowlishaw
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
| | - Andrew Gibson
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | - Nils Gutacker
- Centre for Health Economics, University of York, York, UK
| | - Dan Liu
- Centre for Health Economics, University of York, York, UK
| | - Sarah Purdy
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paul Roy
- Bristol NHS Clinical Commissioning Group, Bristol, UK
| | | | | | - Anu Vaittinen
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Rose Watson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Lau W, Silove D, Edwards B, Forbes D, Bryant R, McFarlane A, Hadzi-Pavlovic D, Steel Z, Nickerson A, Van Hooff M, Felmingham K, Cowlishaw S, Alkemade N, Kartal D, O’Donnell M. Adjustment of refugee children and adolescents in Australia: outcomes from wave three of the Building a New Life in Australia study. BMC Med 2018; 16:157. [PMID: 30176864 PMCID: PMC6122776 DOI: 10.1186/s12916-018-1124-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 07/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High-income countries like Australia play a vital role in resettling refugees from around the world, half of whom are children and adolescents. Informed by an ecological framework, this study examined the post-migration adjustment of refugee children and adolescents 2-3 years after arrival to Australia. We aimed to estimate the overall rate of adjustment among young refugees and explore associations with adjustment and factors across individual, family, school, and community domains, using a large and broadly representative sample. METHODS Data were drawn from Wave 3 of the Building a New Life in Australia (BNLA) study, a nationally representative, longitudinal study of settlement among humanitarian migrants in Australia. Caregivers of refugee children aged 5-17 (N = 694 children and adolescents) were interviewed about their children's physical health and activity, school absenteeism and achievement, family structure and parenting style, and community and neighbourhood environment. Parent and child forms of the Strengths and Difficulties Questionnaire (SDQ) were completed by caregivers and older children to assess social and emotional adjustment. RESULTS Sound adjustment according to the SDQ was observed regularly among young refugees, with 76-94% (across gender and age) falling within normative ranges. Comparison with community data for young people showed that young refugees had comparable or higher adjustment levels than generally seen in the community. However, young refugees as a group did report greater peer difficulties. Bivariate and multivariate linear regression analyses showed that better reported physical health and school achievement were associated with higher adjustment. Furthermore, higher school absenteeism and endorsement of a hostile parenting style were associated with lower adjustment. CONCLUSIONS This is the first study to report on child psychosocial outcomes from the large, representative longitudinal BNLA study. Our findings indicate sound adjustment for the majority of young refugees resettled in Australia. Further research should examine the nature of associations between variables identified in this study. Overall, treating mental health problems early remains a priority in resettlement. Initiatives to enhance parental capability, physical health, school achievement and participation could assist to improve settlement outcomes for young refugees.
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Affiliation(s)
- Winnie Lau
- Phoenix Australia, Melbourne, Victoria Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria Australia
| | - Derrick Silove
- Liverpool Hospital, Sydney, NSW Australia
- School of Psychiatry, University of New South Wales, Sydney, NSW Australia
| | - Ben Edwards
- ANU Centre for Social Research and Methods, Australian National University, Canberra, Australian Capital Territory Australia
| | - David Forbes
- Phoenix Australia, Melbourne, Victoria Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW Australia
| | - Alexander McFarlane
- Centre for Traumatic Stress Studies, University of Adelaide, Adelaide, SA Australia
| | | | - Zachary Steel
- School of Psychiatry, University of New South Wales, Sydney, NSW Australia
- Black Dog Institute, Sydney, NSW Australia
- St John of God Hospital Richmond, Sydney, Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, NSW Australia
| | - Miranda Van Hooff
- Centre for Traumatic Stress Studies, University of Adelaide, Adelaide, SA Australia
| | - Kim Felmingham
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria Australia
| | - Sean Cowlishaw
- Phoenix Australia, Melbourne, Victoria Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria Australia
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Dzenana Kartal
- Phoenix Australia, Melbourne, Victoria Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria Australia
| | - Meaghan O’Donnell
- Phoenix Australia, Melbourne, Victoria Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria Australia
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Abstract
The DSM-5 includes provisions for episodic forms of gambling disorder, with such changes aligned with earlier accounts of potential binge gambling behaviours. However, there is little research that indicates the utility of these classifications of episodic or binge gambling, and this study considered their characteristics in a clinical sample. It involved administration of a new binge gambling screening tool, along with routine measures, to n = 214 patients entering a specialist treatment clinic for gambling problems. Results indicated that episodic gambling was common in this clinical context, with 28 and 32% of patients reporting gambling episodes that were (a) regular and alternating, and (b) irregular and intermittent, respectively. These patterns were distinguished by factors including associations with covariates that indicated differences from continuous gamblers. For example, the irregular episodic gamblers, but not the regular pattern, demonstrated lower levels of problem gambling severity and comorbidity. Rates of potential binge gambling, which was defined in terms of additional criteria, were around 4% and numbers were insufficient for comparable analyses. The findings support inclusion of episodic forms of gambling disorder in the DSM-5, but highlight the need for improved recognition and research on heterogeneous forms of episodic gambling.
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Affiliation(s)
- S Cowlishaw
- School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.
| | - E Nespoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - J K Jebadurai
- University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK.,National Problem Gambling Clinic, Central North West London NHS Foundation Trust, London, UK
| | - N Smith
- National Problem Gambling Clinic, Central North West London NHS Foundation Trust, London, UK
| | - H Bowden-Jones
- National Problem Gambling Clinic, Central North West London NHS Foundation Trust, London, UK.,Department of Medicine, Imperial College London, London, UK
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Phelps AJ, Steele Z, Cowlishaw S, Metcalf O, Alkemade N, Elliott P, O'Donnell M, Redston S, Kerr K, Howard A, Nursey J, Cooper J, Armstrong R, Fitzgerald L, Forbes D. Treatment Outcomes for Military Veterans With Posttraumatic Stress Disorder: Response Trajectories by Symptom Cluster. J Trauma Stress 2018; 31:401-409. [PMID: 29958337 DOI: 10.1002/jts.22299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 03/12/2018] [Accepted: 03/17/2018] [Indexed: 11/11/2022]
Abstract
Although effective posttraumatic stress disorder (PTSD) treatments are available, outcomes for veterans with PTSD are relatively modest. Previous researchers have identified subgroups of veterans with different response trajectories but have not investigated whether PTSD symptom clusters (based on a four-factor model) have different patterns of response to treatment. The importance of this lies in the potential to increase treatment focus on less responsive symptoms. We investigated treatment outcomes by symptom cluster for 2,685 Australian veterans with PTSD. We used Posttraumatic Stress Disorder Checklist scores obtained at treatment intake, posttreatment, and 3- and 9-month follow-ups to define change across symptom clusters. Repeated measures effect sizes indicated that arousal and numbing symptoms exhibited the largest changes between intake and posttreatment, dRM = -0.61 and dRM = -0.52, respectively, whereas avoidance and intrusion symptoms showed more modest reductions, dRM = -0.36 and dRM = -0.30, respectively. However, unlike the other symptom clusters, the intrusions cluster continued to show significant changes between posttreatment and 3-month follow-up, dRM = -0.21. Intrusion and arousal symptoms also showed continued changes between 3- and 9-month follow-ups although these effects were very small, dRM = -0.09. Growth curve model analyses produced consistent findings and indicated modest initial changes in intrusion symptoms that continued posttreatment. These findings may reflect the longer time required for emotional processing, relative to behavioral changes in avoidance, numbing, and arousal, during the program; they also reinforce the importance of prioritizing individual trauma-focused therapy directly targeting intrusions as the core component of programmatic treatment.
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Affiliation(s)
- Andrea J Phelps
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Zachary Steele
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Olivia Metcalf
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Nathan Alkemade
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Peter Elliott
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Meaghan O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Suzy Redston
- Psychological Trauma Recovery Service, Austin Health, Melbourne, Australia
| | - Katelyn Kerr
- Trauma Recovery Program, Toowong Private Hospital, Brisbane, Australia
| | - Alexandra Howard
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Jane Nursey
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - John Cooper
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Renee Armstrong
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Lea Fitzgerald
- Trauma Recovery Centre, Mater Health Services, Townsville, Australia
| | - David Forbes
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
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Rodda S, Merkouris SS, Abraham C, Hodgins DC, Cowlishaw S, Dowling NA. Therapist-delivered and self-help interventions for gambling problems: A review of contents. J Behav Addict 2018; 7:211-226. [PMID: 29895185 PMCID: PMC6174602 DOI: 10.1556/2006.7.2018.44] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 04/13/2018] [Accepted: 04/14/2018] [Indexed: 01/12/2023] Open
Abstract
Background and aims To date, no systematic approach to identifying the content and characteristics of psychological interventions used to reduce gambling or problem gambling has been developed. This study aimed to develop a reliable classification system capable of identifying intervention characteristics that could, potentially, account for greater or lesser effectiveness. Methods Intervention descriptions were content analyzed to identify common and differentiating characteristics. A coder manual was developed and applied by three independent coders to identify the presence or absence of defined characteristics in 46 psychological and self-help gambling interventions. Results The final classification taxonomy, entitled Gambling Intervention System of CharacTerization (GIST), included 35 categories of intervention characteristics. These were assigned to four groups: (a) types of change techniques (18 categories; e.g., cognitive restructuring and relapse prevention), (b) participant and study characteristics (6 categories; e.g., recruitment strategy and remuneration policy), and (c) characteristics of the delivery and conduct of interventions (11 categories; e.g., modality of delivery and therapist involvement), and (d) evaluation characteristics (e.g., type of control group). Interrater reliability of identification of defined characteristics was high (κ = 0.80-1.00). Discussion This research provides a tool that allows systematic identification of intervention characteristics, thereby enabling consideration, not only of whether interventions are effective or not, but also of which domain-relevant characteristics account for greater or lesser effectiveness. The taxonomy also facilitates standardized description of intervention content in a field in which many diverse interventions have been evaluated. Conclusion Application of this coding tool has the potential to accelerate the development of more efficient and effective therapist-delivered and self-directed interventions to reduce gambling problems.
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Affiliation(s)
- Simone Rodda
- School of Population Health, University of Auckland, Auckland, New Zealand
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | | | - Charles Abraham
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - David C. Hodgins
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicki A. Dowling
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia
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McCarthy S, Thomas SL, Randle M, Bestman A, Pitt H, Cowlishaw S, Daube M. Women's gambling behaviour, product preferences, and perceptions of product harm: differences by age and gambling risk status. Harm Reduct J 2018; 15:22. [PMID: 29690876 PMCID: PMC5916584 DOI: 10.1186/s12954-018-0227-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/28/2018] [Indexed: 12/28/2022] Open
Abstract
Background Women’s participation in, and harm from gambling, is steadily increasing. There has been very limited research to investigate how gambling behaviour, product preferences, and perceptions of gambling harm may vary across subgroups of women. Methods This study surveyed a convenience sample of 509 women from Victoria and New South Wales, Australia. Women were asked a range of questions about their socio-demographic characteristics and gambling behaviour. Focusing on four gambling products in Australia—casino gambling, electronic gambling machines (EGMs), horse betting, and sports betting—women were asked about their frequency of participation, their product preferences, and perceptions of product harms. The sample was segmented a priori according to age and gambling risk status, and differences between groups were identified using Chi-square tests and ANOVAs. Thematic analysis was used to interpret qualitative data. Results Almost two thirds (n = 324, 63.7%) of women had engaged with one of the four products in the previous 12 months. Compared to other age groups, younger women aged 16–34 years exhibited a higher proportion of problem gambling, gambled more frequently, and across more products. While EGMs were the product gambled on most frequently by women overall, younger women were significantly more likely to bet on sports and gamble at casinos relative to older women. Qualitative data indicated that younger women engaged with gambling products as part of a “night out”, “with friends”, due to their “ease of access” and perceived “chance of winning big”. There were significant differences in the perceptions of the harms associated with horse and sports betting according to age and gambling risk status, with younger women and gamblers perceiving these products as less harmful. Conclusions This study highlights that there are clear differences in the gambling behaviour, product preferences, and perceptions of product harms between subgroups of women. A gendered approach will enable public health researchers and policymakers to ensure that the unique factors associated with women’s gambling are taken into consideration in a comprehensive public health approach to reducing and preventing gambling harm.
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Affiliation(s)
- Simone McCarthy
- Centre for Population Health Research, Faculty of Health, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.
| | - Samantha L Thomas
- Centre for Population Health Research, Faculty of Health, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Melanie Randle
- Faculty of Business, School of Management, Operations and Marketing, University of Wollongong, Wollongong, Australia
| | - Amy Bestman
- Centre for Population Health Research, Faculty of Health, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Hannah Pitt
- Centre for Population Health Research, Faculty of Health, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Australia.,Bristol Medical School, University of Bristol, Bristol, UK
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Perth, Australia
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