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Over 20% of cardiovascular disease (CVD) patients have a comorbid mental health disorder, resulting in an increased risk of recurring major adverse cardiac events (MACE) and mortality. Despite the higher risk, patients with comorbid depression or anxiety disorders are twice as likely to be non-adherent to secondary prevention. Therefore, better understanding of the adherence experiences of this subgroup is needed to inform service delivery and enhance adherence for this higher risk group. This study aims to explore the perceptions, understandings, and experiences of adherence to secondary prevention amongst 33 cardiac patients with diagnosed depression and/or anxiety disorder. Participants were recruited as part of the Cardiovascular Health in Anxiety or Mood Problems Study. Semi-structured interviews were conducted and data were analysed via inductive thematic analysis. Patient understandings of adherence to secondary prevention were limited, with medication compliance considered the marker of adherence. Further, participants did not perceive unintentional non-adherence to constitute non-adherence, rather an intent to engage was viewed as defining adherence. Participants also reported that a lack of practitioner understanding and management around their mental health negatively impacted the practitioner–patient relationship and their engagement with secondary prevention. Results highlight that unique barriers, especially around management of comorbid mental health exist for this subgroup. Additionally, adherence to secondary prevention might be limited by patients' narrow understandings of adherence as the intent to engage and as medication compliance. [ABSTRACT FROM AUTHOR]

Despite many patients waiting more than 2 years for treatment at publicly funded multidisciplinary chronic pain services, waitlist studies rarely examine beyond 6 months. We investigated psychological adjustment and health-care utilisation of individuals (N = 339) waiting ≤30 months for appointments at an Australian tertiary pain unit. Outcomes were relatively stable during the first 6 months, but long-term deteriorations in pain-related interference, distress and pain acceptance were evident, albeit with sex differences. Sexes also differed in uptake of new treatments. Medication use increased over time, but pain severity and medication relief did not. Results suggest that early intervention is important, especially for women. [ABSTRACT FROM AUTHOR]

Objective: Pre-treatment side effect expectancies often influence subsequent experiences; however, expectancy-based reduction strategies are lacking. We explored whether framing information about adverse responses (in positive or negative formats) altered expectancies and experiences of a cold pressor task. We further investigated associations between expectancies and experiences, to inform potential interventions. Design: Healthy volunteers (N = 134), randomised to receive positively- or negatively-framed pre-cold pressor task information, self-rated 12 expectancies for cold pressor experiences, emotional state and coping style. Main Outcome Measures: Self-reports of the same 12-experiences (recorded during and after the experiment) were assessed. Results: Framing had minimal impact on expectancies and experiences; however, discomfort threshold (p =.08, d = 0.22) showed a trend in the expected direction. Hierarchical regressions revealed expectancies uniquely, significantly predicted 6–23% of the variance for 11 subsequent experiences. Following a popular charity event (Ice Bucket Challenge), all participants showed higher 'discomfort thresholds' (p =.001, d = 0.59), and those in the negative frame reported more overall 'discomfort' (p =.01, d = 0.60) than participants in the positive condition. Conclusion: Expectancies uniquely influenced subsequent cold pressor experiences. Framing had minimal impact in this 'analogue' medical setting, only influencing 'discomfort threshold'. 'Discomfort threshold' and overall 'discomfort' were also impacted by a social media challenge, highlighting a potential area for intervention. [ABSTRACT FROM AUTHOR]

Objective: As Australia becomes more diverse it is essential for the psychology profession to examine training, cultural competency, and professional development needs of psychologists working in languages other than English. In this exploratory study of bilingual/multilingual psychologists in Australia, we aimed to investigate their self‐perceived language skills, multicultural counselling competency, and professional development needs; understand their training and practice experiences; and seek recommendations for policy and practice. Method: An online survey including demographic and practice information, the Multicultural Counselling Inventory and open‐ended text questions was completed by 38 bilingual/multilingual psychologists working in Australia in 2015. Eleven participants undertook supplementary telephone interviews which along with survey responses were transcribed for qualitative thematic analysis. Results: Most participants trained in English. They expressed concerns about their application of psychological concepts in other languages, despite good conversational fluency. Participants highlighted language barriers to entering the profession; limited multicultural and multilingual training and supervision in Australia; and the need for more transcultural mental health resources, particularly for small/new migrant communities and people outside large cities. Conclusion: To effectively serve clients, significant changes are required to psychology training in Australia, including but not limited to bilingual and multilingual psychologists. These include enhanced training and competency standards in MCC and using interpreters. The profession must actively support supervision, professional development, and practice in community languages. The Psychology Board of Australia and the universities need to examine policies operating as barriers to the admission of culturally and linguistically diverse people to the psychology profession in Australia. [ABSTRACT FROM AUTHOR]

Objective: To investigate correlates of Australian university students’ help‐seeking intentions and actual service usage, testing and extending new models based on the Theory of Planned Behaviour and the Behavioural Model of Health Services Use. Method: 611 Australian domestic students (209 males and 402 females, mean age = 21 years; SD = 5.6) completed standardised measures and commented on facilitators, barriers, benefits, and potential improvements to student mental health services. Results: A model based on Chinese university student data also fit the Australian data best. Bootstrapping revealed relationships between several predictors (knowledge concerning mental health and services, evaluated and perceived need, anticipated benefits, stigma concerns, and Asian values) and help‐seeking intentions were significantly mediated by attitudes toward help‐seeking and subjective norms. Logistic regression analysis identified predictors of service usage: help‐seeking intentions, perceived behavioural control, gender, study major, knowledge of mental health, social support, income, self‐rated mental health status, perceived need for help, and Asian values. Conclusions: Practitioners need to consider psycho‐educational and marketing approaches to engage students, raise awareness of available services, increase understanding of mental illness and treatments, and reduce stigmatized attitudes. [ABSTRACT FROM AUTHOR]

This study investigated help-seeking intentions and use of mental health services within a sample of 1128 Mainland Chinese college students (630 males and 498 females; mean age = 20.01 years, SD = 1.48). Results of structural equation modeling and logistic regression analysis suggested that social-cognitive variables had significant effects both on students' intentions to seek professional mental health care and their actual service use. To promote help-seeking, practitioners should consider marketing campaigns and psycho-education for students and communities, enhancing knowledge and acceptance of mental health problems and effective treatment options. [ABSTRACT FROM AUTHOR]

Objectives. To examine: 1) whether a single brief pre-clinic educational session improved the wellbeing and quality of life of individuals entering the wait-list for a tertiary chronic pain (CP) service; and 2) the impact of waiting for services on these outcomes. Methods. Participants were 346 adults, with basic English skills and non-urgent triage codes, who were recruited on referral to a tertiary Australian metropolitan CP unit. Participants were randomized across two conditions: "treatment as usual" (normal wait-list) and "experimental" (normal wait-list plus a 3-hour CP educational session). The educational session encouraged self-management and life engagement despite pain. Multiple outcomes (pain acceptance, pain-related interference, psychological distress, health care utilization [frequency, types], quality of life, health knowledge/beliefs), as well as pain severity and symptom exaggeration, were assessed at intake and again at 2 weeks and 6 months post-educational session (or equivalent for the wait-list group). Results. Satisfaction with the educational session was moderate-to-high, but attendance was not associated with improved outcomes. At 2 weeks, all study participants reported significant improvements in pain acceptance (willingness, overall acceptance), health care utilization (frequency) and quality of life (physical), which were maintained/ enhanced at 6 months. Use of psychological and physical therapies increased significantly by 6 months. There was no functional deterioration while wait-listed. Conclusions. Attending a brief pre-clinic education session did not improve function. There was no deterioration in wait-listed participants who agreed to be involved in research and who completed study measures at 2 and 6 months, but referral was associated with short-term functional improvements. This is the first study to link positive change with referral to, rather than treatment by, a tertiary CP service. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this review was to systematically evaluate the available heterogeneous research examining determinants of mental health service use among young adults.Methods: Nine electronic databases were searched to identify quantitative studies examining sociodemographic and psychological variables predictive of or associated with mental health service use. Included studies were examined against the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Effect size estimates in the form of odds ratios were calculated and classified according to predisposing, enabling, and need factors, consistent with Andersen's behavioral model of health care.Results: Eighteen studies met all of the inclusion criteria (N=96,297 participants). Studies generally followed the STROBE recommendations for external validity, although limitations in internal validity were noted. Prior service contact and being homosexual or bisexual, female, or Caucasian were predisposing factors significantly associated with mental health service use. Social support was the single enabling factor identified, although this finding was based on limited data. In relation to need, young adults who reported higher perceived need for professional help or more mental health difficulties were more likely to have utilized services.Conclusions: This review identified subgroups of young adults who are less likely to access mental health support. Future research should focus on developing psychoeducational interventions targeted at young men and racial-ethnic minority groups, in addition to informing young adults of the success of mental health counseling in the absence of a diagnosis. [ABSTRACT FROM AUTHOR]

The negative psychological impacts of working with traumatised people are well documented and include vicarious traumatisation (VT): the cumulative effect of identifying with clients' trauma stories that negatively impacts on service providers' memory, emotions, thoughts, and worldviews. More recently, the concept of vicarious resilience (VR) has been also identified: the strength, growth, and empowerment experienced by trauma workers as a consequence of their work. VR includes service providers' awareness and appreciation of their clients' capacity to grow, maintaining hope for change, as well as learning from and reassessing personal problems in the light of clients' stories of perseverance, strength, and growth. This study aimed at exploring the experiences of mental health, physical healthcare, and settlement workers caring for refugees and asylum seekers in South Australia. Using a qualitative method (data-based thematic analysis) to collect and analyse 26 semi-structured face-to-face interviews, we identified four prominent and recurring themes emanating from the data: VT, VR, work satisfaction, and cultural flexibility. These findings—among the first to describe both VT and VR in Australians working with refugee people—have important implications for policy, service quality, service providers' wellbeing, and refugee clients' lives. [ABSTRACT FROM AUTHOR]

This paper reports on leadership program participants' experience of, and readiness for, stage transition (when one adult developmental stage gives way to another-as in Loevinger's (Ego development. Jossey-Bass, San Francisco, ) stage theory of consciousness, or ego, development). This appears to be the first study reporting the subjective experience of recent shifts in consciousness specifically within the context of leadership development programs. Using qualitative thematic methods to analyse survey responses from 84 individuals graduating from three Australian community leadership programs, we compared the accounts of those who had shifted a stage of consciousness ('shifters'), those who had changed but not transitioned ('movers'), and those who had not experienced change ('non-shifters'). We found support for theoretical predictions concerning the types of changes shifters noticed in themselves, consistent with the small but growing body of research showing positive associations between consciousness development and better leadership performance and organisational outcomes. The data additionally provide support for the conceptual framework of consciousness development articulated by Manners and Durkin (Dev Rev 20:475-513, . doi:), and contextual information which may help explain and predict the differing responses to leadership training of people with Myers Briggs Type Indicator Sensing and Intuition preferences-thus contributing to program selection and design. An important, if preliminary, finding was that when selecting candidates for developmental training programs, people who are experiencing significant work or other life changes and challenges should arguably be prioritised rather than sidelined: our shifters cited such challenges as influences promoting readiness for change. Although these conclusions are based on an analysis of survey data, they provide direction for future in-depth qualitative and quantitative research. [ABSTRACT FROM AUTHOR]

Objectives Chronic pain ( CP; >3 months) is a common condition that is associated with significant psychological problems. Many people with CP do not fit into discrete diagnostic categories, limiting the applicability of research that is specific to a particular pain diagnosis. This meta-analysis synthesized the large extant literature from a general CP, rather than diagnosis-specific, perspective to systematically identify and compare the psychological problems most commonly associated with CP. Methods Four databases were searched from inception to December 2013 (PsychINFO, The Cochrane Library, Scopus, and Pub Med) for studies comparing the psychological functioning of adults with CP to healthy controls. Data from 110 studies were meta-analysed and Cohen's d effect sizes calculated. Results The CP group reported experiencing significant problems in a range of psychological domains (depression, anxiety, somatization, anger/hostility, self-efficacy, self-esteem and general emotional functioning), with the largest effects observed for pain anxiety/concern and somatization; followed by anxiety and self-efficacy; and then depression, anger/hostility, self-esteem and general emotional functioning. Conclusions This study demonstrates, for the first time, that individuals with CP are more likely to experience physically focussed psychological problems than other psychological problems and that, unlike self-efficacy, fear of pain is intrinsically tied to the CP experience. This challenges the prevailing view that, for individuals with CP, problems with depression are either equal to, or greater than, problems with anxiety, thereby providing important information to guide therapeutic targets. Practitioner points Positive clinical implications This is the first time that the CP literature has been synthesized from a general perspective to examine psychological functioning in the presence of CP and provide practical recommendations for assessment and therapy., Individuals with CP were most likely to experience psychological problems in physically focussed areas - namely pain anxiety/concern and somatization., Although fear of pain was intrinsically tied to the CP experience, self-efficacy was not., CP was more strongly associated with anxiety than with depression., Limitations The study focuses on the general CP literature, adults and research-utilizing self-report measures., Meta-analyses are limited by the empirical literature on which they are based. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To document staffing (medical, nursing, allied health [AH], administrative) in Australian multidisciplinary persistent pain services and relate them to clinical activity levels. Methods Of the 68 adult outpatient persistent pain services approached (Dec'08-Jan'10), 45 agreed to participate, received over 100 referrals/year, and met the contemporaneous International Association for the Study of Pain criteria for Level 1 or 2 multidisciplinary services. Structured interviews with Clinical Directors collected quantitative data regarding staff resources (disciplines, amount), services provided, funding models, and activity levels. Results Compared with Level 2 clinics, Level 1 centers reported higher annual demand (referrals), clinical activity (patient numbers) and absolute numbers of medical, nursing and administrative staff, but comparable numbers of AH staff. When staffing was assessed against activity levels, medical and nursing resources were consistent across services, but Level 1 clinics had relatively fewer AH and administrative staff. Metropolitan and rural services reported comparable activity levels and discipline-specific staff ratios (except occupational therapy). The mean annual AH staffing for pain management group programs was 0.03 full-time equivalent staff per patient. Conclusions Reasonable consistency was demonstrated in the range and mix of most disciplines employed, suggesting they represented workable clinical structures. The greater number of medical and nursing staff within Level 1 clinics may indicate a lower multidisciplinary focus, but this needs further exploration. As the first multidisciplinary staffing data for persistent pain clinics, this provides critical information for designing and implementing clinical services. Mapping against clinical outcomes to demonstrate the impact of staffing patterns on safe and efficacious treatment delivery is required. [ABSTRACT FROM AUTHOR]

This study investigated the extent to which pathological gambling and gambling-related erroneous beliefs are related to personality disorders and the general dysfunctional beliefs that are common to these disorders. Respondents were recruited from the general community by advertising in community newspapers in southern Australia. Participants were asked to contact the researchers and were administered a short screening telephone interview to ensure that volunteers met study criteria. A package of measures, a consent form and other related information were mailed to them for self-completion. Once this was returned, participants were again interviewed by phone to validate their responses and finalise data collection. The sample comprised 140 regular gamblers who were recruited from the general public. A variety of self- report and semi structured questionnaires were administered, including the NORC DSM-IV Screen for Gambling Problems, The 21-item PDI (Peters et al. Delusions Inventory), the PAI-BOR measure of borderline personality disorder and the Gambling Related Cognition Scale (GRCS). Pathological gambling scores were strongly related to scores on borderline personality disorder measure as well as gambling-specific belief scores. A path analysis showed that personality disorders are only weakly related to gambling-related belief after controlling for delusion-proneness. In other words, there is evidence of a pathway between personality disorder scores, delusion-proneness scores and Gambling Related Cognition Scale scores which, in turn, are positively associated with pathological gambling scores. Dysfunctional beliefs associated with common personality disorders such as borderline personality may make people more susceptible to the gambling-related erroneous cognitions commonly held by pathological gamblers. [ABSTRACT FROM AUTHOR]

Using narrative methodology this paper analyses the life stories of 25 former refugees from two African countries, resettled in Australia. Study findings demonstrated a salient divergence between the stories of the two communities; within which there were also individual differences in structure and content of participants' narratives. Five narrative types were identified along a continuum from detailed disclosure to near-complete silence about traumatic events and experiences. They were: (1) avoiding narratives; (2) struggling narratives; (3) prompted narratives; (4) narratives exceeding demarcated boundaries of disclosure; and (5) returning narratives. We discuss these differences in narrative structure, narrated experience, identity reconstruction, and meaning-making within the context of the personal, interpersonal, sociocultural and historical influences that have shaped the lives of participants. Findings were supported by interviews with 25 resettlement agency staff. Broader implications of the study's findings for therapists and researchers working with refugees are also discussed. [ABSTRACT FROM AUTHOR]

Background: Community-based rehabilitation can help to maximize function following acquired brain injury (ABI); however, data on treatment outcome is limited in quantity. Objective: To describe and evaluate client outcomes of an outpatient programme for adults with moderate-to-severe traumatic and non-traumatic ABI. Methods: Two phase design involving retrospective and longitudinal study of programme completers with ABI ( n = 47). Changes in functioning were measured with the Mayo-Portland Inventory (MPAI-4), administered pre- and immediately post-rehabilitation and at 3 years follow-up. Self-ratings were supplemented with MPAI-4 data from significant others ( n = 32) and staff ( n = 32). Results: Injured individuals and informants reported improved physical and psychosocial functioning immediately following the completion of community rehabilitation, with medium-to-large and significant treatment gains noted on the MPAI-4 ability, adjustment and participation sub-scales (Cohen's d range = 0.31-1.10). A deterioration in individuals' adjustment was further reported at follow-up, although this was based on limited data. Issues with longer-term rehabilitation service provision were additionally noted. Conclusions: The data support the need for continuity of care, including ongoing emotional support, to cater to the complex and dynamic needs of the ABI population. However, these results need to be considered in the context of a small sample size and quasi-experimental design. [ABSTRACT FROM AUTHOR]

The aims of this study were to examine the associations between psychiatric disorders and pathological gambling (PG) and the clustering of psychiatric disorders in high risk gambler populations. The sample comprised 140 regular gamblers who were recruited from the general public. A variety of self- report and semi structured questionnaires was administered, including the Mini International Neuropsychiatric Interview, The Personality Diagnostic Questionnaire-4th Edition, NORC DSM-IV Screen for Gambling Problems Self- administered and Problem Gambling Severity Index. Axis I and Axis II psychiatric disorders and personality disturbances were found to be more prevalent amongst pathological gamblers than other gamblers with the strongest differences observed for mood and anxiety-related disorders. Almost two-thirds of pathological gamblers reported both an anxiety or mood disorder in conjunction with another type of disorder. These differences between the gambling groups existed even after controlling for gender. The results highlight the high rates of co-morbidity in pathological gamblers in the community and the extent to which anxiety and mood disorders co-existing with other forms of pathology. These results highlight the significant challenges facing treatment services in the treatment of PG and the extent to which this should be treated as the primary disorder. [ABSTRACT FROM AUTHOR]

Introduction. Cognitive impairment is a pervasive feature of schizophrenia, and is a major determinant of the functional disability that is characteristic of the disorder. However, research investigating whether patients with schizophrenia show a deficit awareness remains unclear. The present study aimed to replicate and extend previous research comparing subjective and objective measures of cognition. Methods. Thirty patients with a diagnosis of schizophrenia or schizoaffective disorder were administered the subjectively assessed Schizophrenia Cognitive Rating Scale (SCoRS) and the objective Brief Assessment of Cognition in Schizophrenia (BACS), which each assess overall global functioning and four specific neurocognitive domains (i.e., Verbal Memory, Working Memory, Processing Speed, and Reasoning and Problem Solving). Because deficit awareness may influence the likelihood of patients engaging in treatments designed to improve cognitive functioning, patients' attitudes towards such therapies were also contrasted with these subjective and objective measures of cognitive functioning. Results. Patients' subjective appraisals did not significantly correlate with the objective neuropsychological assessments for global functioning or any specific neurocognitive domains. However, patients accurately deduced that their memory domains were more impaired than the other domains, and there was a trend for patients to exaggerate their Reasoning and Problem Solving deficits. This suggests that patients show some level of deficit awareness, when overestimating “deficits” for domains that are not impaired. Finally subjective, but not objective, measures of cognitive functioning correlated significantly with willingness to participate in cognitive-enhancing therapies. Conclusions. These results suggest that although patients' perceptions of their cognitive function are no substitute for objective neuropsychological test data, patients do possess a level of deficit awareness which may, in turn, influence willingness to participate in interventions such as cognitive rehabilitation. [ABSTRACT FROM AUTHOR]

We aimed to explore how refugee people utilised their coping resources and strategies to find meaning in their past and present experiences. Using an experience-centred narrative approach, we analysed the stories of 24 former refugees from two African countries resettled in South Australia. Data analysis revealed altruism and helping behaviour as a prominent and recurring theme of participants' narrated lives. This meta-theme encompassed four subthemes: (a) surviving war and exile, (b) adapting to Australian society, (c) reaching back home, and (d) meaning making through religious beliefs. Helping, cooperating, and sharing were entwined with participants' coping strategies and meaning making of experience. Participants' socio-historical, cultural, and religious context influenced the interpretations of their experiences. Taken together, our findings identified a counter narrative in refugee mental health research beyond trauma and psychopathology. Specifically, we have shown that when the refugee experience is also accompanied by situational contingencies such as receiving help and being called upon to help, together with evaluations such as empathy, identification with suffering, and gratitude, people can be motivated to help others. Future research is needed to explore how altruism and helping behaviour can promote healing from trauma, alleviate distress of separation, and ameliorate acculturation stress among diverse refugee populations. [ABSTRACT FROM AUTHOR]

Depression is associated with increased cardiac morbidity and mortality in people with and without cardiac risk factors, and this relationship is, in part, mediated by heart rate variability (HRV). Increased heart rate and reduced HRV are common in depressed patients, which may explain their higher cardiac risk. This pilot study investigated whether mindfulness-based cognitive therapy (MBCT) promoted objective changes in (1) HRV, and (2) depressive symptoms and quality of life, in mental health outpatients. Twenty-seven adults meeting criteria for DSM-IV Axis I disorders completed an 8-week MBCT program. Data were collected on three occasions, 8 weeks apart; twice before and once after MBCT. Participants completed the Short Form-36 and the Center for Epidemiological Studies Depression Scale (CES-D) at each test period. Heart rate and HRV were measured during electrocardiographic monitoring before and after a cognitive stressor. At baseline, 78% of participants met criteria for depression (CES-D ≥16). Multivariate analyses revealed a significant treatment effect for SF-36 physical summary score and depression (as a dichotomous variable), but not for HRV. This pilot study highlights the immediate psychological and health benefits of MBCT. Low power may have influenced the lack of a finding of an association between HRV and MBCT. However, the feasibility of the study design has been established, and supports the need for larger and longer-term studies of the potential physiological benefits of MBCT for cardiac health. [ABSTRACT FROM PUBLISHER]

There is considerable evidence for an association between pathological gambling and scores on validated psychometric measures of erroneous gambling-related cognitions. However, a potential problem with this literature is that samples of pathological gamblers score higher on indicators of co-morbidity (e.g. substance misuse) that are also associated with poorer decision-making and reasoning abilities. We aimed to examine the relationship between pathological gambling and gambling-related erroneous beliefs after controlling for alcohol misuse. A sample of 140 regular gamblers completed a detailed psychological assessment including measures of pathological gambling (NORC DSM-IV Screen Self-Administered), delusion proneness (the Peters et al. Delusions Inventory), alcohol use (the Alcohol Use Disorders Identification Test) and gambling beliefs (Gambling-Related Cognitions Scale). Pathological gamblers scored higher than other regular gamblers on all these measures. Although alcohol use disorder was not directly related to delusion proneness, a combination of higher alcohol use disorder and delusion proneness was associated with higher gambling-related cognition scores. Our findings confirm previous evidence supporting an association between pathological gambling and greater endorsement of erroneous gambling-related cognitions. Alcohol misuse and delusion proneness may be factors that strengthen this association. [ABSTRACT FROM AUTHOR]

Our study explored the relationships between baby boomer grandparents' mental health and the multiple roles they commonly fulfil: Grandchild care, other family care, home duties, and paid work. There is limited research on non-custodial grandparenting. Studies to date have suggested that psychosocial distress may be more associated with satisfaction levels than with actual time spent on activities, but these studies are mainly qualitative and have not always excluded grandparents who only provide secondary grandchild care. Our on-line survey asked 148 non-custodial Australian boomer grandparents (90 female, 58 male) providing regular sole or primary childcare for at least one grandchild about their experiences. Spearman correlations confirmed significant correlations between satisfaction and psychological health (distress and self-esteem), whereas time spent providing care was not significantly related to psychological health. Unlike previous researchers we identified few significant gender differences, perhaps because we focussed on grandparents providing sole or primary care. These outcomes provide direction for parents, grandparents, and policy makers addressing the needs of this social group. [ABSTRACT FROM AUTHOR]

The article presents information on a study the efficacy of counselling services provided remotely in managing mental health outcomes after spinal cord injury. The study accessed electronic databases and critical reviews. The study highlighted the need of further evidence to establish the benefits of telecounselling.

The growth of adult ego development to post-conventional levels is associated with many adaptive advantages for the individual and society. However, the vast majority of adults across a wide range of samples demonstrate ego stages well below the maximum potential. In an effort to advance understanding of why and how development to higher ego levels might occur for some individuals and not others, we explored whether particular personality preferences and combinations thereof (as measured by the Myers-Briggs Type Indicator or MBTI) are associated with higher ego levels and whether particular personality preferences might act as inhibiting or facilitating factors in ego development. Participants were 374 adults (aged 18–61; 50 % female) undertaking 11 community leadership development and 2 professional management development programs. After adjusting for effects of age and education, a preference for Intuition on the MBTI was associated with significantly higher ego development on program entry and with greater ego development during the programs. These results are consistent with previous research and provide support for Manners’ and Durkin’s (Developmental Review, 20:475–513, 2000 ) proposal that dispositional personality characteristics may enhance or constrain ego development. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2013; 27; 3-12 Discharge-planning for long-term care needs: the values and priorities of older people, their younger relatives and health professionals Discharge-planning decisions about long-term care (LTC) can be difficult and distressing for older people, families and discharge-planning health professionals. Retrospective research suggests that despite good intentions and a shared focus on the best interests of the older person, stakeholders may hold very different values about good outcomes and how to decide them. We aimed to compare the opinions and values of frail elders living at home, younger relatives and health professionals experienced in discharge-planning, prospectively: before, not after, a LTC decision. We interviewed three types of stakeholders (10 older people, 8 relatives and 18 health professionals) using a hypothetical vignette about a frail elder leaving hospital. In a mixed methods design, we quantitatively compared the discharge plans and decision-makers that stakeholders suggested, and qualitatively analysed the 36 interview transcripts for participants' articulation of underlying values during these discussions. Older participants often suggested safe restrictive options (residential care, proxy decision-making) for the hypothetical frail elder, while advocating autonomy for themselves. Younger people generally endorsed autonomous decision-making and less restrictive discharge options especially if the elder was mentally competent, but reported difficult ethical tensions between safety and autonomy. Individual personality and preferences, mental capacity, and the importance of personal care in supporting autonomy were central themes consistent with the Ecological Theory of Aging. Accordingly, discharge planners can usefully articulate the balance of safety and autonomy, conceptualizing home care as maintaining independence rather than accepting dependence. Ethical training should incorporate sophisticated models of practice specifying both psychological and physical safety as components of beneficence. Few elders adopt a consumer approach to LTC: health professionals can encourage mid-life adults to consider later care needs when planning for retirement. [ABSTRACT FROM AUTHOR]

The aim of this study was to conduct an empirical investigation of the validity of Jacobs' (in J Gambl Behav 2:15-31, ) general theory of addictions in relation to gambling problems associated with electronic gaming machines (EGM). Regular EGM gamblers (n = 190) completed a series of standardised measures relating to psychological and physiological vulnerability, substance use, dissociative experiences, early childhood trauma and abuse and problem gambling (the Problem Gambling Severity Index). Statistical analysis using structural equation modelling revealed clear relationships between childhood trauma and life stressors and psychological vulnerability, dissociative-like experiences and problem gambling. These findings confirm and extend a previous model validated by Gupta and Derevensky (in J Gambl Stud 14: 17-49, using an adolescent population. The significance of these findings are discussed for existing pathway models of problem gambling, for Jacobs' theory, and for clinicians engaged in assessment and intervention. [ABSTRACT FROM AUTHOR]

An increasing number of working parents are making use of out of school hours care (OSHC) for their young primary-school aged children, but in Australia very little is known about how effectively these services meet parent needs. The present pilot study aimed to gather information non-directively from employed parents, first, about how OSHC use affects their workforce participation and ability to resolve the competing demands of work and family responsibilities. The second goal was to gain some idea of what parents look for in OSHC and how satisfied they feel with the service they use. Thirteen mothers answered open-ended but structured questions in a telephone interview. They expressed how vital OSHC services are in enabling them to work, but usually did not spontaneously evaluate the quality of the service. Results suggest a need for more systematic research on OSHC quality, and how it does or might contribute to parent and child well-being. [ABSTRACT FROM PUBLISHER]

This study highlights psychosocial needs of gynecological cancer survivors, contributing to evaluation of the Cancer Survivors Unmet Needs measure. Of the 45 participants, 28.9% reported clinical anxiety, 20.0% mild-to-severe depression, and 15.6% had probable posttraumatic stress disorder. Strength of unmet needs was associated with anxiety, depression, posttraumatic stress, poorer quality of life, younger age, and greater time since diagnosis. Linear regressions showed clinical measures, quality of life, optimism, and self-blaming coping style explained 56.4% of strength of unmet needs. Anxiety, functional well-being, posttraumatic stress, and emotional well-being accounted for 40.7% of variance in fear of recurrence, with emotional well-being the strongest predictor. [ABSTRACT FROM PUBLISHER]

In a pilot evaluation study, effectiveness of a 20-week dialectical behavioural therapy (DBT) skills training group program was explored for adult clients with borderline personality disorder (BPD; N = 140). Subjective ratings of depression, anxiety and BPD symptomatology were obtained pre and post group therapy. Objective measures of service utilisation levels were obtained for the 6 months prior to group therapy, the duration of therapy, and the 6 months following therapy. Group completers ( n = 68) showed reductions in depression, anxiety and BPD symptomatology, as well as in the number of emergency department attendances. Completers with previous high service utilisation had decreases in telephone counselling calls and inpatient days during therapy, and fewer emergency department attendances post therapy. Completers had larger decreases in service utilisation than noncompleters ( n = 72). Simultaneous engagement in individual DBT was related to higher group completion than was individual therapy as usual, but it did not impact on level of service utilisation or psychological functioning. This quasi-experimental pilot study suggests that DBT groups may improve psychological functioning and decrease service utilisation for BPD clients, particularly those with high service utilisation. The treatment warrants systematic evaluation. [ABSTRACT FROM AUTHOR]

Background: Mindfulness-based Cognitive Therapy (MBCT) is a relapse prevention treatment for major depressive disorder. Method: An observational clinical audit of 39 participants explored the long-term effects of MBCT using standardized measures of depression (BDI-II), rumination (RSS), and mindfulness (MAAS). Results: MBCT was associated with statistically significant reductions in depression from pre to post treatment. Gains were maintained over time (Group 1, 1-12 months, p = .002; Group 2, 13-24 months, p = .001; Group 3, 25-34 months, p = .04). Depression scores in Group 3 did begin to worsen, yet were still within the mild range of the BDI-II. Treatment variables such as attendance at "booster" sessions and ongoing mindfulness practice correlated with better depression outcomes (p = .003 and p = .03 respectively). There was a strong negative correlation between rumination and mindful attention (p < .001), consistent with a proposed mechanism of metacognition in the efficacy of MBCT. Conclusion: It is suggested that ongoing MBCT skills and practice may be important for relapse prevention over the longer term. Larger randomized studies of the mechanisms of MBCT with longer follow-up periods are recommended. [ABSTRACT FROM AUTHOR]

We aimed to explore how refugee people utilised their coping resources and strategies to find meaning in their past and present experiences. Using an experience-centred narrative approach, we analysed the stories of 24 former refugees from two African countries resettled in South Australia. Data analysis revealed altruism and helping behaviour as a prominent and recurring theme of participants' narrated lives. This meta-theme encompassed four subthemes: (a) surviving war and exile, (b) adapting to Australian society, (c) reaching back home, and (d) meaning making through religious beliefs. Helping, cooperating, and sharing were entwined with participants' coping strategies and meaning making of experience. Participants' socio-historical, cultural, and religious context influenced the interpretations of their experiences. Taken together, our findings identified a counter narrative in refugee mental health research beyond trauma and psychopathology. Specifically, we have shown that when the refugee experience is also accompanied by situational contingencies such as receiving help and being called upon to help, together with evaluations such as empathy, identification with suffering, and gratitude, people can be motivated to help others. Future research is needed to explore how altruism and helping behaviour can promote healing from trauma, alleviate distress of separation, and ameliorate acculturation stress among diverse refugee populations. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article on the assessment of patients' decision-making capacity by professor Pēteris Dārzinņš in the 2010 issue of "Australian Occupational Therapy."

A letters to the editor is presented in response to the article about how to assess a patient's medical decision-making capacity.