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Identification of factors which influence health after a cardiovascular disease (CVD) event will assist with reducing the high health and economic burden of CVD. We undertook a systematic review to investigate the association between social health (lower social isolation, higher social support and lower loneliness) and health and well‐being after a CVD event among people living in Australia and New Zealand. Four electronic databases were systematically searched until June 2020. Two reviewers undertook title/abstract screen. One reviewer undertook full‐text screen and data extraction. A second author either independently extracted or checked data. Narrative thematic analysis was undertaken. Of the 752 unique records retrieved, 39 papers from 29 studies met our inclusion criteria. Included studies recruited between 10 and 1,455 participants, aged 12–96 years, and the majority were male. Greater social health was consistently associated with better mental health outcomes (lower depressive symptoms, anxiety symptoms and psychological distress). Lower social isolation and higher social support were associated with the extent to which patient needs were being met. Living situation was not associated with mental health outcomes, and being married or living with someone was associated with greater medication adherence. Our systematic review demonstrates that greater social health is associated with better mental health outcomes and met patient needs among cardiac patients. As partner status and living status did not align with social isolation and social support findings in this review, we recommend they not be used as social health proxies when assessing health outcomes among CVD patients. Our review highlights the need for more research focused on women and the importance of gender‐disaggregated reporting. Further assessment is required to evaluate whether loneliness is associated with health and well‐being outcomes after a CVD event. [ABSTRACT FROM AUTHOR]

Aims To report a systematic review of the psychometric properties of self-report instruments to identify the symptoms of anxiety in pregnancy to help clinicians and researchers select the most suitable instrument. Background Excessive anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed. Design Psychometric systematic review. Data sources A systematic literature search of the multiple databases (1990-September 2014). Review methods Identification of self-report instruments to measure anxiety in pregnancy using COSMIN guidelines to assess studies reporting a psychometric evaluation of validity and reliability. Results Thirty-two studies were included. Studies took place in the UK, Australia, Belgium, Canada, Germany, Italy, Scandinavia, Spain and the Netherlands. Seventeen different instruments were identified. Measures of validity were reported in 19 papers and reliability in 16. The overall quality of the papers was rated as fair to excellent using the COSMIN checklist. Only one paper scored excellent in more than one category. Conclusion Many instruments have been adapted for use in different populations to those for which they were designed. The State Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale and the Hospital Anxiety and Depression Scale have been tested more frequently than other instruments, yet require further assessment to confirm their value for use in pregnancy. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Substance use disorders (SUDs) are common and frequently co-occur with mood and anxiety disorders. This paper provides a detailed analysis of patterns, prevalence and correlates of mood and anxiety disorders among those with a (i) pure SUD; (ii) SUD plus a mood or anxiety disorder (SUDs + 1); and (iii) SUD plus a mood and anxiety disorder (SUDs + 2).Design and Methods: Data came from the 2007 National Survey of Mental Health and Wellbeing; a nationally representative household survey of 8841 Australians aged 16-85 years.Results: The 12-month prevalence of SUDs was 5.1%. Of those with a 12-month SUD, 65% met the criteria for pure SUDs, 19% for SUDs + 1 and 16% for SUDs + 2. Major depression was the most common mood disorder in both comorbid groups. One-third of SUDs + 1 experienced social phobia, while over half of SUDs + 2 experienced generalised anxiety disorder. Compared with pure SUDs, SUDs + 1 experienced two times more and SUDs + 2 experienced over four times more days out of role in the preceding 30 days. Both comorbid groups were more likely to experience severe levels of impairment. SUDs + 2 were over 18 times more likely to experience suicidal thoughts in the same year. SUDs + 1 were over three times and SUDs + 2 were over 10 times more likely to have had one or more consultations with a health professional in the previous year.Discussions and Conclusions: These findings highlight the complexities inherent with responding to and treating multiple comorbidities among substance users and emphasise the need for coordinated, cohesive responses from drug and alcohol treatment services.[Prior K, Mills K, Ross J, Teesson M. Substance use disorders comorbid with mood and anxiety disorders in the Australian general population. Drug Alcohol Rev 2017;36:317-324]. [ABSTRACT FROM AUTHOR]

General practice has an important role within the Australian healthcare system to provide access to care and effective management of chronic health conditions. However, people with serious mental illness experience challenges associated with service access. The current paper seeks to examine drivers of access to general practice for people with common and serious mental disorders, compared with people who access care for type II diabetes, a common physical health problem managed in general practice. The Bettering the Evaluation and Care of Health (BEACH) programme provides the most comprehensive and objective measurement of general practitioner activity in Australia. Using BEACH data, this study compared general practice encounters for depression, anxiety, bipolar disorder, schizophrenia, and type II diabetes during a 10-year period between 2006 and 2016. Analysis revealed more frequent encounters for depression compared to anxiety, and a higher representation of women in encounters for bipolar disorder compared to men. The relationship between number of encounters and patient age was strongly associated with the life course and mortality characteristics associated with each disorder. The findings highlight specific challenges associated with access to primary care for people with serious mental illness, and suggest areas of focus to improve the ability of these patients to access and navigate the health system. [ABSTRACT FROM AUTHOR]

Objective: Parent-only cognitive-behavioural therapy (CBT) interventions have promise for youth with anxiety disorders. Fear-Less Triple P (FLTP) is one such intervention that has been found comparable to child-focused CBT. Although traditionally administered in six sessions, a one-day workshop format of FLTP was developed to improve accessibility. The current study compared the effectiveness of the six-session and one-day workshop formats. Method: Seventy-three youth (mean age, 8.4 years; 74% male) were randomized to traditional FLTP (6-week group) or the one-day workshop format. Anxiety diagnostic status, self- and parent-reported anxiety symptoms scores, independent evaluator-rated improvement, treatment satisfaction, and measures of family functioning were included to assess treatment outcome. Data were collected prior to treatment, and 1-week, 6-months, and 12-months following treatment. Results: Both conditions resulted in significant improvement in child anxiety symptom scores per parent report (on both questionnaire and diagnostic interview measures). Furthermore, significant decreases in sibling anxiety were observed in both treatment conditions. There were no statistically significant differences between conditions on any outcome measure. Conclusions: Results of this study add to the growing evidence that brief, low-intensity, parent-only interventions can effectively target child psychopathology. These brief interventions are ideal for families for whom the resources and time required to commit to a standard multi-week intervention are prohibitive. Registration of Clinical Trials: This trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN 12615001284550). [ABSTRACT FROM AUTHOR]

This feasibility study explored suitability of a preventive intervention for internalising problems in young children for culturally and linguistically diverse families in Australia. A subsample of 62 families whose main language at home was other than English was selected from a population-based randomised trial of the Cool Little Kids parenting program. The population trial recruited 545 inhibited preschool children. Measures included family demographics, feedback post-intervention and child internalising problems at longitudinal follow-up. Parents of children whose main language at home was not English gave feedback that Cool Little Kids was helpful for managing their inhibited child's emotional distress. Significantly fewer intervention than control children whose main language at home was not English had separation anxiety symptoms after 2 years (M (SD) = 3.00 (3.15) versus 5.95 (3.98), p = 0.041). Further work to expand accessibility of Cool Little Kids to recent immigrant parents who do not speak English could be worthwhile. [ABSTRACT FROM AUTHOR]

Background: Compared to the general population, among gay and bisexual men (GBM) prevalence rates of anxiety and depression, and of drug use, are high.Objective: This paper explores the relationship between mental health, sexual risk behavior, and drug use among Australian GBM. We identify factors associated with indicators of poor mental health.Methods: Between September 2014 and July 2017, 3017 GBM responded to measures of anxiety and depression in an online cohort study of drug use.Results: Mean age was 35.3 years (SD 12.8). 17.9% screened positive for current moderate-severe anxiety and 28.3% for moderate-severe depression. The majority (52.2%) reported use of illicit drugs in the previous six months, including 11.2% who had used methamphetamine. One third had high (20.4%) or severe (10.6%) risk levels of alcohol consumption, and 18.3% who were current daily smokers. Most illicit drug use in general was not associated with either anxiety or depression, but men who used cannabis were more likely to show evidence of depression (p = 0.005). Among recent methamphetamine users, 28.0% were assessed as dependent: dependent users were more likely to show evidence of both depression and anxiety than were non-dependent users. High or severe risk drinking was associated with depression and daily tobacco use was associated with both anxiety and depression. Depression and anxiety was associated with: less personal support, viewing oneself as 'feminine', and being less socially engaged with gay men. Sexual risk behavior was not associated with either depression or anxiety.Conclusion: Prevalence of anxiety and depression was high, as was prevalence of licit and illicit drug use. Substance use was associated with anxiety and depression only when the use was considered problematic or dependent. Social isolation and marginalization are strong drivers of poor mental health, even within this population for whom anxiety and depression are common. [ABSTRACT FROM AUTHOR]

Objective: Evidence is accumulating that components of the Cannabis sativa plant may have therapeutic potential in treating psychiatric disorders. Medicinal cannabis (MC) products are legally available for prescription in Australia, primarily through the Therapeutic Goods Administration (TGA) Special Access Scheme B (SAS-B). Here we investigated recent prescribing practices for psychiatric indications under SAS-B by Australian doctors. Methods: The dataset, obtained from the TGA, included information on MC applications made by doctors through the SAS-B process between 1st November 2016 and 30th September 2022 inclusive. Details included the primary conditions treated, patient demographics, prescriber location, product type (e.g., oil, flower or capsule) and the general cannabinoid content of products. The conditions treated were categorized according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR). Trends in prescribing for conditions over time were analyzed via polynomial regression, and relationships between categorical variables determined via correspondence analyses. Results: Approximately 300,000 SAS-B approvals to prescribe MC had been issued in the time period under investigation. This included approvals for 38 different DSM-5-TR defined psychiatric conditions (33.9% of total approvals). The majority of approvals were for anxiety disorders (66.7% of psychiatry-related prescribing), sleep-wake disorders (18.2%), trauma- and stressor-related disorders (5.8%), and neurodevelopmental disorders (4.4%). Oil products were most prescribed (53.0%), followed by flower (31.2%) and other inhaled products (12.4%). CBD-dominant products comprised around 20% of total prescribing and were particularly prevalent in the treatment of autism spectrum disorder. The largest proportion of approvals was for patients aged 25-39 years (46.2% of approvals). Recent dramatic increases in prescribing for attention deficit hyperactivity disorder were identified. Conclusion: A significant proportion of MC prescribing in Australia is for psychiatry-related indications. This prescribing often appears somewhat "experimental", given it involves conditions (e.g., ADHD, depression) for which definitive clinical evidence of MC efficacy is lacking. The high prevalence of THC-containing products being prescribed is of possible concern given the psychiatric problems associated with this drug. Evidence-based clinical guidance around the use of MC products in psychiatry is lacking and would clearly be of benefit to prescribers. [ABSTRACT FROM AUTHOR]

Mental illness and substance use disorders have been increasing worldwide. Mental illness has a significant impact upon the lives of the individual as well as their loved ones. Mental disorders are known to result in a high level of disability. This article provides a comparative review of the epidemiology of mental disorders in Australia and India, summarizing and comparing prevalence rates in both countries based upon available data. Overall, it is evident that Australia has higher prevalence rates of mental disorders than India, across most diagnostic groups. Australia has the highest prevalence of anxiety disorders whereas India has the highest prevalence of substance use disorders; including tobacco use disorders. The next most prevalent mental disorders in India are depressive disorders. However, there are demographic parameters such as gender and age as well as service‐provision differences across the countries that need to be factored into any interpretation of the data. There are also problems associated with different diagnostic instruments with language and cultural nuances that may impact comparisons. We suggest that a joint epidemiological survey between the two countries would help better understand and delineate the key similarities pertaining to the epidemiology of mental disorders in Australia and India. This will in turn assist with the development of policy and treatment of mental disorders. [ABSTRACT FROM AUTHOR]

There is a large body of research showing that psychological treatment can be effectively delivered via the internet, and Digital Mental Health Services (DMHS) are now delivering those interventions in routine care. However, not all attempts to translate these research outcomes into routine care have been successful. This paper draws on the experience of successful DMHS in Australia and Canada to describe ten lessons learned while establishing and delivering internet-delivered cognitive behavioural therapy (ICBT) and other mental health services as part of routine care. These lessons include learnings at four levels of analysis, including lessons learned working with (1) consumers, (2) therapists, (3) when operating DMHS, and (4) working within healthcare systems. Key themes include recognising that DMHS should provide not only treatment but also information and assessment services, that DMHS require robust systems for training and supervising therapists, that specialist skills are required to operate DMHS, and that the outcome data from DMHS can inform future mental health policy. We also confirm that operating such clinics is particularly challenging in the evolving funding, policy, and regulatory context, as well as increasing expectations from consumers about DMHS. Notwithstanding the difficulties of delivering DMHS, we conclude that the benefits of such services for the broader community significantly outweigh the challenges. [ABSTRACT FROM AUTHOR]

Background: In 2006, the British government launched 'Improving Access to Psychological Therapies' (IAPT), a low intensity cognitive behaviour therapy intervention (LiCBT) designed to manage people with symptoms of anxiety and depression in the community. The evidence of the effectiveness of IAPT has been demonstrated in multiple studies from the UK, USA, Australia and other countries. MindStep™ is the first adaptation of IAPT in Australia, delivered completely by telephone, targeting people with a recent history of a hospital admission for mental illnesses within the private health system. This paper reports on the outcome of the first 17 months of MindStep™ implemented across Australia from March 2016. Methods: This prospective observational study investigated the MindStep™ program in a cohort of clients with a recent hospitalisation for mental illnesses. The study used quantitative methods to compare pre-post treatment clinical measures (N = 680) using Patient Health Questionnaire (PHQ-9) and the Generalised Anxiety Disorder (GAD-7). This study also included in-depth interviews with participants (N = 14) and coaches (N = 4) to determine the feasibility and acceptability of the program. Results: Of the 867 clients referred to MindStep™, 757 had initial assessments by phone making an enrolment rate of 87.3%. Following assessment, 680 commenced treatment and of them, 427 (62.7%) completed treatment. According to 'per-protocol' analysis (N = 427), there was a large effect size for post-treatment PHQ-9 (d = 1.03) and GAD-7 (d = 0.99) scores; reliable recovery rate was 62% (95% CI: 57–68%). For intent-to-treat analysis using multiple imputation (N = 680), effect sizes were also large for pre-post treatment change: PHQ-9 (d = 0.78) and GAD-7 (d = 0.76). The reliable recovery rate was 49% (95% CI: 45–54%). Qualitative findings supported these claims where participants were positive about MindStep™ and found the telephone delivery and use of mental health coaches highly acceptable. Conclusions: MindStep™ has demonstrated encouraging outcomes that suggest LiCBT can be successfully delivered to people with a history of hospital admissions for anxiety and depressive disorders and achieve target recovery rates of > 50%. Other promising evaluation findings indicate the MindStep™ option is acceptable, feasible and safe within the stepped models of mental health care delivery in Australia. [ABSTRACT FROM AUTHOR]

Background: The potential for early interventions to reduce the later prevalence of common mental disorders (CMD) first experienced in adolescence is unclear.Aims: To examine the course of CMD and evaluate the extent to which the prevalence of CMD could be reduced by preventing adolescent CMD, or by intervening to change four young adult processes, between the ages of 20 and 29 years, that could be mediating the link between adolescent and adult disorder.Method: This was a prospective cohort study of 1923 Australian participants assessed repeatedly from adolescence (wave 1, mean age 14 years) to adulthood (wave 10, mean age 35 years). Causal mediation analysis was undertaken to evaluate the extent to which the prevalence of CMD at age 35 years in those with adolescent CMD could be reduced by either preventing adolescent CMD, or by intervening on four young adult mediating processes: the occurrence of young adult CMD, frequent cannabis use, parenting a child by age 24 years, and engagement in higher education and employment.Results: At age 35, 19.2% of participants reported CMD; a quarter of these participants experienced CMD during both adolescence and young adulthood. In total, 49% of those with CMD during both adolescence and young adulthood went on to report CMD at age 35 years. Preventing adolescent CMD reduced the population prevalence at age 35 years by 3.9%. Intervening on all four young adult processes among those with adolescent CMD, reduced this prevalence by 1.6%.Conclusions: In this Australian cohort, a large proportion of adolescent CMD resolved by adulthood, and by age 35 years, the largest proportion of CMD emerged among individuals without prior CMD. Time-limited, early intervention in those with earlier adolescent disorder is unlikely to substantially reduce the prevalence of CMD in midlife. [ABSTRACT FROM AUTHOR]

Background: Clinical pathways (CPs) are intended to standardise and improve care but do not always produce positive outcomes, possibly because they were not adapted to suit the specific context in which they were enacted. This qualitative study aimed to explore staff perspectives of implementation of a CP for routine screening, assessment, referral and management of anxiety and depression (the ADAPT CP) for patients with cancer, focussing on perceived feasibility of the CP and negotiated adaptations made during the implementation phase.Methods: The ADAPT CP was implemented in 12 urban and regional oncology services in Australia. Services were randomised to receive core versus enhanced implementation strategies. Core sites received support until implementation commencement and could access progress reports. Enhanced sites received proactive, ongoing support during the 12-month implementation. Purposively selected staff were interviewed prior to implementation (n = 88) and 6 months later, half-way through the implementation period (n = 89). Monthly meetings with lead multi-disciplinary teams at the eight enhanced sites were recorded. Data were thematically analysed.Results: Six overarching themes were identified: ADAPT is of high value; timing for introducing the CP and screening is difficult; online screening is challenging; a burden too much; no-one to refer patients to; and micro-logistics are key. While early screening was deemed desirable, diverse barriers meant this was complex, with adaptations made to time and screening location. Online screening prompted by email, seen as time-saving and efficient, also proved unsuccessful in some services, with adaptations made to in-clinic or phone screening, or repeated email reminders. Staff negative attitudes to ADAPT, time constraints, and perceived poor fit of ADAPT to work roles and flows, all impacted implementation, with key tasks often devolving to a few key individuals. Nevertheless, services remained committed to the ADAPT CP, and worked hard to create, review and adapt strategies to address challenges to optimise success.Conclusions: This study demonstrates the interactive nature of health service change, with staff actively engaging with, forming views on, and problem-solving adaptations of the ADAPT CP to overcome barriers. Obtaining staff feedback is critical to ensure health service change is sustainable, meaningful and achieves its promise of improving patient outcomes.Trial Registration: The study was registered prospectively with the ANZCTR on 22/3/2017. Trial ID ACTRN12617000411347. [ABSTRACT FROM AUTHOR]

Aim: There is now a strong body of literature showing that bullying victimisation during childhood and adolescence precedes the later development of anxiety and depressive disorders. This study aimed to quantify the burden of anxiety and depressive disorders attributable to experiences of bullying victimisation for the Australian population. Methods: This study updated a previous systematic review summarising the longitudinal association between bullying victimisation and anxiety and depressive disorders. Estimates from eligible studies published from inception until 18 August 2018 were included and meta-analyses were based on quality-effects models. Pooled relative risks were combined with a contemporary prevalence estimate for bullying victimisation for Australia in order to calculate population attributable fractions (PAFs) for the two mental disorder outcomes. PAFs were then applied to estimates of the burden of anxiety and depressive disorders in Australia expressed as disability-adjusted life years (DALYs). Results: The findings from this study suggest 7.8% of the burden of anxiety disorders and 10.8% of the burden of depressive disorders are attributable to bullying victimisation in Australia. An estimated 30 656 DALYs or 0.52% (95% uncertainty interval 0.33–0.72%) of all DALYs in both sexes and all ages in Australia were attributable to experiences of bullying victimisation in childhood or adolescence. Conclusion: There is convincing evidence to demonstrate a causal relationship between bullying victimisation and mental disorders. This study showed that bullying victimisation contributes a significant proportion of the burden of anxiety and depressive disorders. The investment and implementation of evidence-based intervention programmes that reduce bullying victimisation in schools could reduce the burden of disease arising from common mental disorders and improve the health of Australians. [ABSTRACT FROM AUTHOR]

Objective: To determine whether infants with severe persistent sleep problems are at increased risk of (1) meeting diagnostic criteria for a psychiatric disorder (age 10 years), and (2) having elevated symptoms of mental health difficulties (ages 4 and 10 years), in comparison with infants with settled sleep.Design and Setting: Prospective longitudinal community cohort study-the Maternal Health Study. Mothers completed questionnaires/interviews at 15 weeks' gestation; 3, 6, 9 and 12 months post partum; and when their child turned 4 and 10 years old. Measures included parental report of infant night waking and sleep problems and child mental health (Strengths and Difficulties Questionnaire; Spence Children's Anxiety Scale; Development and Well-being Assessment).Participants: 1460 mother-infant dyads.Results: 283 (19.4%) infants had persistent severe sleep problems, 817 (56.0%) had moderate/fluctuating sleep problems and 360 (24.7%) infants were settled. Infants with persistent severe sleep problems were more likely to report emotional symptoms at age 4 (adjusted odds ratio (AOR)=2.70, 95% CI 1.21 to 6.05, p=0.02), and meet diagnostic criteria for an emotional disorder at age 10 (AOR=2.37, 95% CI 1.05 to 5.36, p=0.04). Infants with persistent severe sleep problems also had elevated symptoms of separation anxiety (AOR=2.44, 95% CI 1.35 to 4.41, p<0.01), fear of physical injury (AOR=2.14, 95% CI 1.09 to 4.18, p=0.03) and overall elevated anxiety (AOR=2.20, 95% CI 1.13 to 4.29, p=0.02) at age 10.Conclusions: Infants with persistent severe sleep problems during the first postnatal year have an increased risk of anxiety problems and emotional disorders at age 10. [ABSTRACT FROM AUTHOR]

Aim: This study investigated the acceptability, clinical utility and preliminary effectiveness of Youth version, Case-finding and Help Assessment Tool (YouthCHAT), a novel electronic, tablet-based screener designed to identify issues similar to Home, Education/Employment, Activity, Drugs, Sexuality, Suicide/Depression, Safety assessment.Methods: YouthCHAT was administered to a group of 30 young people aged 13-17 years with different long-term physical conditions attending outpatient clinics between September and December 2017. Outcome measures were: (i) acceptability and feasibility of YouthCHAT as assessed via feedback from young people and clinicians and the time taken to complete YouthCHAT screening; and (ii) detection rates for each domain of YouthCHAT measured by mental health or life-style issues 'present' or 'absent', and where relevant, validated symptom scores.Results: YouthCHAT was quick to administer and positively received by both young people and clinicians. Rates of anxiety (37%) and depression (13%) detected using YouthCHAT were similar to those in previous studies of young people with long-term physical conditions. Rates of other problems were similar to a previously screened high school sample.Conclusions: YouthCHAT is a viable and acceptable psychosocial screener with the potential to improve the holistic care of young people with long-term physical conditions attending outpatient clinics.Trial Registration: This study has been registered with the Australian New Zealand Clinical Trials Network Registry ACTRN12616001243404p. [ABSTRACT FROM AUTHOR]

As student population numbers increase in tertiary institutions, so does the number of students presenting with diagnosed and undiagnosed mental health issues. According to the ABS (2008), 4.1% of the general population experience depressive episodes and 14.4% are diagnosed with anxiety disorders. However, students attending regional universities such as the University of the Sunshine Coast are at a greater risk of developing a mental illness due to factors such as social isolation, relocation and financial difficulties. A recent study (Mulder & Cashin, 2015) indicated that 16% of the student cohort in a regional university in Australia presented in very high levels of distress. Considering the high volume of students presenting with mental health issues compared to the general Australian population, it is imperative that universities invest in the overall health of its students to improve retention rates, academic results, career outcomes, general wellbeing, and student satisfaction. The following article demonstrates how the counselling team at the University of the Sunshine Coast provided additional support to students with mental health issues using a case-managed approach within the UNIfy program during the 2018 academic year. [ABSTRACT FROM AUTHOR]

Background and Objectives Many individuals with anxiety difficulties present with co-occurring anxiety disorders yet no evidence-based guidelines exist on how to treat this presentation. The present study investigated how Australian psychologists approach treating co-occurring anxiety disorders. Methods A total of 169 psychologists practicing in Australia undertook an online survey consisting of open-questions relating to the treatment of DSM-IV anxiety disorder diagnoses and reported practice in relation to two clinical vignettes. Participant responses were coded using a directed content analysis approach. Results The majority of psychologists reported utilising cognitive behaviour therapy ( CBT) interventions in the treatment of single and co-occurring anxiety disorders but not specific evidence-based treatment guides or protocols. The majority of the psychologists surveyed reported that they adopt a transdiagnostic approach to addressing co-occurring anxiety disorders. Conclusions Psychologists typically do not follow a specific treatment guide in the treatment of anxiety disorders and judge a transdiagnostic approach incorporating CBT techniques as the best way to treat comorbidity. More effort may be needed to disseminate evidence-based interventions for anxiety disorders and for authors of empirically supported treatments to provide clear guidelines regarding treating co-occurring anxiety disorders. [ABSTRACT FROM AUTHOR]

Purpose: There is ongoing controversy on the effectiveness of psychotherapy in inflammatory bowel disease (IBD). In the few small studies, cognitive-behavioural therapy (CBT) has been shown to alleviate symptoms of anxiety or depression. However, there is little research on the impact of CBT on physical outcomes in IBD and no studies on long-term effectiveness of CBT. Methods: The present two-arm pragmatic randomised controlled trial aimed to establish the impact of CBT on disease course after 24 months of observation. The study compared standard care plus CBT (+CBT) with standard care alone (SC). CBT was delivered over 10 weeks, face-to-face (F2F) or online (cCBT). The data were analysed using linear mixed-effects models. Results: CBT did not significantly influence disease activity as measured by disease activity indices at 24 months (Crohn's Disease Activity Index (CDAI), p = 0.92; Simple Clinical Colitis Activity Index (SCCAI), p = 0.88) or blood parameters (C-reactive protein (CRP), p < 0.62; haemoglobin (Hb), p = 0.77; platelet, p = 0.64; white cell count (WCC), p = 0.59) nor did CBT significantly affect mental health, coping or quality of life (all p > 0.05). Conclusions: Therefore, we conclude that CBT does not influence the course of IBD over 24 months. Given the high rate of attrition, particularly in the CBT group, future trials should consider a personalised approach to psychotherapy, perhaps combining online and one-to-one therapist time. [ABSTRACT FROM AUTHOR]

This study examined anxiety in preschool children within a South-African context. The parents and teachers of 101 South African children aged 2 to 6 years completed measures of children's anxiety-prone temperament (behavioral inhibition) and anxiety disorders symptoms. Parents and teachers of 59 children could be re-approached one year later, with the request to fill in both scales again, while parents at that time also completed a measure of parental overprotection. Results indicated that, compared with normative scores collected in Western countries, young South African children displayed relatively high levels of anxiety-proneness and anxiety disorders symptoms, although this cultural difference could only be demonstrated when using the parentreport data. Further, on both occasions there were substantial and positive correlations between children's behavioral inhibition and anxiety symptoms. Behavioral inhibition and anxiety symptoms, in particular when assessed by parent report, appeared to be fairly stable during the one-year period, and we found only tentative support for the idea that behavioral inhibition on time 1 increased the risk for anxiety symptoms on time 2. Finally, a cross-sectional analysis of the data collected on time 2 revealed a positive correlation between overprotection and children's anxiety symptoms as well as a marginally significant interaction of behavioral inhibition and overprotection on children's anxiety symptoms, indicating that in particular the combination of high behavioral inhibition and high overprotection tended to be associated with the highest anxiety levels. [ABSTRACT FROM AUTHOR]

The study aim was to test whether a 12-week publically rebated group programme, based upon Steketee and Frost's Cognitive Behavioural Therapy-based hoarding treatment, would be efficacious in a community-based setting. Over a 3-year period, 77 participants with clinically significant hoarding were recruited into 12 group programmes. All completed treatment; however, as this was a community-based naturalistic study, only 41 completed the post-treatment assessment. Treatment included psychoeducation about hoarding, skills training for organization and decision making, direct in-session exposure to sorting and discarding, and cognitive and behavioural techniques to support out-of-session sorting and discarding, and nonacquiring. Self-report measures used to assess treatment effect were the Savings Inventory-Revised (SI-R), Savings Cognition Inventory, and the Depression, Anxiety and Stress Scales. Pre-post analyses indicated that after 12 weeks of treatment, hoarding symptoms as measured on the SI-R had reduced significantly, with large effect sizes reported in total and across all subscales. Moderate effect sizes were also reported for hoarding-related beliefs (emotional attachment and responsibility) and depressive symptoms. Of the 41 participants who completed post-treatment questionnaires, 14 (34%) were conservatively calculated to have clinically significant change, which is considerable given the brevity of the programme judged against the typical length of the disorder. The main limitation of the study was the moderate assessment completion rate, given its naturalistic setting. This study demonstrated that a 12-week group treatment for hoarding disorders was effective in reducing hoarding and depressive symptoms in an Australian clinical cohort and provides evidence for use of this treatment approach in a community setting. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message A 12-week group programme delivered in a community setting was effective for helping with hoarding symptoms with a large effect size., Hoarding beliefs (emotional attachment and responsibility) and depression were reduced, with moderate effect sizes., A third of all participants who completed post-treatment questionnaires experienced clinically significant change., Suggests that hoarding CBT treatment can be effectively translated into real-world settings and into a brief 12-session format, albeit the study had a moderate assessment completion rate. [ABSTRACT FROM AUTHOR]

Although we do know that out-of-pocket healthcare expenditure is relatively high in Australia, little is known about what health conditions are associated with the highest out-of-pocket expenditure, and whether the cost of healthcare acts as a barrier to care for people with different chronic conditions. Cross-sectional analysis using linear and logistic regression models applied to the Commonwealth Fund international health policy survey of adults aged 18 years and over was conducted in 2013. Adults with asthma, emphysema and chronic obstructive pulmonary disease (COPD) had 109% higher household out-of-pocket healthcare expenditure than did those with no health condition (95% CI: 50-193%); and adults with depression, anxiety and other mental health conditions had 95% higher household out-of-pocket expenditure (95% CI: 33-187%). People with a chronic condition were also more likely to forego care because of cost. People with depression, anxiety and other mental health conditions had 7.65 times higher odds of skipping healthcare (95% CI: 4.13-14.20), and people with asthma, emphysema and chronic obstructive pulmonary disease had 6.16 times higher odds of skipping healthcare (95% CI: 3.30-11.50) than did people with no health condition. People with chronic health conditions in Canada, the United Kingdom, Germany, France, Norway, Sweden and Switzerland were all significantly less likely to skip healthcare because of cost than were people with a condition in Australia. The out-of-pocket cost of healthcare in Australia acts as a barrier to accessing treatment for people with chronic health conditions, with people with mental health conditions being likely to skip care. Attention should be given to the accessibility and affordability of mental health services in Australia. [ABSTRACT FROM AUTHOR]

This study examined the psychometric properties and diagnostic accuracy of the Swedish translations of the Spence Children’s Anxiety Scale, self- and parent report versions, in a sample of 104 adolescents presenting at two general psychiatric outpatient units. Results showed high informant agreement and good internal reliability and concurrent and discriminant validity for both versions and demonstrated that this scale can distinguish between adolescents with and without an anxiety disorder in a non–anxiety-specific clinical setting. The relative clinical utility of different cutoff scores was compared by looking at the extent to which dichotomized questionnaire results altered the pretest probability of the presence of a diagnosis as defined by the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Optimized for screening and diagnostic purposes in Sweden, cutoff scores obtained in the current study outperformed a previously identified cutoff score derived from an Australian community sample. The Spence Children’s Anxiety Scale is a useful clinical instrument for the assessment of anxiety in adolescents. [ABSTRACT FROM AUTHOR]

Objective University students are vulnerable to depression and other co-occurring mental disorders, but few receive treatment. Male university students are at particular risk of not receiving assistance. A better understanding of gender differences in the experience of depression may assist in improving its detection and the provision of appropriate support and prevention strategies. Accordingly, this study aimed to identify whether male and female university students have different patterns of self-reported depression and co-occurring anxiety and stress. Method A total of 1,401 first year students from a regional Australian university completed the 21-item version of the Depression Anxiety and Stress Scales. Data were collected in 2001, 2006, 2010, and 2012. Multidimensional scaling analyses were conducted to identify patterns of depression, anxiety, and stress in men and women with different depression severity. Results Depressed men reported mixed patterns of depression, anxiety, and stress that were clustered by behavioural and physiological function, whereas depressed women reported distinctive patterns of depression, anxiety, and stress as prescribed by categories of the individual Depression Anxiety and Stress Scales. Conclusions Depressed male and female university students may categorise and interpret their psychological distress differently. Depressed men might tend to categorise symptoms by function and physiology, whereas depressed women might prefer to use common verbally defined constructs of psychological distress. It may be important for mental health professionals to consider these gender differences in categorisation and patterns of symptoms when screening for depression to increase chances of university students receiving appropriately targeted treatment. [ABSTRACT FROM AUTHOR]

BackgroundThe aims of the study were to describe the patterning and persistence of anxiety and depressive symptoms from adolescence to young adulthood and to examine long-term developmental relationships with earlier patterns of internalizing behaviours in childhood.MethodWe used parallel processes latent growth curve modelling to build trajectories of internalizing from adolescence to adulthood, using seven waves of follow-ups (ages 11–27 years) from 1406 participants of the Australian Temperament Project. We then used latent factors to capture the stability of maternal reported child internalizing symptoms across three waves of early childhood follow-ups (ages 5, 7 and 9 years), and examined relationships among these patterns of symptoms across the three developmental periods, adjusting for gender and socio-economic status.ResultsWe observed strong continuity in depressive symptoms from adolescence to young adulthood. In contrast, adolescent anxiety was not persistent across the same period, nor was it related to later depressive symptoms. Anxiety was, however, related to non-specific stress in young adulthood, but only moderately so. Although childhood internalizing was related to adolescent and adult profiles, the associations were weak and indirect by adulthood, suggesting that other factors are important in the development of internalizing symptoms.ConclusionsOnce established, adolescent depressive symptoms are not only strongly persistent, but also have the potential to differentiate into anxiety in young adulthood. Relationships with childhood internalizing symptoms are weak, suggesting that early adolescence may be an important period for targeted intervention, but also that further research into the childhood origins of internalizing behaviours is needed. [ABSTRACT FROM AUTHOR]

Objective This study aimed to evaluate the complex clinical phenomenology of Tourette's syndrome within a community-based Australian sample. It also aimed to determine the service needs of this population. Method Participants included parents of individuals with Tourette's syndrome ( n = 86; mean age = 11.4, standard deviation [ SD] = 2.8) and control group peers ( n = 108; mean age = 11.3, SD = 2.6). Clinical phenomenology was assessed using the Parent Tic Questionnaire, and the Strengths and Difficulties Questionnaire ( SDQ). Reports of formally diagnosed disorders, a comprehensive family history and accounts of service needs were also gathered. Results Findings mirrored the profile of Tourette's syndrome reported in international populations, revealing heterogeneous tic and comorbidity profiles. High rates of comorbidity (77%), often involving multiple co-occurring diagnoses, were reported for the Tourette's syndrome group. These included obsessive compulsive disorder (44%), anxiety disorder (36%), attention deficit hyperactivity disorder (32%), and learning disorders (18%). Results of the SDQ determined significant elevations in symptoms of conduct and mood disorders for individuals with Tourette's syndrome ( p = .01). Parents also reported shortcomings in health and education services, low levels of understanding of Tourette's syndrome by health professionals, and half reported stigmatisation within the Australian context. Conclusions The study confirmed the challenges confronting youth with Tourette's syndrome and revealed deficits in Australian health and educational services for individuals with Tourette's syndrome. Findings indicate the need for increased education for health professionals and the provision of multidisciplinary services to meet the complex needs of this clinical population. [ABSTRACT FROM AUTHOR]

Purpose: People with cancer and their families experience high levels of psychological morbidity. However, many cancer services do not routinely screen patients for anxiety and depression, and there are no standardized clinical referral pathways. This study aimed to establish consensus on elements of a draft clinical pathway tailored to the Australian context.Methods: A two-round Delphi study was conducted to gain consensus among Australian oncology and psycho-oncology clinicians about the validity of 39 items that form the basis of a clinical pathway that includes screening, assessment, referral and stepped care management of anxiety and depression in the context of cancer. The expert panel comprised 87 multidisciplinary clinician members of the Australian Psycho-oncology Co-operative Research Group (PoCoG). Respondents rated their level of agreement with each statement on a 5-point Likert scale. Consensus was defined as >80% of respondents scoring within 2 points on the Likert scale.Results: Consensus was reached for 21 of 39 items, and a further 15 items approached consensus except for specific contextual factors, after two Delphi rounds. Formal screening for anxiety and depression, a stepped care model of management and recommendations for inclusion of length of treatment and time to review were endorsed. Consensus was not reached on items related to roles and responsibilities, particularly those not applicable across cancer settings.Conclusions: This study identified a core set of evidence- and consensus-based principles considered essential to a stepped care model of care incorporating identification, referral and management of anxiety and depression in adult cancer patients. [ABSTRACT FROM AUTHOR]

Background.Individuals identified as at ultra-high risk (UHR) for psychosis are at risk of poor functional outcome regardless of development of psychotic disorder. Studies examining longitudinal predictors of poor functioning have tended to be small and report only medium-term follow-up data. We sought to examine clinical predictors of functional outcome in a long-term longitudinal study.Method.Participants were 268 (152 females, 116 males) individuals identified as UHR 2–14 years previously. A range of clinical and sociodemographic variables were assessed at baseline. Functioning at follow-up was assessed using the Social and Occupational Functioning Assessment Scale (SOFAS).Results.Baseline negative symptoms, impaired emotional functioning, disorders of thought content, low functioning, past substance use disorder and history of childhood maltreatment predicted poor functioning at follow-up in univariate analyses. Only childhood maltreatment remained significant in the multivariate analysis (p < 0.001). Transition to psychosis was also significantly associated with poor functioning at long-term follow-up [mean SOFAS score 59.12 (s.d. = 18.54) in the transitioned group compared to 70.89 (s.d. = 14.00) in the non-transitioned group, p < 0.001]. Childhood maltreatment was a significant predictor of poor functioning in both the transitioned and non-transitioned groups.Conclusions.Childhood maltreatment and transition to psychotic disorder independently predicted poor long-term functioning. This suggests that it is important to assess history of childhood maltreatment in clinical management of UHR individuals. The finding that transition to psychosis predicts poor long-term functioning strengthens the evidence that the UHR criteria detect a subgroup at risk for schizophrenia. [ABSTRACT FROM PUBLISHER]

The aim of the present study was to examine predictors of 'escape style' problem gambling among young Australian gamblers. Anxiety and dissociation are considered to be predictors of 'escape style' gambling behaviour although this assessment has neglected consideration of different modes of gambling. This study builds on existing research, to examine the role of anxiety and dissociation in the gambling habits of young Australian male and female gamblers. One hundred and forty-two participants aged between 18 and 35 years self-selected and completed an online questionnaire. The hypothesis that gamblers would have similar levels of dissociation and anxiety despite different modes of gambling was supported. The hypothesis that anxiety and dissociation would both together and uniquely predict problem gambling behaviour across a range of gambling modalities was supported. Further, the hypothesis that there would be an interaction effect between anxiety and dissociation such that their presence together would predict a higher degree of problem gambling behaviour was supported. Results suggest that anxiety and dissociation play an important role in 'escape style' gambling and that strategies to combat problem gambling may benefit from research targeting anxiety and attempting to rechannel dissociative behaviour into healthier pursuits. [ABSTRACT FROM AUTHOR]

Children with autism spectrum disorder (ASD) have high levels of anxiety. It is unclear whether they exhibit threat-related attentional biases commensurate with anxiety disorders as manifest in non-ASD populations, such as facilitated attention toward, and difficulties disengaging engaging from, threatening stimuli. Ninety children, 45 cognitively able with ASD and 45 age, perceptual-IQ, and gender matched typically developing children, aged 7-12 years, were administered a visual dot probe task using threatening facial pictures. Parent-reported anxiety symptoms were also collected. Children with ASD showed similarly high levels of anxiety compared with normative data from an anxiety disordered sample. Children with ASD had higher levels of parent-reported anxiety but did not show differences in disengaging from, or facilitated attention toward, threatening facial stimuli compared with typically developing children. In contrast to previously published studies of anxious children, in this study there were no differences in attentional biases in children with ASD meeting clinical cutoff for anxiety and those who did not. There were no correlations between attentional biases and anxiety symptoms and no gender differences. These findings indicate the cognitive mechanisms underlying anxiety in cognitively able children with ASD could differ from those commonly found in anxious children which may have implications for both understanding the aetiology of anxiety in ASD and for anxiety interventions [ABSTRACT FROM AUTHOR]

Background Prevention and early intervention for anxiety disorders has lagged behind many other forms of mental disorder. Recent research has demonstrated the efficacy of a parent-focussed psycho-educational programme. The programme is directed at parents of inhibited preschool children and has been shown to reduce anxiety disorders at 1 and 3 years following intervention. The current study assesses the cost-effectiveness of this intervention to determine whether it could provide value-for-money across a population. Method A cost-utility economic framework, using Disability-Adjusted-Life-Years ( DALYs) as the outcome, was adopted. Economic modelling techniques were used to assess the incremental cost-effectiveness ratio ( ICER) of the intervention within the Australian population context, which was modelled as add-on to current practice. The perspective was the health sector. Uncertainty was measured using multivariate probabilistic testing and key assumptions were tested using univariate sensitivity analysis. Results The median ICER for the intervention was AUD$8,000 per DALY averted with 99.8% of the uncertainty iterations falling below the threshold value-for-money criterion of AUD$50,000 per DALY averted. The results were robust to sensitivity testing. Conclusions Screening young children in a preschool setting for an inhibited temperament and providing a brief intervention to the parents of children with high levels of inhibition appears to provide very good value-for-money and worth considering in any package of preventive care. Further evaluation of this intervention under routine health service conditions will strengthen conclusions. Acceptability issues associated with this intervention, particularly to preschool staff and parents, need to be considered before wide-scale adoption is undertaken. [ABSTRACT FROM AUTHOR]

A randomized-controlled trial (RCT) was conducted from September 2009 to June 2011. National Diabetes Services Scheme registrants diagnosed with type 2 diabetes and aged 30-70 years were invited to participate in a 3-week intervention programme with follow-up at 4 weeks and 6 months. Data were collected using self-report questionnaires in the participant's homes. The intervention group received diabetes factsheets and a DVD comprising patient stories (narratives) of type 2 diabetes management. The control group (CG) received factsheets only. The RCT evaluated the impact of patient narratives on the study outcomes, self-efficacy and self-care, using the Aust/ English Diabetes Management Self-efficacy Scale and the Summary Diabetes Self-care Activities measure. Participants were randomly assigned to the intervention or CG using block randomization. The study was not blinded. Six hundred and seventy people enrolled into the study with 335 allocated to each group. At 4 weeks, data were available for 598 participants. t-tests were used to analyse the results. The mean difference between the groups for self-efficacy was 7.2 units (P, 0.001, 95% Confidence Interval (CI) 3.8, 10.7) favouring the intervention group. Change in self-care behaviours during the previous 7 days was also significantly greater for the intervention group: general diet (0.31 days, 95% CI 0.13, 0.48), specific diet (0.26 days, 95% CI 0.05, 0.46), exercise (0.51 days, 95% CI 0.23, 0.80), blood glucose (0.52 days, 95% CI 0.19, 0.85) and foot care (0.38 days, 95% CI 0.06, 0.71). Narrative communication shows promise as a valuable component of type 2 diabetes self-management programmes. [ABSTRACT FROM AUTHOR]

Temperamental inhibition has been identified as a key risk factor for childhood anxiety and internalizing problems. An efficacious early prevention programme for shy/inhibited children has been developed; however, accurate, efficient and acceptable screening is needed to support wider implementation. We explore community screening options in the context of a trial implementing the Cool Little Kids prevention programme for anxiety disorders. In comparison to the Australian Temperament Project's inhibition scale, we examine the Strengths and Difficulties Questionnaire's (SDQ) ability to screen for inhibited preschool children. Parents of 6307 children aged 3 to 6 years enrolled in preschool programmes from eight socio-economically diverse districts in Melbourne, Australia, first completed the measures of inhibition and SDQ. Parents with inhibited children then enrolled in the Cool Little Kids randomized trial ( n = 545). Of these, 88% provided feedback about inhibition screening. Parents allocated to the intervention also provided feedback on the Cool Little Kids parenting programme. Results demonstrated that parents of preschool children (i) find inhibition screening acceptable, (ii) take up this parenting programme and (iii) report favourable feedback. The SDQ emotional symptoms subscale demonstrated acceptable sensitivity but insufficient specificity to identify inhibited preschool children. Presenting parents with a brief, validated inhibition scale could be a low-cost option for identifying inhibited preschool children in the community to offer early anxiety prevention. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]