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Background: Sex differences in rates of depression emerge during adolescence. However, it is unclear whether symptom patterns and trajectories differ significantly according to gender in youth. Barriers to research include the fact that most self-report tools are weighted towards psychological rather than somatic symptoms., Methods: Data were collected on symptoms of depression in about 1800 individuals at ages 12, 14 and 16 years. Odds ratios and 95% confidence intervals were used to examine the trajectory of psychological and somatic phenotypes and self-reported depression caseness over time., Results: At age 12, 24% of participants met criteria for self-reported depression caseness. Although there was only a small incremental increase in the prevalence over time (about 5%), 57% of participants met criteria for self-reported depression caseness at least once. Generic symptoms at age 12 were associated with depression longitudinally, although early transition to caseness was reported in females only. Categorization as a psychological phenotype at age 12 predicted depression at age 14 and/or 16 years, especially in females. The somatic phenotype was more common in males, but showed a weaker association with self-reported depression caseness over time., Limitations: Depression was assessed by self-report; only 30% of participants had ratings for age 12, 14 and 16., Conclusions: Although sub-threshold psychological and somatic syndromes often co-occur in cases of self-reported depression in adolescence, longitudinally they may represent independent symptom trajectories. However, it is important to remember that self-reported depression is indicative of, but not confirmation of a depressive episode that meets diagnostic criteria., (Copyright © 2017. Published by Elsevier B.V.)

Objective: To delineate the risk factors, symptom patterns, and longitudinal course of prolonged illnesses after a variety of acute infections., Design: Prospective cohort study following patients from the time of acute infection with Epstein-Barr virus (glandular fever), Coxiella burnetii (Q fever), or Ross River virus (epidemic polyarthritis)., Setting: The region surrounding the township of Dubbo in rural Australia, encompassing a 200 km geographical radius and 104,400 residents., Participants: 253 patients enrolled and followed at regular intervals over 12 months by self report, structured interview, and clinical assessment., Outcome Measures: Detailed medical, psychiatric, and laboratory evaluations at six months to apply diagnostic criteria for chronic fatigue syndrome. Premorbid and intercurrent illness characteristics recorded to define risk factors for chronic fatigue syndrome. Self reported illness phenotypes compared between infective groups., Results: Prolonged illness characterised by disabling fatigue, musculoskeletal pain, neurocognitive difficulties, and mood disturbance was evident in 29 (12%) of 253 participants at six months, of whom 28 (11%) met the diagnostic criteria for chronic fatigue syndrome. This post-infective fatigue syndrome phenotype was stereotyped and occurred at a similar incidence after each infection. The syndrome was predicted largely by the severity of the acute illness rather than by demographic, psychological, or microbiological factors., Conclusions: A relatively uniform post-infective fatigue syndrome persists in a significant minority of patients for six months or more after clinical infection with several different viral and non-viral micro-organisms. Post-infective fatigue syndrome is a valid illness model for investigating one pathophysiological pathway to chronic fatigue syndrome.

Objective: To propose alternative Medicare Benefits Schedule-based funding models for outpatient psychiatric services in Australia., Method: Development of alternative funding schedules for a variety of under-serviced populations., Conclusions: Consideration of alternative systems is necessary to address the restrictive work practices, inequity and poor distribution of the psychiatric workforce.

Objective: To explore the experiences of carers and families of people with depression., Design and Setting: Structured focus groups conducted in six Australian capital cities between February 2002 and July 2002. Thematic analyses were conducted using the QSR NUD*IST software package for qualitative data., Participants: Thirty-seven carers or family members., Results: Thematic analyses highlighted five key themes. Most notably, the carer's role is made more difficult by the lack of community awareness about depression, and, in some instances, an unwillingness of other family and friends to provide ongoing support. Carers experience a resulting sense of isolation, often exacerbated by adverse experiences with healthcare providers. Carers and family members are frequently excluded when key decisions are made, and report that emergency services are relatively unresponsive to their concerns. By contrast, community support organisations usually provided a sense of inclusion and common purpose., Conclusions: The experiences of carers and families of people with depression highlight the urgent need for more extensive community education about the illness and more productive collaboration within the healthcare system.

Objectives: To examine the uptake by general practitioners (GPs) of the five key components of the Better Outcomes in Mental Health Care (BOiMHC) initiative: education and training for GPs; the three-step mental health process; focussed psychological strategies; access to allied health services; and access to psychiatrist support., Setting: All Australian states and territories during the first 15 months of the initiative (1 July 2002 - 30 September 2003)., Design: Retrospective survey of de-identified registration data held by the General Practice Mental Health Standards Collaboration (training uptake), de-identified Health Insurance Commission (HIC) billing data (provision of the three-step mental health process, focussed psychological strategies and case conferences with psychiatrists), and reports from "access to allied health services" projects to the Australian Department of Health and Ageing (project participation)., Main Outcome Measures: Number and percentage of Australian GPs certified as eligible to participate in the initiative; provision of the three-step mental health process and focussed psychological strategies by GPs; participation in allied health pilot projects; and access to psychiatrist support., Results: Within 15 months of the BOiMHC initiative commencing, 3046 GPs (about 15% of Australian GPs) had been certified as eligible to participate, including 387 who had registered to provide focussed psychological strategies. GPs had completed 11 377 three-step mental health processes and 6472 sessions of focussed psychological strategies. Sixty-nine "access to allied health services" projects had been funded, with the original 15 pilot projects enabling 346 GPs to refer 1910 consumers to 134 individual allied health professionals and 10 agencies. In contrast, the "access to psychiatrist support" component was less successful, with the HIC billed for 62 case conferences at which a psychiatrist and a GP were present., Conclusion: The level of uptake of the main components of the BOiMHC initiative has expanded the national capacity to respond to the needs of people with common mental disorders, such as depression and anxiety.

Objective: To describe the experiences of people with bipolar disorder with primary care and specialist mental health services., Design and Setting: Focus groups and indepth interviews were conducted in seven Australian capital cities between July 2002 and April 2003. Thematic analyses were conducted using the QSR NUD*IST software package for qualitative data., Participants: Forty-nine people with bipolar disorder participated in the focus groups and four participated in the interviews., Results: Thematic analyses highlighted eight key themes. Most notably, respondents identified a lack of awareness and understanding about bipolar disorder within the Australian community, which contributed to apparent delays in seeking medical assessment. The burden of illness was exacerbated by difficulties experienced with obtaining an accurate diagnosis and optimal treatment. The healthcare system responses were described as inadequate and included inappropriate crisis management, difficulties accessing hospital care, inappropriate exclusion of carers and families from management decisions, and frequent discontinuities of medical and psychological care., Conclusions: People with extensive experience of bipolar disorder report barriers to optimal care because of lack of community understanding and healthcare system shortcomings. These barriers exacerbate the social, interpersonal and economic costs of this illness.

Objective: To determine if screening in general practice and related medical settings improves management and clinical outcomes in people with depression., Data Sources: The Medline (1966-2002), EMBASE (1980-2002) and PsycINFO (1966-2002) databases were searched. These were supplemented by searching the Cochrane databases (to 2002); performing additional specific searches on Medline, EMBASE and PsycINFO; scrutinising reference lists of selected articles; and querying experts., Study Selection: Inclusion criteria were: review of prospective studies with a primary focus of depression screening in general practice settings; review of studies of healthy populations or people with known depression; publication in a peer-reviewed journal; and written in English. Eleven reviews that satisfied these criteria were assessed for quality using the Oxman and Guyatt Index. Four reviews met the criterion of a score of five or more., Data Extraction: One author tabulated relevant material (including number and type of studies, outcomes/endpoints, measures of association/statistical results, and findings) from the four key reviews. A second author independently checked the accuracy of this extracted material., Data Synthesis: Brief self-report instruments have acceptable psychometric properties and are practical for use in general practice settings. Screening increases the recognition and diagnosis of depression and, when integrated with a commitment to provide coordinated and prompt follow-up of diagnosis and treatment, clinical outcomes are improved., Conclusions: Although controversial, the evidence is now in favour of the appropriate use of screening tools in primary care.

Background: Neurasthenia imposes a high burden on primary medical health care systems in all societies., Aims: To determine the prevalence of ICD-10 neurasthenia and associated comorbidity, disability and health care utilisation., Method: Utilisation of a national sample of Australian households previously surveyed using the Composite International Diagnostic Interview and other measures., Results: Prolonged and excessive fatigue was reported by 1465 people (13.29% of the sample). Of these, one in nine people meet current ICD-10 criteria for neurasthenia. Comorbidity was associated with affective, anxiety and physical disorders. People with neurasthenia alone (<0.5% of the population) were less disabled and used less services than those with comorbid disorders., Conclusions: Fatigue is frequent in the Australian community and is common in people attending general practice. Neurasthenia is disabling and demanding of services largely because of its comorbidity with other mental and physical disorders. Until a remedy for persistent fatigue is provided, doctors should take an active psychological approach to treatment.

Objectives: To describe the experiences of people whose lives have been affected by depression., Design, Setting and Participants: Thematic review of data collected from 21 community meetings (1529 people, providing 911 evaluation forms) and nine focus groups (69 individuals) held nationally, and written feedback and website-based interactions with beyondblue: the national depression initiative between April and December 2001., Main Outcome Measures: Barriers to social participation experienced by people whose lives have been affected by depression, and their interactions with the healthcare system., Results: The key theme was the experience of stigma, which was evident in healthcare settings and in barriers to social participation, particularly regarding employment. Inadequacies of primary care and specialist treatment systems were highlighted. Particular emphasis was placed on limited access to high-quality primary care and non-pharmacological care. The stigmatising attitudes of many healthcare providers were notable. Within society, lack of access to knowledge and self-care or mutual support services was evident. Lack of support both from and for people in caring roles was also emphasised., Conclusions: People with depression are subject to many of the same attitudes, inadequate healthcare and social barriers reported by people with psychotic disorders. Consumers and carers prioritise certain notions of illness, recovery and quality of healthcare, and expect healthcare providers to respond to these concerns.