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Study Objectives To systematically determine subjective and objective outcome measures used to measure the efficacy of narcolepsy interventions in randomized controlled trials (RCTs) in adults and children and assess psychometric properties of patient-reported outcome measures (PROMs) used. Methods We searched bibliographical databases and clinical trial registries for narcolepsy RCTs and extracted objective and subjective outcome measures. If PROMs were used, we searched for psychometric studies conducted in a narcolepsy population using bibliographical databases and appraised using Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. Results In total, 80 different outcome measures were used across 100 RCTs. Epworth Sleepiness Scale (ESS) (n = 49) and Maintenance of Wakefulness Test (n = 47) were the most frequently used outcome measures. We found 19 validation studies of 10 PROMs in narcolepsy populations. There was limited evidence for validity or responsiveness of the ESS; yet sufficient reliability (pooled ICC: 0.81–0.87). Narcolepsy Severity Scale (NSS) had sufficient reliability (pooled ICC: 0.71–0.92) and both adult and pediatric versions had sufficient discriminant validity (treated/untreated). Content validity was only evaluated in pediatric populations for ESS-CHAD and NSS-P and rated inconclusive. Quality of evidence of the psychometric studies for all scales ranged from very low to low. Conclusions Although recognized by regulatory bodies and widely used as primary outcome measures in trials, there is surprisingly little evidence for the validity, reliability, and responsiveness of PROMs frequently used to assess treatment efficacy in narcolepsy. The field needs to establish patient-centered minimal clinically important differences for the PROMs used in these trials.

ObjectivesThe Brief Health Check (BHC) is a health screener used by the Get Healthy at Work programme, which identifies workers with chronic disease risk and provides them with advice and referrals to support services. The BHC was revised to include mental health to provide a holistic approach to workplace health. This study aimed to evaluate the acceptability and appropriateness of the revised BHC by comparing the results around psychological distress and future risk with previous research, and a participant feedback survey.MethodData collection took place between October 2018 and May 2019. The study used data that were collected as part of programme delivery, as well as a participant feedback survey that was administered after the health check was completed.ResultsBHCs were completed by n=912 workers, out of which, n=238 completed the feedback survey. The mean Distress Questionnaire 5 score was 10.5, and 10% of participants met the threshold for ‘high’ future risk. The feedback survey revealed that the majority of participants found the mental health advice to be useful (76%), agreed with their mental health distress and risk ratings (92%–94%) and most intended on using the referred services (62%–68%).ConclusionThe findings around mental health risk were comparable to previous findings in employed samples. The inclusion of mental health assessments, advice and referral pathways into the BHC was found to be acceptable and the subsequent referrals were appropriate, indicating that this approach could be scaled up and implemented to help address worker’s mental ill health

PurposeDiscrimination and bullying contribute to mental ill-health in the workplace. At face value, they would seem linked but are often dealt with by different legislations. Workplace studies generally focus on bullying and population studies on discrimination. The authors aimed to evaluate the prevalence and relationship of discrimination and bullying in a male-dominated workforce, associated factors and relative impact on mental ill-health.Design/methodology/approachAn online cohort survey was conducted amongst employees of an Australian mining company, measuring discrimination, bullying, demographics and workplace and health factors over two months. Cross-sectional and prospective analyses assessed the prevalence of each, their association and their effects on depression and anxiety.FindingsA total of 580 employees (82% male) participated. There was no association between workplace bullying (n = 56, 9.7%) and discrimination (n = 160, 27.6%). Discrimination, but not bullying, was associated with higher depression, anxiety and suicidal ideation and lower well-being and resilience. After controlling for demographic, workplace and health and well-being factors, depression had the main effect on discrimination ß = 0.39, p = 0.003. Discrimination predicted an increase in depression scores at follow-up F (1, 129) = 4.88, p = 0.029.Originality/valueIn this male-dominated industry, discrimination was more prevalent than bullying. Discrimination, but not bullying, was associated with poorer mental health both cross sectionally and prospectively. Supporting the need to assess and manage discrimination and bullying in the workplace independently and the need for interventions to reduce a broader range of adverse interpersonal behaviours.

AIM: Risk algorithms predicting personal mental ill-health will form an important component of digital and personalized preventive interventions, yet it is unknown whether informing people of personal risk may cause unintended harm. This trial evaluated the comparative effect of communicating personal mental ill-health risk profiles on psychological distress. METHODS: Australian participants using a mood-monitoring app were randomly allocated to receiving their current personal mental ill-health risk profile (n = 119), their achievable personal risk profile (n = 118) or to a control group (n = 118) in which no risk information was communicated, in a non-inferiority trial design. The primary outcome was psychological distress at four-weeks as assessed on the Kessler Psychological Distress Scale. RESULTS: There was high attrition in the trial with 64% of data missing at follow up. Per-protocol (completer) analysis found that the lower bounds of the confidence intervals of the estimated mean change of the current risk (m = 0.19, 95% CI: -2.59- 2.98) and achievable risk (m = -0.09, 95% CI: -2.84 to 2.66) groups were within the non-inferiority margin of the control group's mean at follow up. Supplementary intention-to-treat analysis using Multivariate Imputation by Chained Equations (MICE) found that 98/100 imputed datasets of the current risk profile group, and all imputed datasets of the achievable risk profile group showed non-inferiority to the control group. CONCLUSIONS: This study provides preliminary support that providing personal mental health risk profiles does not lead to unacceptable worsening of distress compared to no risk feedback, although this needs to be replicated in a fully powered RCT.

BackgroundThere is evidence that depression can be prevented; however, traditional approaches face significant scalability issues. Digital technologies provide a potential solution, although this has not been adequately tested. The aim of this study was to evaluate the effectiveness of a new smartphone app designed to reduce depression symptoms and subsequent incident depression amongst a large group of Australian workers.MethodsA randomized controlled trial was conducted with follow-up assessments at 5 weeks and 3 and 12 months post-baseline. Participants were employed Australians reporting no clinically significant depression. The intervention group (N = 1128) was allocated to use HeadGear, a smartphone app which included a 30-day behavioural activation and mindfulness intervention. The attention-control group (N = 1143) used an app which included a 30-day mood monitoring component. The primary outcome was the level of depressive symptomatology (PHQ-9) at 3-month follow-up. Analyses were conducted within an intention-to-treat framework using mixed modelling.ResultsThose assigned to the HeadGear arm had fewer depressive symptoms over the course of the trial compared to those assigned to the control (F3,734.7 = 2.98, p = 0.031). Prevalence of depression over the 12-month period was 8.0% and 3.5% for controls and HeadGear recipients, respectively, with odds of depression caseness amongst the intervention group of 0.43 (p = 0.001, 95% CI 0.26–0.70).ConclusionsThis trial demonstrates that a smartphone app can reduce depression symptoms and potentially prevent incident depression caseness and such interventions may have a role in improving working population mental health. Some caution in interpretation is needed regarding the clinical significance due to small effect size and trial attrition.Trial Registration Australian and New Zealand Clinical Trials Registry (www.anzctr.org.au/) ACTRN12617000548336

The mental health and well-being of employees is an increasingly important issue, both in terms of the financial costs to the Australian economy and human costs to society. This review examines two major technology-driven trends in the workplace and presents evidence for their impact on mental health, both positive and negative. First, we consider how we work, with a focus on changes which have been driven by automation and advanced technology in the workplace. Next, we consider where and when we work, with a focus on flexible work arrangements afforded by changes in telecommunication technology. Finally, we look forward with a critical lens to examine the implications for future research and for industry, government and education. JEL Classification: I31

Objectives Supporting healthy ageing is a key priority worldwide. Physical activity, diet quality and sleep are all associated with health outcomes, but few studies have explored their independent associations with all-cause mortality in an older population in the same model. The study aim was to examine associations between step-count, self-reported diet quality, restless sleep, and all-cause mortality in adults aged 55–85 years. Design A prospective cohort study of adults in Newcastle, New South Wales, Australia. Method Data were from 1697 participants (49.3% women; baseline mean age 65.4 ± 7.1 years). Daily steps (measured by pedometer), diet quality (from a modified Australian Recommended Food Score), and frequency of restless sleep (by self-report) were assessed in relation to all-cause mortality using Cox proportional hazard regression with adjustment for sex, age, household income and smoking. Baseline data were collected between January 2005 and April 2008, and last follow-up was in March 2017 (median follow-up 9.6 years). Results Higher step count (HR: 0.93, 95%CI: 0.88–0.98 per 1000-step increment) and higher diet quality (HR: 0.86, 95%CI: 0.74–0.99 per 8-point increment in diet quality score) were associated with reduced mortality risk. Restless sleep for ≥3 nights/week was not associated with mortality risk (HR: 1.03, 95%CI: 0.78–1.39). Sensitivity analyses, adjusting for chronic disease and excluding deaths Conclusions Increased daily steps and consumption of a greater variety of nutrient-dense foods every week would result in substantial health benefits for older people. Future research should include a greater variety of sleep measures.

Apprenticeships are a common pathway for young people transitioning from education to employment, and adolescence to adulthood. Apprenticeships have undergone considerable reform, and since the 199...

BACKGROUND Shift is a novel smartphone application (app) to provide a digital-first mental health resource to junior doctors. It contains psychoeducational material, cognitive behavioural modules, guided mediations, information on common work stressors, and a section on help-seeking options for psychological problems through workplace and private avenues. OBJECTIVE To conduct a preliminary investigation of the usage and potential effectiveness of Shift on depressive and anxiety symptoms (primary outcomes), and work and social functioning, coronavirus safety concerns, and help-seeking (secondary outcomes). This study also sought feedback on whether Shift was seen as an acceptable tool. METHODS Junior doctors in New South Wales, Australia were approached through promotional activities from the Ministry of Health, specialist medical colleges, and social media advertisements between June and August 2020. Consenting participants provided online baseline data, used the Shift app for 30 days, and were asked to complete a post-study online questionnaire. Outcomes were analysed under the ITT principle. RESULTS A total of 222 (156/222 female, 70%; mean age = 29.2 years) junior doctors provided full baseline data. Of those, 198/222 (89%) downloaded the app, logged into the app about 6 times (M = 5.68, SD = 7.51), completed 4 in-app activities (M = 3.77, SD = 4.36), and spent a total of one hour on in-app activities (M = 52:23, SD = 6:00:18) over 30 days. Post-intervention data were provided by 54/222 (24%) of participants. Depressive and anxiety symptoms significantly decreased between the pre- and post-assessment points as expected, however, doctors’ coronavirus safety concerns significantly increased. Work and social functioning, coronavirus concerns for family and friends, and help seeking did not change significantly. There was no significant relationship between symptom changes and app usage (number of logins, days between first and last login, and total activity time). Most post-study completers (31/54, 57%) rated Shift highly or very highly. CONCLUSIONS Despite high levels of non-response to the post-study assessment and increases in coronavirus safety concerns, junior doctors who used the app reported some improvements in depression and anxiety that warrant further exploration in a robust manner. CLINICALTRIAL The study was prospectively registered with the Australian New Zealand Clinical Trials Registry under the trial number ACTRN12620000571976.

Lockdowns were used worldwide to mitigate the spread of SARS-CoV-2. We demonstrate that the 112-day hard lockdown in Melbourne, Australia, the longest among OECD jurisdictions, exclusively penalized families with young children. To identify the causal impact of lockdown, we interrogated nationally-representative longitudinal survey data and exploited quasi- experimental variation in Melbourne’s lockdown, one that left other jurisdictions unaffected. Using difference-in-differences estimation, we found that, surprisingly, most vulnerable groups (the young, poor, lonely and those with previous mental health conditions) were left unscathed. However, we found mothers experienced significant, sizable declines in health and work hours, and increases in loneliness, despite feeling safer and being more active. Zero-COVID policies are not as harmful as may have been expected but came at high cost to mothers in society.One-Sentence Summary:Melbourne’s hard lockdown left most vulnerable groups unscathed but led to greater ill- health and loneliness in mothers.

Communicating personal Alzheimer’s disease risk profiles based on validated risk algorithms may improve public knowledge about risk reduction, and initiate action. This proof of concept pilot trial aimed to test whether this is feasible and potentially effective and/or harmful. Older at-risk adults (N=24) were provided with their personal Alzheimer’s disease risk profile online, which contained information on their personal risk level, scores and tailored recommendations to manage modifiable risk factors. After receiving the risk profile, participants were significantly more accurate in identifying risk and protective factors, and revised their perceived risk to be lower than their initial estimate. There was no apparent harm seen in psychological distress or dementia-related worry. This shows preliminary support for the feasibility of delivering personal dementia risk profiles to low risk, help-seeking older adults in an online format. A definitive trial examining behavioural outcomes and testing in groups with higher risk profiles is now warranted.

BACKGROUND The mental health of international students is a growing concern for education providers, students, and their families. Chinese international students have low rates of help seeking owing to language, stigma, and mental health literacy barriers. Web-based help-seeking interventions may improve the rate of help seeking among Chinese international students. OBJECTIVE This study aimed to describe the development of a mental well-being web app providing personalized feedback and tailored psychoeducation and resources to support help seeking among international university students whose first language is Chinese and test the web application’s uptake and engagement. METHODS The bilingual MindYourHead web application contains 6 in-app assessments for various areas of mental health, and users are provided with personalized feedback on symptom severity, psychoeducation tailored to the person’s symptoms and information about relevant interventions, and tailored links to external resources and mental health services. A feasibility study was conducted within a school at the University of Sydney to examine the uptake and engagement of the web application among Chinese international students and any demographic characteristics or help-seeking attitudes or intentions that were associated with its engagement. RESULTS A total of 130 Chinese international students signed up on the web application. There was an uptake of 13.4% (122/908) in the schools’ Chinese student enrollment. Most participants (76/130, 58.5%) preferred to use the web application in Chinese and used informal but not formal help for their mental health. There was considerable attrition owing to a design issue, and only 46 students gained access to the full content of the web application. Of these, 67% (31/46) of participants completed 1 or more of the in-app mental well-being assessments. The most commonly engaged in-app assessments were distress (23/31, 74%), stress (17/31, 55%), and sleep (15/31, 48%), with the majority scoring within the moderate- or high-risk level of the score range. In total, 10% (9/81) of the completed in-app assessments led to clicks to external resources or services. No demographic or help-seeking intentions or attitudes were associated with web-application engagement. CONCLUSIONS There were promising levels of demand, uptake, and engagement with the MindYourHead web application. The web application appears to attract students who wished to access mental health information in their native language, those who had poor mental health in the past but relied on informal support, and those who were at moderate or high risk of poor mental well-being. Further research is required to explore ways to improve uptake and engagement and to test the efficacy of the web application on Chinese international students’ mental health literacy, stigma, and help seeking.

This short commentary article reviews Mason EC, Grierson AB, Sie A, et al. Co-occurring insomnia and anxiety: A randomized controlled trial of internet CBT for insomnia vs. internet CBT for anxiety. Sleep. 2022

Given the human, industrial and societal costs of Musculoskeletal Disorders (MSDs) we evaluated antecedents to MSDs (assessed as pain, doctor diagnosis, and workplace injury) over a six-year period T1 (2014/2015) and T2 (2020/2021). The purpose of the study was to examine the role of We proposed that the the organisational climate (i.e., psychosocial safety climate, PSC) for employees' psychological health and safety is as an antecedent to physical demands, and psychosocial risks (e.g., low control, harassment) that in turn might relate to MSDs using a longitudinal design. Thus, we aimed to discourse the shortage of longitudinal investigations of the MSDs, causation and the role of corporate climate and psychosocial risk factors. We used matched data from follow-up telephone interviews of 432 Australian employees. We found evidence for several psychosocial paths; PSC was related to future workplace injuries through decision authority; PSC was related to MSD pain through depressive symptoms. For future doctor diagnosed MSDs, PSC was directly negatively related. Older age, being male and low income was related to work injury; being female associated with MSD pain; and being older was associated with MSD diagnosis. A novel finding was the linkage between psychosocial risks (low skill discretion and harassment) and future physical demands leading to future MSD pain and work injury highlighting a new pathways (mechanism) mechanism –linking how psychosocial mechanisms relate to and physical mechanisms aspects. Overall poor PSC was found as a distal antecedent of all MSDs. Decision authority and skill discretion were most critical psychosocial risks in predicting future pain and injuries. Psychosocial factors predicted future demands. Actions should target improving PSC and autonomy and reducing harassment and physical demands, to decrease the incidence of MSDs. Refereed/Peer-reviewed

Two years ago, in the early stages of the COVID-19 pandemic, there were widespread and grim predictions of an ensuing suicide epidemic. Not only has this not happened but also by the end of 2021 in the majority of countries and regions with available data, the suicide rates had, if anything, declined. We discuss four reasons why the predictions of suicide models were exaggerated: (1) government intervention reduced the economic and mental costs of lockdowns, (2) the pandemic itself and lockdowns had less of an effect on mental health than assumed, (3) the evidence for a link between economic downturns, distress and suicide is weaker and less consistent than the models assumed and (4) predicting suicide is generally hard. Predictive models have an important place, but their strong modelling assumptions need to acknowledge the inherent high degree of uncertainty which has been further augmented by behavioural responses of pandemic management.

The impact of the global COVID-19 pandemic, including the indirect effect of policy responses, on psychological distress has been the subject of much research. However, there has been little consideration of how the prevalence of psychological distress changed with the duration and repetition of lockdowns, or the rate of resolution of psychological distress once lockdowns ended. This study describes the trajectories of psychological distress over multiple lockdowns during the first two years of the pandemic across five Australian states for the period May 2020 to December 2021 and examines whether psychological distress trajectories varied as a function of time spent in lockdown, or time since lockdown ended. A total of

A fundamental question for society is how much happiness does a dollar buy? The accepted view among economists and psychologists is that income has diminishing marginal returns on happiness: money and happiness increase together up to a point after which there is relatively little further gain. In this paper we estimate the relationship between income and subjective wellbeing over a 19-year period focusing on where the greatest change in the marginal return on income occurs and whether this change point has shifted over time. We formally test for the presence of a change point as well as temporal changes in the relationship between income and affective wellbeing (happiness), and income and cognitive wellbeing (life satisfaction), using household economic data from Australia between 2001 and 2019. The results indicate that the change point between affective wellbeing and income has increased over those 19 years faster than inflation (i.e., cost of living). This suggests that inequalities in income may be driving increasing inequities in happiness between the rich and the poor, with implications for health and recent government policy-goals to monitor and improve wellbeing., Highlights • We investigate how the relationship between income and subjective wellbeing (happiness and life satisfaction) has changed over time. • Detailed wellbeing data from Australia over an economically stable 19-year period provided an undisturbed view of the changes. • Happiness was less responsive to income after a certain income level, and this level had almost doubled since 2001. • Conversely the relationship between income and life-satisfaction had remained relatively constant over the same period. • A steep association between happiness and income has become more prevalent this millennium, and likely to drive inequities in wellbeing between the rich and poor.

Background Mental health problems are common within the working population. Depression is both highly prevalent and debilitating and is linked to increases in absenteeism and presenteeism. The use of summed depression scale scores may conceal differential impacts of depressive symptoms on absenteeism and presenteeism. We aimed to explore both the relationship between absenteeism and presenteeism and both depression severity, along with the independent contributions of different symptoms. Methods Participants ( N = 4953) were employees recruited as part of a larger study to evaluate a mental health smartphone app and were recruited via industry partner organisations and social media. Participants completed in-app assessment which included demographic information, the Patient Health Questionnaire-9 depression tool, and items of the World Health Organization Health and Work Performance Questionnaire. The relationship between depressive symptoms, absenteeism and presenteeism was estimated using both total summed scores and individual symptoms of depression. Results Univariate linear regression confirmed a negative linear relationship between depression severity and presenteeism, which remained significant after controlling for age, gender, industry, and work position. Similarly, there was a statistically significant relationship between depression severity and the amount of mental health related sickness absence taken over the preceding 28 days. Johnson's relative weights analysis showed contributory differences amongst depression symptoms in relation to presenteeism and absenteeism. Discussion Significant relationships between depression severity and both absenteeism and presenteeism were present indicating increases in absence and decreases in performance with increasing severity. There existed differences amongst the contribution of specific symptoms of depression to both outcomes of interest. The symptoms that contribute most to absence were more behavioural in nature, whilst those contributing most to presenteeism were more cognitive. These findings have practical implications for clinicians and employers in making treatment and return-to-work decisions.

Objectives\ud \ud To determine the validity, sensitivity, specificity and acceptability of the culturally adapted nine‐item Patient Health Questionnaire (aPHQ‐9) as a screening tool for depression in Aboriginal and Torres Strait Islander people.\ud \ud Design\ud \ud Prospective observational validation study, 25 March 2015 – 2 November 2016.\ud \ud Setting, participants\ud \ud 500 adults (18 years or older) who identified as Aboriginal or Torres Strait Islander people and attended one of ten primary health care services or service events in urban, rural and remote Australia that predominantly serve Indigenous Australians, and were able to communicate sufficiently to respond to questionnaire and interview questions.\ud \ud \ud Main outcome measures\ud \ud Criterion validity of the aPHQ‐9, with the depression module of the Mini‐International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standard.\ud \ud \ud Results\ud \ud 108 of 500 participants (22%; 95% CI, 18–25%) had a current episode of major depression according to the MINI criterion. The sensitivity of the aPHQ‐9 algorithm for diagnosing a current major depressive episode was 54% (95% CI, 40–68%), its specificity was 91% (95% CI, 88–94%), with a positive predictive value of 64%. For screening for a current major depressive episode, the area under the receiver operator characteristic curve was 0.88 (95% CI, 0.85–0.92); with a cut‐point of 10 points its sensitivity was 84% (95% CI, 74–91%) and its specificity 77% (95% CI, 71–83%). The aPHQ‐9 was deemed acceptable by more than 80% of participants.\ud \ud \ud Conclusions\ud \ud Indigenous Australians found the aPHQ‐9 acceptable as a screening tool for depression. Applying a cut‐point of 10 points, the performance characteristics of the aPHQ were good.

Social functioning is an important component of mental disorders for assessment and treatment. There is no recognised self-report instrument to measure social functioning across disorders where social impairment is significant. The Social Functioning Scale (SFS) has, however, been used to assess social functioning in psychotic disorders, including Schizophrenia and Early Psychosis. The current study investigated the reliability, validity and sensitivity of the SFS in Early Psychosis, Autism Spectrum Disorder (ASD), Social Anxiety Disorder (SAD) and neurotypical control populations. As expected, all clinical groups showed significant impairment on the total and sub-scale scores of the SFS. The SFS showed good internal consistency and concurrent validity for people diagnosed with SAD and Early Psychosis and a similar factors structure was found for these groups. Participants with ASD reported a relatively low internal consistency and poor concurrent validity, as well as a three-component solution. The SFS has also showed a good sensitivity to separate clinical populations and neurotypical controls. This study supports the use of the SFS for those with SAD and Early Psychosis. Lower internal consistency in ASD populations suggests further research in larger samples is required and that the relationship between its scales are likely different to other populations. Alternative scales or significant other reports may be required for adults with ASD.

The World Health Organization Disability Assessment Schedule II (WHODAS-II) is one of the most widely used generic assessments for measuring disability levels in both clinical and nonclinical populations, with sound psychometrics that is also aligned with the International Classification of Functioning framework. However, its psychometric properties have not been explored extensively in individuals with autism spectrum disorder (ASD). This study examined the psychometric properties of the 36-item and 12-item Self-Report WHODAS-II from 109 individuals diagnosed with ASD and without intellectual disability (IQ ≥ 70). Participants were consecutively recruited from the Brain and Mind Centre in New South Wales, Australia. The WHODAS-II showed adequate internal consistency for all domain scores (α = 0.78-0.97 for 36-item) and for the summary scale (α = 0.95 for 36-item; 0.86 for 12-item). All items also exhibited satisfactory correlations with their respective domain (r = 0.39-0.94 for 36-item) and summary scores (r = 0.42-0.71 for 36-item; 0.42-0.67 for 12-item), except item 4.5 "sexual activity" from the 36-item WHODAS-II (r = 0.19). Concurrent validity was shown by moderate correlations between similar constructs across the WHODAS-II and the World Health Organization Quality of Life BREF (Ps < 0.05). The second-order 7-factor model showed the best fit for the 36-item WHODAS-II, while the second-order 6-factor model demonstrated an acceptable fit for the 12-item WHODAS-II. The model fit could be improved with some modifications. The Schmid-Leiman transformation further confirmed the appropriateness of the second-order factor structure. Overall, the results indicated that the WHODAS-II is a viable generic self-report measure for disability in autistic individuals without ID. Autism Res 2019, 12: 1101-1111. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The majority of autistic people have a disability with a profound or severe limitation in their core activities. However, there is currently limited research identifying reliable and valid self-report measures for disability in the autistic population. This study examined the psychometric properties of the World Health Organization Disability Assessment Schedule II (WHODAS-II) from 109 autistic individuals without intellectual disability. Our results suggest that the WHODAS-II is a viable generic self-report measure for disability in autistic individuals.

Objective\ud \ud To determine the patterns and predictors of disability over the first 12 months after a diagnosis of epilepsy.\ud \ud \ud Patients and methods\ud \ud The Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC) was a prospective, multicenter, community-based study of people with newly diagnosed epilepsy in Sydney, Australia. Disability was assessed using the World Health Organization’s, Disability Assessment Schedule (WHODAS) 2.0 12-item version, at baseline (i.e. within 28 days of diagnosis) and 12 months post-diagnosis. Demographic, socioeconomic, clinical and epilepsy-related data, obtained through structured interviews, were entered into multivariable linear regression and shift analysis to determine predictors of greater disability.\ud \ud \ud Results\ud \ud Of 259 adults (≥18 years), 190 (73%) had complete WHODAS at baseline (mean ± SD scores 4 ± 6) and follow-up (4 ± 8). After adjustment for age, sex and co-morbidity, greater overall disability at 12 months was associated with lower education (P = 0.05), economic hardship (P = 0.004), multiple antiepileptic medications (P = 0.02) and greater disability (P

To explore associations between intraindividual variability (IIV) in sleep patterns and sleep problems, lifestyle factors, and mental and physical health in individuals with chronic insomnia.Cross-sectional study of 1720 adults with chronic insomnia (67.8% female, mean age = 44.5) who completed online self-report questionnaires and kept a sleep diary (for at least 10 out of 14 days). Linear regression analyses examined IIV in sleep patterns as independent variables, and sleep problems, lifestyle factors, and mental and physical health outcomes as dependent variables. Analysis of each sleep variable was separately adjusted for the mean value of the corresponding variable and for selected background factors.IIV in sleep variables was significantly and positively associated with scores on the Insomnia Severity Index (ISI), dysfunctional beliefs and attitudes about sleep (DBAS-16), the Chalder Fatigue Scale (CFQ), body mass index (BMI) and alcohol consumption (AUDIT-C) at study entry. The association between IIV and mental health outcomes (ie the Hospital Anxiety and Depression Scale [HADS] and subjectively reported mental health status [SF-12 Mental health]) were not significant. IIV was associated with higher (ie more positively rated) mean level of sleep quality.IIV of sleep patterns may be a useful construct for understanding subjective experiences of sleep problems, fatigue and health in people with chronic insomnia. Our findings support notions suggesting that IIV offers additional insights beyond those offered by studying mean values alone; however, discordant findings regarding sleep quality highlight the need for further studies to examine the consequences of IIV.

Objectives To justify the capital investment, employers require proof of benefit of digital mHealth beyond symptomatic improvement. Methods A systematic review and meta-analysis were conducted to identify studies investigating digital mHealth interventions for employees and their effects on workplace outcomes. Results We identified 28 eligible studies, (8023 employees) comparing digital mHealth interventions to controls. Small significant effects at postintervention in engagement (g = 0.19), and productivity (g = 0.16) were found. Sustained effects were observed, engagement (g = 0.24) and productivity (g = 0.20). There was a wide range of study heterogeneity (I2 = 16% to 94%). Conclusion In RCTs digital mHealth interventions demonstrate small, potentially sustained efficacy on employee's engagement and productivity. Similar small yet non-significant effect sizes were seen for absenteeism and presenteeism. This supports the need to find ways of enabling employers to deliver these low-cost digital mHealth interventions that can help improve employee's mental health.

Objective Parliamentary inquiries into health-related issues empower everyday Australians to contribute to the development and reform of health policy. We explored how patient and family/carers concerns are translated by this process, using a less well-known disease, narcolepsy, as an example. Methods Written submissions made to the Parliamentary Inquiry into Sleep Health Awareness in Australia 2018 by self-identified patients or family/carers with narcolepsy (n = 13) were extracted and thematically analysed using the Framework Approach. Each submission was systematically coded and abstracted into emergent themes before being evaluated against the final policy recommendations. Results Although patients and their family/carers prioritised issues that affected their daily lives (i.e. mental health sequela, workplace accommodations), the policy recommendations in the report focused mainly on issues of healthcare infrastructure, funding and engagement. Our analysis highlighted several barriers that patients and their family/carers face when contributing to this part of healthcare policy formation. Conclusions Our findings suggest that the parliamentary inquiry process in its current form is not an ideal vehicle by which patients and family/carers can contribute or influence healthcare policy. Despite calling for submissions from patients and their family/carers, the final report and subsequent health policy recommendations made by the inquiry do not appear to be patient-centric or reflective of the submissions written by these stakeholders. Increased transparency, development of processes to balance stakeholder priorities and improved accessibility for stakeholders to participate are needed if health-related parliamentary inquiries are to produce healthcare policy that ultimately meets the needs of patients and family/carers.

Implementation of an electronic medical record (EMR) is a significant workplace event for nurses in hospitals. Understanding nurses’ key concerns can inform EMR implementation and ongoing optimisation strategies to increase the likelihood of nurses remaining in the nursing workforce. This concurrent mixed-methods study included surveys from 540 nurses (response rate 15.5%), and interviews with 63 nurses to examine their perceptions of using a new EMR prior to implementation at a single healthcare organisation. Survey findings revealed 32.2% (n = 174) of nurses reported low well-being scores and 28.7% (n = 155) were experiencing burnout symptoms. In contrast, 40.3% (n = 216) of nurses reported high work satisfaction, 62.3% (n = 334) had high intentions of staying in their role, and 34.3% (n = 185) were engaged in their work. Nearly half (n = 250, 46.3%) reported intrinsic motivation towards EMR use. Thematic analysis of focus group interviews revealed two themes, each with three subthemes: (1) Us and Them, detailed the juxtaposition between nurses’ professional role and anticipated changes imposed on them and their work with the EMR implementation, and (2) Stuck in the middle, revealed nurses’ expectations and anticipations about how the EMR may affect the quality of nurse-patient relationships. In conclusion, anticipation of the EMR implementation emerged as a stressor for nursing staff, with some groups of nurses particularly vulnerable to negative consequences to their well-being.

IntroductionInsomnia is a prevalent sleep disorder that causes substantial personal and societal harm. There is evidence that placebo interventions can reduce insomnia symptoms, but this research has involved deceptively administering the placebo under the guise of a real medication (conventional placebo, CP), which has obvious ethical constraints. Open-label placebo (OLP) treatment, in which a placebo is administered with full disclosure that there are no active ingredients, has been proposed as a method of using the placebo effect ethically, but the efficacy and acceptability of OLP for insomnia is currently unknown.Methods and analysisThis study uses a cohort multiple randomised controlled trial design to compare OLP, CP and no treatment for insomnia. Two-hundred and sixty-seven participants with self-reported insomnia symptoms (Insomnia Severity Index, ISI ≥10) will be recruited into an observational study and have their sleep monitored over a 2-week period. Participants will then be randomised to one of three groups: invite to OLP, invite to CP described deceptively as a new pharmacological agent, or no invite/observational control. Those in OLP and CP accepting the invite receive identical placebos for a 2-week treatment period while sleep is monitored in all participants. The primary outcome is ISI at the end of the treatment period. Secondary outcomes include treatment uptake and clinically significant response rates, objective and subjective sleep parameters, fatigue, mood, expectancy, treatment satisfaction and side effects. Predictors of uptake and responses to OLP and CP will be explored.Ethics and disseminationThe trial has been approved by The University of Sydney Human Research Ethics Committee. Written informed consent is obtained from every participant. OLP and CP participants accepting the invite undergo an additional consent process. Results will be disseminated via peer-reviewed conference proceedings and publications.Trial registration numberACTRN12620001080910.

Introduction The parliamentary inquiry into sleep health represents one of few platforms accessible to patients and their family/carers to contribute to the development of healthcare policy alongside other key stakeholder groups (i.e. healthcare professionals, organisations). Balancing diverse and sometimes divergent views of various stakeholder groups can be challenging, thus we set out to explore how patients and family/carer submissions were interpreted by the inquiry and translated into health policy recommendations. Methods Written submissions made to the Parliamentary Inquiry into Sleep Health Awareness in Australia 2018 by self-identified patients or family/carers with narcolepsy (n=13) were extracted and thematically analysed using the Framework Approach. Each submission was systematically coded, with emergent themes evaluated against the final policy recommendations made by the inquiry. Results We identified three major themes: 1) ‘Pathways to Treatment & Care’ regarding concerns around lack of healthcare and research resource allocation for narcolepsy; 2) ‘Help-seeking Experience’ related to barriers to help-seeking and accessing care; 3) ‘Patient and Family/Carers’ Lived Experience of Disease’ which encompassed the tangible effects narcolepsy has on the daily lives of patients and family/carers. Discussion While patients and their family/carers prioritised issues that affected their daily lives (i.e. mental health sequela, workplace accommodations), policy recommendations focused on healthcare infrastructure, funding and engagement. Increased transparency, developing processes to balance stakeholder priorities and improving accessibility to stakeholder engagement are needed if patient and family/carer needs are to be met, and for healthcare policy to remain targeted and trusted by the public.

Background Mobile health (mHealth) apps offer a scalable option for treating sleep disturbances at a population level. However, there is a lack of clarity about the development and evaluation of evidence-based mHealth apps. Objective The aim of this systematic review was to provide evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. Methods A systematic search of studies published from the inception of databases through February 2020 was conducted using 5 databases (MEDLINE, Embase, Cochrane Library, PsycINFO, and CINAHL). Results A total of 6015 papers were identified using the search strategy. After screening, 15 papers were identified that examined the design engineering and clinical implementation and evaluation of 8 different mHealth apps for sleep disturbance. Most of these apps delivered cognitive behavioral therapy for insomnia (CBT-I, n=4) or modified CBT-I (n=2). Half of the apps (n=4) identified adopting user-centered design or multidisciplinary teams in their design approach. Only 3 papers described user and data privacy. End-user acceptability and engagement were the most frequently assessed implementation metrics. Only 1 app had available evidence assessing all 4 implementation metrics (ie, acceptability, engagement, usability, and adherence). Most apps were prototype versions (n=5), with few matured apps. A total of 6 apps had supporting papers that provided a quantitative evaluation of clinical outcomes, but only 1 app had a supporting, adequately powered randomized controlled trial. Conclusions This is the first systematic review to synthesize and examine evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. The minimal number of apps with published evidence for design engineering and clinical implementation and evaluation contrasts starkly with the number of commercial sleep apps available. Moreover, there appears to be no standardization and consistency in the use of best practice design approaches and implementation assessments, along with very few rigorous efficacy evaluations. To facilitate the development of successful and evidence-based apps for sleep disturbance, we developed a high-level framework to guide researchers and app developers in the end-to-end process of app development and evaluation.

BACKGROUND Physician trainees have elevated rates of psychological distress, mental disorders and suicide. Physician supervisors can support the mental health needs of trainees. AIMS To test the feasibility and acceptability of a tailored online mental health training programme and to ascertain the potential effectiveness of the programme to alter the confidence and behaviours of physician supervisors. METHODS Thirty Australian hospital-based physicians who were supervising physician trainees participated in this quasi-experimental pre-post pilot study. All received the intervention that comprised 12 5-min modules to complete over a 3-week period. Baseline and post-intervention data were collected. The primary outcome evaluated participants' confidence to respond to trainees experiencing mental ill-health and promote a mentally healthy workplace. Secondary outcomes evaluated change in self-reported behaviour, mental health knowledge and stigmatising attitudes. Differences in mean scale scores for each outcome measure from baseline and post-intervention were compared using paired sample t-tests. RESULTS Thirty physicians completed the baseline assessment and 23 (76.7%) completed all programme modules. Most participants found the programme engaging, interesting and useful. Post-intervention data, available for 25 (83.3%) participants, showed a significant increase in participants' knowledge of their role in supporting trainees under their supervision (P = 0.002), confidence to initiate conversations about mental health with staff (P

ObjectivesClinician well-being has been recognised as an important pillar of healthcare. However, research mainly addresses mitigating the negative aspects of stress or burnout, rather than enabling positive aspects. With the added strain of a pandemic, identifying how best to maintain and support the well-being, satisfaction and flourishing of general practitioners (GPs) is now more important than ever.DesignSystematic review.Data sourcesWe searched MEDLINE, PsycINFO, Embase, CINAHL and Scopus from 2000 to 2020.Study selectionIntervention studies with more than 50% GPs in the sample evaluating self-reported well-being, satisfaction and related positive outcomes were included. The Cochrane Risk of Bias 2 tool was applied.ResultsWe retrieved 14 792 records, 94 studies underwent full-text review. We included 19 studies in total. Six randomised controlled trials, three non-randomised, controlled trials, eight non-controlled studies of individual or organisational interventions with a total of 1141 participants. There were two quasi-experimental articles evaluating health system policy change. Quantitative and qualitative positive outcomes were extracted and analysed. Individual mindfulness interventions were the most common (k=9) with medium to large within-group (0.37–1.05) and between-group (0.5–1.5) effect sizes for mindfulness outcomes, and small-to-medium effect sizes for other positive outcomes including resilience, compassion and empathy. Studies assessing other intervention foci or other positive outcomes (including well-being, satisfaction) were of limited size and quality.ConclusionsThere is remarkably little evidence on how to improve GPs well-being beyond using mindfulness interventions, particularly for interventions addressing organisational or system factors. This was further undermined by inconsistent reporting, and overall high risk of bias. We need to conduct research in this space with the same rigour with which we approach clinical intervention studies in patients.PROSPERO registration numberCRD42020164699.Funding sourceDr Diana Naehrig is funded through the Raymond Seidler PhD scholarship.

A substantial proportion of Australians report recurring pain and mental health problems, but their separate and joint contributions to sick leave use has not been examined. This study examines the interaction of pain and mental health problems with sick leave usage and the extent to which unobservable time-invariant factors contribute to these conditions and the propensity to take sick leave. Longitudinal data on self-reported paid sick leave days, pain, mental health problems and multiple covariates, and spanning the period 2005 to 2019, were derived from the Household, Income, and Labour Dynamics in Australia Survey. The analysis included 3404 and 3448 employed women and men, respectively, with paid sick leave entitlements, with an average of 6 observations each. Negative binomial regression models were used to investigate the association while adjusting for multiple covariates. After multiple adjustments, recurring pain was linked to 1.7 additional sick leave days per year among women and 2.3 among men, whereas the corresponding figures for recurring mental health problems were 1.5 and 0.7, respectively. Further adjustment for time-constant within-individual heterogeneity slightly attenuated these estimates, suggesting that unobserved characteristics contribute to both symptoms and a higher propensity to take sick leave. Pain and mental health problems – single-occasion but particularly recurring – are both important contributors to sick leave days in Australia. However, their effects do not appear to interact with one another. Thus, to help the employees continue working, mental health problems and pain have to be tackled early on, aiming to reduce any stigma related to them. Moreover, modification in working conditions could be useful in finding better matches between employees and their jobs, provided that the employer is aware of the mental health problems and pain of their employees.

The COVID-19 pandemic has heightened interest in how physician mental health can be protected and optimised, but uncertainty and misinformation remain about some key issues. In this Review, we discuss the current literature, which shows that despite what might be inferred during training, physicians are not immune to mental illness, with between a quarter and a third reporting increased symptoms of mental ill health. Physicians, particularly female physicians, are at an increased risk of suicide. An emerging consensus exists that some aspects of physician training, working conditions, and organisational support are unacceptable. Changes in medical training and health systems, and the additional strain of working through a pandemic, might have amplified these problems. A new evidence-informed framework for how individual and organisational interventions can be used in an integrated manner in medical schools, in health-care settings, and by professional colleagues is proposed. New initiatives are required at each of these levels, with an urgent need for organisational-level interventions, to better protect the mental health and wellbeing of physicians.

Background People with serious mental illness (SMI) have significantly worse surgical outcomes compared to the general population. There are many contributing factors to this complex issue, however consideration of the surgical experience from the patient’s own perspective has never been undertaken. This lack of understanding prevents the provision of truly patient centred care and may limit the impact of potential improvement initiatives. Therefore this study aims to describe and better understand the surgical experience from the perspective of patients with SMI. Methods Within this qualitative study, semi-structured, audio-recorded interviews were conducted between August 2019 – June 2020, with 10 consenting participants with SMI who had surgery in the previous 2 years. A thematic analysis approach was used to explore both the positive and negative aspects of the participant’s surgical experience commencing from pre-operative consultation to hospital discharge and follow-up. Results Four main themes and related subthemes emerged including i) the perceived lack of mental ill health recognition, ii) highly variable patient and clinician interactions, iii) the impact of healthcare services, and iv) strategies for improvement. Conclusion Surgical patients with SMI want to be treated like everyone else whilst still having their mental ill health acknowledged and proactively managed despite this rarely occurring, which is valuable information for all surgical teams to consider and learn from. Participants were able to describe several readily implementable strategies to potentially improve their care and overall surgical experience, and as such highlight considerable opportunities for these to be tested and evaluated for this underserved patient group.

Objective To assess the association between having a serious mental illness and surgical outcomes for adults, including in-hospital and 30-day mortality, post-operative complications, and hospital length of stay. Study design Systematic review and meta-analysis of publications in English to 30 July 2018 of studies that examined associations between having a serious mental illness and surgical outcomes for adults who underwent elective surgery. Primary outcomes were in-hospital and 30-day mortality, post-operative complications, and length of hospital stay. Risk of bias was assessed with the Quality in Prognosis Studies (QUIPS) tool. Studies were grouped by serious mental illness diagnosis and outcome measures. Odds ratios (ORs) or mean differences (MDs), with 95% confidence intervals (CIs), were calculated in random effects models to provide pooled effect estimates. Data sources MEDLINE, EMBASE, PsychINFO, and the Cochrane Library. Data synthesis Of the 3824 publications identified by our search, 26 (including 6 129 806 unique patients) were included in our analysis. The associations between having any serious mental illness diagnosis and having any post-operative complication (ten studies, 125 624 patients; pooled effect: OR, 1.44; 95% CI, 1.15-1.79) and a longer stay in hospital (ten studies, 5 385 970 patients; MD, 2.6 days; 95% CI, 0.8-4.4 days) were statistically significant, but not those for in-hospital mortality (three studies, 42 926 patients; OR, 1.21; 95% CI, 0.69-2.12) or 30-day mortality (six studies, 83 013 patients; OR, 1.85; 95% CI, 0.86-3.99). Conclusions Having a serious mental illness is associated with higher rates of post-operative complications and longer stays in hospital, but not with higher in-hospital or 30-day mortality. Targeted pre-operative interventions may improve surgical outcomes for these vulnerable patients. Systematic review registration PROSPERO, CRD42018080114 (prospective).

Digital technology influences behaviours, moods and wellbeing. The relationships are complex, but users are increasingly interested in finding how to balance a digital life with psychological wellbeing. We present an approach for investigating the relationship between lifestyle aspects and digital technology usage patterns that combines MindGauge, a mobile app enabling users collect and analyse their moods and behaviours, with a productivity tool (RescueTime). We then report a 16-month study in which we collected computer and smartphone usage and self-reports from 72 participants. We present methods for analysing the relationship between productivity, task-switching, mood and lifestyle, and more specifically how digital technology usage associates with productivity and task-switching. Our study also investigates how lifestyle aspects (sleep quality, physical activity, workload, social interaction and alcoholic drink consumption) relate to mood, task-switching and productivity. Results show that more frequent task-switching is associated with negative moods. A few lifestyle aspects, such as sleep quality and physical activity, had a significant relationship with positive moods. We also contribute a mood detection model that utilise both digital footprints and lifestyle contexts, yielding an accuracy of 87%. The study provides evidence that such methods can be used to understand the impact of technology on wellbeing.

Background Decisions of whether to disclose mental health conditions are extremely personal and require the consideration of multiple factors associated with the disclosure process (eg, weighing the risks and benefits). Decision aid tools help people make these complex decisions. Such an aid needs to be confidential, easily accessible, and easy to use with the potential to access the tool on multiple occasions. Web programs are well suited to meet these requirements and, if properly developed, can provide feasible, accessible, affordable, and effective workplace interventions. Objective This study aims to gain insights from potential end users, in this case both employees and organizations, into what type of components including language, style, and content would avoid potential stigma and ensure that elements of clear value for users would be built into a web-based decision aid tool that aims to assist employees in making decisions about the disclosure of their mental health condition at work. Methods A participatory design approach was used to allow developers, researchers, experts, and end users to collaborate in co-designing the tool. During the user research phase of the development of the web-based tool, a participatory design workshop approach was selected as a part of a larger study of focus groups. Australian employees and managers in rural, suburban, and urban locations participated in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for a decision aid tool. Results A total of 2 workshops were conducted with 13 participants. The majority were from a transport company (9/13, 69%), male (8/13, 62%), and employed full time (11/13, 85%). Six employees had previous experience disclosing their own mental health condition, and 7 were in a supervisory role and had previously been disclosed to. In any co-design development, there are certain trade-offs that need to be made between the views of experts, developers, end users, and the available budget. In this specific instance of a very delicate, personal decision, the end users provided valuable design insights into key areas such as language, and they were very antipathetic to a key feature, the avatar, which was thought to be desirable by experts and developers. Findings including aspects of the tool where all stakeholders were in agreement, aspects where some stakeholders disagreed and adaptations were implemented, where disagreements could not be implemented because of financial constraints, and misalignment between stakeholders and how to decide on a balance were shared. Conclusions The co-design with a lived experience approach is useful for contributing much to the design, language, and features. The key in this study was balancing the needs of the workers and the potential impact for the managers and organizations, while ensuring legislation and regulation requirements were upheld.

BACKGROUND Mobile health (mHealth) apps offer a scalable option for treating sleep disturbances at a population level. However, there is a lack of clarity about the development and evaluation of evidence-based mHealth apps. OBJECTIVE The aim of this systematic review was to provide evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. METHODS A systematic search of studies published from the inception of databases through February 2020 was conducted using 5 databases (MEDLINE, Embase, Cochrane Library, PsycINFO, and CINAHL). RESULTS A total of 6015 papers were identified using the search strategy. After screening, 15 papers were identified that examined the design engineering and clinical implementation and evaluation of 8 different mHealth apps for sleep disturbance. Most of these apps delivered cognitive behavioral therapy for insomnia (CBT-I, n=4) or modified CBT-I (n=2). Half of the apps (n=4) identified adopting user-centered design or multidisciplinary teams in their design approach. Only 3 papers described user and data privacy. End-user acceptability and engagement were the most frequently assessed implementation metrics. Only 1 app had available evidence assessing all 4 implementation metrics (ie, acceptability, engagement, usability, and adherence). Most apps were prototype versions (n=5), with few matured apps. A total of 6 apps had supporting papers that provided a quantitative evaluation of clinical outcomes, but only 1 app had a supporting, adequately powered randomized controlled trial. CONCLUSIONS This is the first systematic review to synthesize and examine evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. The minimal number of apps with published evidence for design engineering and clinical implementation and evaluation contrasts starkly with the number of commercial sleep apps available. Moreover, there appears to be no standardization and consistency in the use of best practice design approaches and implementation assessments, along with very few rigorous efficacy evaluations. To facilitate the development of successful and evidence-based apps for sleep disturbance, we developed a high-level framework to guide researchers and app developers in the end-to-end process of app development and evaluation. CLINICALTRIAL

In this study, we consecutively recruited treatment-seeking young autistic adults without intellectual impairment aged 16–30 years who presented to a mental health service and evaluated general health (distress, quality of life, and disability), functioning (work loss days and social functioning), and mood symptoms (depression, anxiety, and stress) in those diagnosed with autism spectrum disorder ( n = 96). This group was compared to young adults presenting to the same service with primary mental health disorders (depression, n = 343; bipolar, n = 132; psychosis, n = 166; and anxiety, n = 303). This study also investigated the influence of mood symptoms on general health and functioning in the autism spectrum disorder group. Young autistic adults reported significant general health and functioning impairments that were of similar degree to those presenting with primary mental health disorders. Interestingly, the autistic group also reported similarly high levels of mood symptoms to those with primary depressive and anxiety disorders. In the autistic group, depressive symptoms were strongly associated with distress, quality of life, and work loss days, while stress symptoms were strongly associated with disability. This study highlights further research, and mental health services are required specifically targeting young autistic adults to address their significant unmet needs.

Background and Objectives: Epilepsy influences the ability to drive. We undertook a systematic review to determine the prevalence of driving or holding a driver’s license among people with seizures, the prevalence of traffic accidents among those who drive, and factors that may explain heterogeneity in these point estimates. Method: We followed MOOSE and PRISMA guidelines in searching 8 databases from inception to June 27, 2018. All published observational studies were included, with the exception of case-control studies where prevalence could not be determined, case reports, and studies with fewer than 50 participants. We assessed external and internal validity and quality of studies, produced forest plots, and conducted meta-regression in “Stata 13.” Results: Data were available from 67 studies published between 1967 and 2018. Across the studies there was a wide range in the prevalence of driving (3–90%) and holding a driver’s license (8–98%). Up to 39% of people with epilepsy drove in violation of restrictions. Prevalence of traffic accidents ranged from 0 to 61% following seizure onset, or in the past 1–5 years. The percentage of people with seizures who drove decreased as time since diagnosis increased (p = 0.01, adjusted R2 = 31%). The number of people with seizures who drove or held a driver’s license appears to have increased over time (p = 0.02, adjusted R2 = 7%) but without a corresponding increase in the number of traffic accidents. There was considerable heterogeneity between studies related to definitions, design, and population differences. Conclusions: There is considerable variation in the prevalence of driving after a diagnosis of epilepsy and in reported motor vehicle accidents. Further efforts are required to better understand the impact of epilepsy, and epilepsy surgery, on driving and road safety, especially where driving continues in violation of restrictions. Policy changes are needed to encourage the introduction of available and affordable alternatives for driving, for example, developing public transport networks, and promoting subsidy schemes to encourage use of public transport, taxis, Uber, and Lyft, among people experiencing seizures.

Insomnia is a major public health concern. Sleep restriction therapy (SRT) is an effective behavioral treatment but its delivery is impeded by a shortage of trained clinicians. We developed a mobile app delivering SRT to individuals with insomnia. This feasibility study employed a mixed-methods design to examine the engagement, acceptability, and potential efficacy of the mobile app. Fifteen participants diagnosed with insomnia disorder used the mobile app synchronized with a wearable device for 3 weeks. Those who persisted with the study (n = 12) found the mobile app to be highly acceptable and engaging, logging on average 19 nightly sleep diary entries across the 21 day period. Significant improvements were observed for sleep measures (insomnia severity and sleep efficiency) and daytime symptoms (fatigue and sleepiness). The results suggest that a mobile app delivering SRT to individuals with insomnia is engaging, acceptable, and potentially efficacious. Further, a full-scale effectiveness study is warranted.

Emergency service workers (ESWs) are at increased risk of trauma-related mental disorders. However, volunteer ESWs, who comprise the majority of firefighters in Western countries, have limited access to the necessary support services for mental health problems. This study aimed to examine the impact of the level and types of trauma exposure on the development of mental disorders in a volunteer fire service. Members of an Australian volunteer fire service (N = 459) completed a cross-sectional survey. Information on the number and types of distressing critical incidents involved within the last year was collected. Validated, self-report measures were used to determine probable post-traumatic stress disorder (PTSD) and psychological distress caseness. The risk of probable PTSD was significantly higher for those with the most frequent involvement with distressing incidents and the highest levels of cumulative trauma exposure. Being trapped in a dangerous situation or being assaulted by other people, resulted in the greatest odds of developing a mental disorder. Volunteer fire service members with the highest levels of trauma exposure and involvement with particular types of critical incidents are at elevated risk of mental health problems. The implications for the provision of psychological support measures amongst volunteer emergency services are discussed.

Describe sleep duration in adult Sri Lankans and determine the bias and agreement of self-report and actigraphic assessments.Validation sub-study nested within the Colombo Twin and Singleton Study (2012-2015).Colombo, Sri Lanka.175 adults with actigraphy, randomly selected from 3497 participants with self-reported sleep assessed in a population-based cohort.Self-reported sleep duration, ascertained by the Pittsburgh Sleep Quality Index (PSQI), was compared to a minimum of four days of actigraphy. Bias and agreement were assessed using the Bland-Altman method and a novel application of criterion cut-point analysis. Objective measurements of wake after sleep onset (WASO) and sleep efficiency were evaluated.Sri Lankans have short sleep duration; averaging 6.4h (SD 1.5) self-reported and 6.0h (SD 0.9) actigraphically. Poor sleep quality was prevalent with an average WASO of 49 min., and sleep efficiency85%. Bias was observed, with self-report consistently over-reporting sleep on average by 27.6 min (95% CI: -0.68, -0.24) compared to objective measures, but wide individual variation in disagreement, ranging from over-reporting by 3.34h to under-reporting by 2.42h. A criterion cut-point method also failed to define agreed definitions of short and long sleep duration.Sleep in Sri Lankan adults, whether measured subjectively or objectively, is of short duration and suboptimal objective quality by High Income Country consensus standards. Given the high cardiometabolic morbidity in Sri Lanka and poor measurement agreement observed, this warrants further investigation and supports the need for culturally appropriate, reliable, and valid assessment for analytic epidemiology in non-Western settings.

Objective: Shark bites are rare, with intense media exposure. There are no known studies of the psychological impacts of this specific type of traumatic event. This is the first study that describes those directly and indirectly affected, and evaluates the prevalence of post-traumatic stress disorder (PTSD) and related risk factors. Methods: In total, 124 members of an Australian shark-bite peer-support group were invited to complete an online survey assessing demographic, event, media and psychological factors. Response rate was 48% ( n = 60, 63% male, 44 ± 14 years). Retrospective and current measures of PTSD (PTSD Checklist for DSM-5 [PCL-5]) and suicidality (Suicidal Ideation Attributes Scale [SIDAS-5]) were used. Results: Post-event PTSD was prevalent in this sample ( n = 16/59, 27.1%, 95% confidence interval [CI] = [15.4, 38.8]), but less so currently ( n = 2/55, 3.6%, 95% CI = [0.0, 8.7]). In addition, nine ( n = 9/59, 15.3%, 95% CI = [5.8, 24.7]) had subthreshold, but highly symptomatic, syndromes post event. There was no association of PTSD with direct/indirect bite involvement, gender, or prior trauma. Two respondents were at risk of suicidal behaviour. PTSD was commonly reported by those without a partner (odds ratio [OR] = 5.91, 95% CI = [1.52, 22.99], p = 0.01) or with two friends or fewer to rely on (OR = 5.83, 95% CI = [1.62, 21.01], p = 0.01). PTSD was more likely in those with a negative media experience ( n = 34/52, 65.4%, OR = 11.90, 95% CI = [1.42, 100.04], p = 0.02) and 61.5% ( n = 32/52) of respondents reported media coverage lasting months or years. In multivariate modelling, negative media impact, relationship status and friendships were independently associated with PTSD and explained much of the variance in PTSD ( F4,41 = 10.94, p 2 = 0.52). Conclusion: Nearly one-third of members of an Australian shark-bite peer-support group report post-event PTSD, and one-quarter of these were not present at the time of the event. Findings support interventions targeting negative media impact, similar to media reporting guidelines for suicide, and enhancing social support.

Objective: Internet-delivered cognitive behavioural therapy for insomnia is efficacious for insomnia, and post hoc analyses suggest mood improvements. We undertook the first clinical trial evaluating the efficacy of Internet-delivered cognitive behavioural therapy for insomnia on depressive symptoms as an adjunct to guideline-based treatment of depressive disorders. Methods: Older men undergoing psychiatrist-coordinated treatment for major depressive disorder or dysthymia and who had significant insomnia symptoms were randomised to either adjunctive Internet-delivered cognitive behavioural therapy for insomnia (Sleep Healthy Using The Internet) or online sleep psychoeducation. The primary outcome was change in depressive symptoms (Centre for Epidemiological Studies Depression scale) from baseline to week 12 (post intervention). Secondary outcomes were insomnia and anxiety symptoms. Results: In all, 87 men were randomised (Internet-delivered cognitive behavioural therapy for insomnia = 45; psychoeducation = 42). The mean observed Centre for Epidemiological Studies Depression scale changes by week 12 were 8.2 (standard deviation = 11.5) and 3.9 (standard deviation = 12.8) for Internet-delivered cognitive behavioural therapy for insomnia and psychoeducation, respectively. The adjunctive effect size of 0.35 in favour of Sleep Healthy Using The Internet programme was not statistically significant (group × time difference in the Mixed effect Model Repeat Measurement analysis difference 4.3; 95% confidence interval = [−1.2, 9.8]; p = 0.15). There was a statistically significant effect on insomnia symptoms (group × time p = 0.02, difference 2.7; 95% confidence interval = [0.2, 5.3]; effect size = 0.62). There were no differences in insomnia or depression at 6 months or differential effects on anxiety at any time point. There were no reported adverse trial-related events in the intervention arm. Conclusion: Adjunctive Internet-delivered cognitive behavioural therapy for insomnia for older men being treated for depression can improve insomnia in the short term, without apparent harm. The short-term depressive symptom effect size in this pilot trial was comparable to other adjunctive interventions and may warrant a larger, definitive trial.

To evaluate whether the prospective association between insomnia and mental illness in the general population remained after controlling for multiple confounders, or whether this represented partly remitted prior mental illness.Cohort study.Australian general population.The participants were 10,444 people aged 15 or older in the Household, Income and Labour Dynamics in Australia (HILDA) survey who did not meet K10 criteria for likely mental illness at baseline (2013-14).The prospective associations of insomnia (yes/no) at baseline with mental illness (yes/no) approximately 2 years later (2015-16), determined from scores on the K10, were evaluated using logistic regression. These were then adjusted for potential confounders including sociodemographic factors, physical health and health behaviors, and baseline and past mental health.Insomnia at baseline increased risk of mental illness onset at two-year follow up (OR 2.23, 95% CI 1.91-2.59, P .001). This relationship was attenuated but still significant after adjustment for confounding variables (OR 1.72 95% CI 1.46-2.02). Accounting for reverse causality from prior mental ill health and baseline symptoms reduced this further but the relationship remained (OR 1.30, 95% CI 1.09-1.55, P = .003). This effect appeared more robust among those65 years of age.Insomnia has a consistent prospective relationship with mental illness at two-year follow-up. Insomnia did not appear to be simply a symptom of past, or baseline subclinical, mental illness. This supports the specific targeting of insomnia symptoms in selective preventive mental health initiatives, particularly among those under 65 years of age.

Background: Many organisations are implementing mental health training for managers to facilitate better communication between managers and employees suffering from mental health problems. Much of this training focuses on improving managers’ mental health literacy and reducing stigma. However, it is unclear whether this focus is appropriate, or whether other targets, such as improving skills and confidence should be given greater consideration. Aims: To test whether knowledge, attitudes and confidence are associated with managers’ behavioural responses to mental health issues amongst their staff. Methods: Managers from a large Australian fire and rescue service completed a questionnaire addressing their knowledge, attitudes, confidence and behavioural responses when managing employee mental health issues. The relationship was assessed using logistic regression. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. Results: Eighty-five managers responded (response rate 66%). Managers’ confidence was the strongest predictor of their behaviour. Managers who felt confident discussing mental health were significantly more likely to make contact with an employee who was suspected to be suffering from a mental illness (odds ratio 15.79 95% CI 3.03-82.31, P < 0.01) or was on sickness leave for mental health reasons (OR 19.84, 95% CI 2.25-175.15, P < 0.01). Non-stigmatising attitudes towards mental illness also significantly predicted contact with a staff member off work due to mental health problems (OR 5.22, 95% CI1.21-22.54, P < 0.05). Conclusions: Our findings suggest that manager mental health training should focus on building their confidence and reducing stigma in order to have the greatest chance of altering workplace practices.

Sleep research has been dominated by high income countries (HIC). Sleep may be different in low and middle income countries (LMIC) due to cultural, demographic, geographical and health factors. We systematically reviewed the epidemiological literature reporting sleep parameters in the adult population in LMIC and meta-analyzed the prevalence of subjective poor sleep quality and sleep duration. We identified 45 publications; over 50% of which came from China and Brazil. Of the 45 identified studies, 32 contained data on sleep quality and 17 on self-reported sleep duration. Only one study utilized polysomnography and only one study utilized actigraphy. This review provides evidence that sleep parameters in LMIC appear to be similar to those in HIC but the variability and bias found suggests any attempt to extract a universal prevalence estimate or average sleep duration from the current data is very likely flawed and should be taken with caution. In our meta-analysis we found an enormous variability that was not explicable by regional, rurality, gender, age group or sleep assessment method. Further, there was a suggestion of significant small study effect, with smaller studies reporting worse sleep. There is surprisingly little consistent high-quality data that could be used for policy, planning, or scientific purposes at a global level in low and middle-income countries about what humans spend a third of their lives doing. High-quality epidemiological research about basic sleep health parameters is needed that focuses on the whole-population in LMIC, and that uses standardized, well-validated and culturally applicable measures.