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BackgroundDecisions 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. ObjectiveThis 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. MethodsA 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. ResultsA 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. ConclusionsThe 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.

Objective: To evaluate an online training program for physician supervisors with the aim of promoting a mentally healthy workplace by improving their use of both responsive and preventive mental health support strategies. Study design: Cluster randomised, waitlist‐controlled trial. Setting, participants: Royal Australasian College of Physicians fellows who were supervising at least one resident physician in any of the 31 primary health networks in Australia and 20 district health boards in New Zealand (health network clusters). Intervention: A brief online skills‐based mental health training program, comprising twelve modules grouped into three topics: common mental illnesses; helping trainees you are concerned about (responsive strategies); and minimising mental health risks at work (preventive strategies). Main outcome measures: Change between baseline and the 3‐month assessment in self‐reported recommended supervisor behaviours; differences between intervention and control groups in recommended behaviour scores three weeks, three months, and six months after the program. Results: Ninety physicians from 20 health network clusters were allocated to the intervention group, 88 physicians from 22 clusters to the control group. Intervention group participants reported greater positive change in behaviour across the study period than those in the control group (mixed model repeated measures analysis, group × time interaction: P < 0.001). The mean change in self‐reported supervisory behaviour score was higher for the intervention than the control group at the 3‐week (mean difference in score, 1.6; 95% confidence interval [CI], 0.8–2.4), 3‐month (0.9; 95% CI, 0.2–1.6), and 6‐month assessments (1.9; 95% CI, 1.1–2.7). The mean change in self‐reported responsive behaviour score was also greater for the intervention group at the 3‐week (mean difference, 2.3; 95% CI, 1.5–3.1), 3‐month (1.0; 95% CI, 0.2–1.9), and 6‐month assessments (2.0; 95% CI, 1.1–2.9); differences in the mean change in preventive behaviour scores were statistically significant at the 3‐week (mean difference, 1.1; 95% CI, 0.1–2.2) and 6‐month assessments (1.8; 95% CI, 0.8–2.8), but not the 3‐month assessment (0.8; 95% CI, –0.1 to 1.7). Conclusions: Brief online mental health training for senior physicians can lead to changes in their self‐reported behaviour for supporting the mental health needs of resident physicians. Whether this leads to better mental health for resident physicians should be investigated. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12619001496101 (prospective). [ABSTRACT FROM AUTHOR]

Objective: To determine the psychometric properties of an Aboriginal and Torres Strait Islander‐developed depressive symptom screening scale. Design: Prospective diagnostic accuracy study. Setting: Ten primary health care services or residential alcohol and other drug rehabilitation services in Australia that predominantly serve Aboriginal and Torres Strait Islander peoples. Participants: 500 adults (18 years or older) who identified as Aboriginal and/or Torres Strait Islander and were able to communicate sufficiently to respond to questionnaire and interview questions. Recruitment occurred between 25 March 2015 and 2 November 2016. Main outcome measure: Criterion validity of seven Aboriginal and Torres Strait Islander‐developed items, using the adapted Patient Health Questionnaire 9 (aPHQ‐9) and depression module of the Mini International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standards. Results: The seven‐item scale had good internal consistency (α = 0.83) and correlated highly with the aPHQ‐9 (ρ = 0.76). All items were significantly associated with diagnosis of a current major depressive episode. Discriminant function and decision tree analysis identified three items forming a summed scale that classified 85% of participants correctly. These three items showed equivalent sensitivity and specificity to the aPHQ‐9 when compared with the MINI‐identified diagnosis of a current major depressive episode. Conclusion: Three items developed by and for Aboriginal and Torres Strait Islander people may provide effective, efficient and culturally appropriate screening for depression in Aboriginal and Torres Strait Islander health care contexts. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the relationship between work-related factors at baseline and the risk of common mental disorder at 12 month follow-up among a cohort of junior doctors. Method: The data comprised the junior doctor respondents from two annual waves of the 'Medicine in Australia: Balancing Employment and Life' (MABEL) survey, a national longitudinal cohort of Australian doctors. Individual and work-related risk factors were assessed at baseline and the mental health outcome of caseness of common mental disorder (CMD) was assessed using the 6-item Kessler Psychological Distress Scale at 12-month follow-up. Unadjusted and adjusted logistic regressions were conducted to estimate the association between each baseline variable and the likelihood of CMD caseness at follow-up 1 year later. Results: Among 383 junior doctors, 24 (6%) had CMD 1 year later. Five work-related baseline variables were significantly associated with a higher likelihood of CMD 1 year later in adjusted models; lack of social support in work location (odds ratios (OR) = 6.11; 95% confidence intervals (CI) = [2.52, 14.81]), work-life imbalance (OR = 4.50; 95% CI = [1.31, 15.46]), poor peer support network in the workplace (OR = 2.61; 95% CI = [1.08, 6.27]), perceptions of patient expectations (OR = 2.46; 95% CI = [1.06, 5.71]) and total weekly work hours (OR 1.04; 95% CI = [1.01, 1.07]; p = 0.002)in models adjusting for gender. Conclusion: These results identify key modifiable work-related factors that are associated with junior doctors' future mental health. Our findings suggest the need for a greater focus upon interpersonal factors and work-life balance in multi-level interventions while continuing to address workplace and system-level factors to prevent future mental disorder in junior doctors. [ABSTRACT FROM AUTHOR]

We estimate whether risk preferences are affected by traumatic events by using a unique survey of Sri Lankan twins which contains information on individual’s exposure to the 2004 Indian Ocean Tsunami, validated measures of mental health and risk preferences, and a rich set of control variables. Our estimation strategy utilizes variation in experiences within twin pairs and allows us to explore wealth shocks and/or changes in mental health as mechanisms. We find that exposure to the tsunami lead to less risk aversion, a result that is not explained by mental health. [ABSTRACT FROM AUTHOR]

Background: There are not many longitudinal studies examining people experiencing homelessness and interacting with the criminal justice system over time. Aims: To describe the type of criminal offences committed, court outcomes, identify probable predictors of reoffending, and estimate the criminal justice costs in a cohort of homeless hostel clinic attendees. Method: A retrospective cohort study of 1646 people attending a homeless clinic who had had contact with the criminal justice system (CJS) in New South Wales (NSW), Australia, using linked clinic, criminal offence, health and mortality data from 1 July 2008 to 30 June 2021. Initial comparisons were made with the 852 clinic attendees without CJS contact in the period. Multivariable logistic regression was used to identify predictors of recidivism. Results: There were 16,840 offending episodes, giving an offence rate of 87.8 per 100 person‐years (95%CI: 86.5–89.1). The most common index offences were acts intended to cause injury (22%), illicit drug (17%) and theft‐related (12%) offences. Most people (83%) were found guilty of the index offence and received a fine (37%) or community‐based sentence (29%). Total court finalisation costs were AUD $11.3 million. Three‐quarters of those convicted reoffended within 24 months. Offenders were more likely to be younger, have a diagnosis of personality disorder (AOR: 1.31; 95% CI: 1.04–1.67), a substance use disorder (AOR: 1.60; 95% CI 1.14–2.23) and/or to have a previous charge dismissed on mental health grounds (AOR: 1.79; 95% CI: 1.31–2.46). Within the offending cohort, reoffenders had almost twice the odds of having theft‐related offences as their principal index offence (AOR: 1.85; 95% CI: 1.29–2.66). Conclusions: This longitudinal study finding of not only a high rate of criminal justice contact, but also a high rate of recidivism among people who have been homeless, lends support to a need for strategies both to address the root causes of homelessness and to provide a comprehensive systems‐based response to reduce recidivism, that includes secure housing as well as mental health and substance use treatment programmes for homeless offenders. [ABSTRACT FROM AUTHOR]