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BackgroundDigital health stations offer an affordable and accessible platform for people to monitor their health; however, there is limited information regarding the demographic profile of users and the health benefits of this technology. ObjectiveThis study aimed to assess the demographic representativeness of health station users, identify the factors associated with repeat utilization of stations, and determine if the health status of repeat users changed between baseline and final health check. MethodsData from 180,442 health station users in Australia, including 8441 repeat users, were compared with 2014-2015 Australian National Health Survey (NHS) participants on key demographic and health characteristics. Binary logistic regression analyses were used to compare demographic and health characteristics of repeat and one-time users. Baseline and final health checks of repeat users were compared using McNemar tests and Wilcoxon signed rank tests. The relationship between the number of checks and final health scores was investigated using generalized linear models. ResultsThe demographic profile of SiSU health station users differs from that of the general population. A larger proportion of SiSU users were female (100,814/180,442, 55.87% vs 7807/15,393, 50.72%), younger (86,387/180,442, 47.88% vs 5309/15,393, 34.49% aged less than 35 years), and socioeconomically advantaged (64,388/180,442, 35.68% vs 3117/15,393, 20.25%). Compared with NHS participants, a smaller proportion of SiSU health station users were overweight or obese, were smokers, had high blood pressure (BP), or had diabetes. When data were weighted for demographic differences, only rates of high BP were found to be lower for SiSU users compared with the NHS participants (odds ratio [OR] 1.26; P

BackgroundVideoconferencing psychotherapy (VCP) is a growing practice among mental health professionals. Early adopters have predominantly been in private practice settings, and more recent adoption has occurred in larger organizations, such as the military. The implementation of VCP into larger health service providers in the public sector is an important step in reaching and helping vulnerable and at-risk individuals; however, several additional implementation challenges exist for public sector organizations. ObjectiveThe aim of this study was to offer an implementation model for effectively introducing VCP into public sector organizations. This model will also provide practical guidelines for planning and executing an embedded service trial to assess the effectiveness of the VCP modality once implemented. MethodsAn iterative search strategy was employed, drawing on multiple fields of research across mental health, information technology, and organizational psychology. Previous VCP implementation papers were considered in detail to provide a synthesis of the barriers, facilitators, and lessons learned from the implementation attempts in the military and other public sector settings. ResultsA model was formulated, which draws on change management for technology integration and considers the specific needs for VCP integration in larger organizations. A total of 6 phases were formulated and were further broken down into practical and measurable steps. The model explicitly considers the barriers often encountered in large organizational settings and suggests steps to increase facilitating factors. ConclusionsAlthough the model proposed is time and resource intensive, it draws on a comprehensive understanding of larger organizational needs and the unique challenge that the introduction of VCP presents to such organizations.

BackgroundInternet-based assessment has the potential to assist with the diagnosis of mental health disorders and overcome the barriers associated with traditional services (eg, cost, stigma, distance). Further to existing online screening programs available, there is an opportunity to deliver more comprehensive and accurate diagnostic tools to supplement the assessment and treatment of mental health disorders. ObjectiveThe aim was to evaluate the diagnostic criterion validity and test-retest reliability of the electronic Psychological Assessment System (e-PASS), an online, self-report, multidisorder, clinical assessment and referral system. MethodsParticipants were 616 adults residing in Australia, recruited online, and representing prospective e-PASS users. Following e-PASS completion, 158 participants underwent a telephone-administered structured clinical interview and 39 participants repeated the e-PASS within 25 days of initial completion. ResultsWith structured clinical interview results serving as the gold standard, diagnostic agreement with the e-PASS varied considerably from fair (eg, generalized anxiety disorder: κ=.37) to strong (eg, panic disorder: κ=.62). Although the e-PASS’ sensitivity also varied (0.43-0.86) the specificity was generally high (0.68-1.00). The e-PASS sensitivity generally improved when reducing the e-PASS threshold to a subclinical result. Test-retest reliability ranged from moderate (eg, specific phobia: κ=.54) to substantial (eg, bulimia nervosa: κ=.87). ConclusionsThe e-PASS produces reliable diagnostic results and performs generally well in excluding mental disorders, although at the expense of sensitivity. For screening purposes, the e-PASS subclinical result generally appears better than a clinical result as a diagnostic indicator. Further development and evaluation is needed to support the use of online diagnostic assessment programs for mental disorders. Trial RegistrationAustralian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG).

BackgroundA relative newcomer to the field of psychology, e-mental health has been gaining momentum and has been given considerable research attention. Although several aspects of e-mental health have been studied, 1 aspect has yet to receive attention: the structure of comorbidity of psychological disorders and their relationships with measures of psychosocial adjustment including suicidal ideation in online samples. ObjectiveThis exploratory study attempted to identify the structure of comorbidity of 21 psychological disorders assessed by an automated online electronic psychological assessment screening system (e-PASS). The resulting comorbidity factor scores were then used to assess the association between comorbidity factor scores and measures of psychosocial adjustments (ie, psychological distress, suicidal ideation, adequate social support, self-confidence in dealing with mental health issues, and quality of life). MethodsA total of 13,414 participants were assessed using a complex online algorithm that resulted in primary and secondary Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) diagnoses for 21 psychological disorders on dimensional severity scales. The scores on these severity scales were used in a principal component analysis (PCA) and the resulting comorbidity factor scores were related to 4 measures of psychosocial adjustments. ResultsA PCA based on 17 of the 21 psychological disorders resulted in a 4-factor model of comorbidity: anxiety-depression consisting of all anxiety disorders, major depressive episode (MDE), and insomnia; substance abuse consisting of alcohol and drug abuse and dependency; body image–eating consisting of eating disorders, body dysmorphic disorder, and obsessive-compulsive disorders; depression–sleep problems consisting of MDE, insomnia, and hypersomnia. All comorbidity factor scores were significantly associated with psychosocial measures of adjustment (P

BackgroundAlthough relatively new, the field of e-mental health is becoming more popular with more attention given to researching its various aspects. However, there are many areas that still need further research, especially identifying attrition predictors at various phases of assessment and treatment delivery. ObjectiveThe present study identified the predictors of posttreatment assessment completers based on 24 pre- and posttreatment demographic and personal variables and 1 treatment variable, their impact on attrition bias, and the efficacy of the 5 fully automated self-help anxiety treatment programs for generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder with or without agoraphobia (PD/A), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). MethodsA complex algorithm was used to diagnose participants’ mental disorders based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR). Those who received a primary or secondary diagnosis of 1 of 5 anxiety disorders were offered an online 12-week disorder-specific treatment program. A total of 3199 individuals did not formally drop out of the 12-week treatment cycle, whereas 142 individuals formally dropped out. However, only 347 participants who completed their treatment cycle also completed the posttreatment assessment measures. Based on these measures, predictors of attrition were identified and attrition bias was examined. The efficacy of the 5 treatment programs was assessed based on anxiety-specific severity scores and 5 additional treatment outcome measures. ResultsOn average, completers of posttreatment assessment measures were more likely to be seeking self-help online programs; have heard about the program from traditional media or from family and friends; were receiving mental health assistance; were more likely to learn best by reading, hearing and doing; had a lower pretreatment Kessler-6 total score; and were older in age. Predicted probabilities resulting from these attrition variables displayed no significant attrition bias using Heckman’s method and thus allowing for the use of completer analysis. Six treatment outcome measures (Kessler-6 total score, number of diagnosed disorders, self-confidence in managing mental health issues, quality of life, and the corresponding pre- and posttreatment severity for each program-specific anxiety disorder and for major depressive episode) were used to assess the efficacy of the 5 anxiety treatment programs. Repeated measures MANOVA revealed a significant multivariate time effect for all treatment outcome measures for each treatment program. Follow-up repeated measures ANOVAs revealed significant improvements on all 6 treatment outcome measures for GAD and PTSD, 5 treatment outcome measures were significant for SAD and PD/A, and 4 treatment outcome measures were significant for OCD. ConclusionsResults identified predictors of posttreatment assessment completers and provided further support for the efficacy of self-help online treatment programs for the 5 anxiety disorders. Trial RegistrationAustralian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG).

BackgroundAlthough in its infancy, the field of e-mental health interventions has been gaining popularity and afforded considerable research attention. However, there are many gaps in the research. One such gap is in the area of attrition predictors at various stages of assessment and treatment delivery. ObjectiveThis exploratory study applied univariate and multivariate analysis to a large dataset provided by the Anxiety Online (now called Mental Health Online) system to identify predictors of attrition in treatment commencers and in those who formally withdrew during treatment based on 24 pretreatment demographic and personal variables and one clinical measure. MethodsParticipants were assessed using a complex online algorithm that resulted in primary and secondary diagnoses in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Those who received a primary or secondary diagnosis of 1 of 5 anxiety disorders (generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and panic disorder) were offered an online 12-week disorder-specific treatment program. ResultsOf 9394 potential participants, a total of 3880 clients enrolled and 5514 did not enroll in one of the treatment programs following the completion of pretreatment assessment measures (pretreatment attrition rate: 58.70%). A total of 3199 individuals did not formally withdraw from the 12-week treatment cycle, whereas 142 individuals formally dropped out (formal withdrawal during treatment dropout rate of 4.25%). The treatment commencers differed significantly (P

BackgroundThe development of e-mental health interventions to treat or prevent mental illness and to enhance wellbeing has risen rapidly over the past decade. This development assists the public in sidestepping some of the obstacles that are often encountered when trying to access traditional face-to-face mental health care services. ObjectiveThe objective of our study was to investigate the posttreatment effectiveness of five fully automated self-help cognitive behavior e-therapy programs for generalized anxiety disorder (GAD), panic disorder with or without agoraphobia (PD/A), obsessive–compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and social anxiety disorder (SAD) offered to the international public via Anxiety Online, an open-access full-service virtual psychology clinic for anxiety disorders. MethodsWe used a naturalistic participant choice, quasi-experimental design to evaluate each of the five Anxiety Online fully automated self-help e-therapy programs. Participants were required to have at least subclinical levels of one of the anxiety disorders to be offered the associated disorder-specific fully automated self-help e-therapy program. These programs are offered free of charge via Anxiety Online. ResultsA total of 225 people self-selected one of the five e-therapy programs (GAD, n = 88; SAD, n = 50; PD/A, n = 40; PTSD, n = 30; OCD, n = 17) and completed their 12-week posttreatment assessment. Significant improvements were found on 21/25 measures across the five fully automated self-help programs. At postassessment we observed significant reductions on all five anxiety disorder clinical disorder severity ratings (Cohen d range 0.72–1.22), increased confidence in managing one’s own mental health care (Cohen d range 0.70–1.17), and decreases in the total number of clinical diagnoses (except for the PD/A program, where a positive trend was found) (Cohen d range 0.45–1.08). In addition, we found significant improvements in quality of life for the GAD, OCD, PTSD, and SAD e-therapy programs (Cohen d range 0.11–0.96) and significant reductions relating to general psychological distress levels for the GAD, PD/A, and PTSD e-therapy programs (Cohen d range 0.23–1.16). Overall, treatment satisfaction was good across all five e-therapy programs, and posttreatment assessment completers reported using their e-therapy program an average of 395.60 (SD 272.2) minutes over the 12-week treatment period. ConclusionsOverall, all five fully automated self-help e-therapy programs appear to be delivering promising high-quality outcomes; however, the results require replication. Trial RegistrationAustralian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG)

Blended learning refers to a method of teaching and learning in which some form of online learning is used in addition to the traditional on-campus/face-to-face learning experience in an integrated manner. Postgraduate Applied Statistics programs at Swinburne University of Technology, Australia adopted the blended learning paradigm almost a decade ago to accommodate an increasingly diverse student population. This paradigm allows for "flexibility in design approaches", and accommodates the range of blended learning capabilities and experience of teachers and learners. The blended learning design adopted in these programs has involved the "thoughtful integration of learning and teaching approaches" in both on-campus, face-to-face and online/virtual learning environments by utilising the benefits of each of these environments. These programs focus on designing learning interactions across formal teaching spaces, informal learning spaces and online learning and teaching spaces. This flexible approach has been well accepted among both online and on-campus students. This paper describes the medium impact blended learning model adopted in these courses and the feedback received from students during recent study periods. The authors make the case that implementation of a successful blended learning model can enhance students' learning experience for a mixed cohort of participants.

The interaction between host environment and international students plays a critical role in the students' cross-cultural adjustment. However, limited research has captured this interaction in investigating international student acculturation. Building on acculturation and person-environment fit theories, this article investigated student-university alignment of different dimensions as predictors of psychological adjustment of international students at universities in Victoria, Australia. The results of structural equation modeling suggested student-university goal alignment was positively associated with student psychological adjustment. A revealing finding of this article is the mediating role of complementary fit in the relationship between supplementary fit and student psychological adjustment, where the complementary fit was represented by the alignment between student needs and university academic and facilities support, and supplementary fit was represented by student-university goal alignment. The findings have implications for universities and practitioners in developing the necessary resources to support international students.

Objectives: This study explored the potential role of stage‐related variables in intervention outcomes in bipolar disorder (BD). Specifically, we aimed to identify which subgroups of individuals were most likely to experience improved quality of life following digitally delivered psychosocial interventions for BD. Methods: The study involved a secondary analysis of combined data from two randomised control trials (RCTs). Each trial assessed the effectiveness of digitally delivered interventions for improving quality of life, in late‐stage (ORBIT RCT) or early‐stage (BETTER RCT) BD. Three iterations of cluster analyses were performed, identifying subgroups of individuals based on (i) current phenomenology, (ii) course of illness and (iii) medication response. The resultant subgroups were compared with regard to changes in quality of life pre‐post intervention, via repeated measures ANOVAs. Results: In each cluster analysis, two clusters were found. The current phenomenology clusters reflected two impairment levels, 'moderate impairment' and 'low impairment'. The course of illness clusters reflected 'more chronicity' and 'less chronicity' and the medication response clusters reflected 'good medication response' and 'poor medication response'. Differences in changes in quality of life over time were observed between the two current phenomenology clusters and between the medication response clusters, while the course of illness subgroups did not respond differently. Conclusions: There are at least two distinct groups of treatment‐seeking individuals with established BD, based on illness features with previously established links to different illness stages. Clusters within the current phenomenology and medication response domains demonstrated significantly different trajectories of QoL change over time in the context of our interventions, highlighting potential implications for treatment selection aligned with precision psychiatry. [ABSTRACT FROM AUTHOR]

Objective: Studies using proton magnetic resonance spectroscopy reveal substantial inconsistencies in the levels of brain glutamate, glutamine and glutamate + glutamine across schizophrenia spectrum disorders. This systematic review employs qualitative and quantitative methods to analyse the patterns and relationships between glutamatergic metabolites, schizophrenia spectrum disorders and brain regions. Methods: A literature search was conducted using various databases with keywords including glutamate, glutamine, schizophrenia, psychosis and proton magnetic resonance spectroscopy. Inclusion criteria were limited to case-control studies that reported glutamatergic metabolite levels in adult patients with a schizophrenia spectrum disorder diagnosis – i.e. first-episode psychosis, schizophrenia, treatment-resistant schizophrenia and/or ultra-treatment-resistant schizophrenia – using proton magnetic resonance spectroscopy at 3 T or above. Pooled study data were synthesized and analysed. Results: A total of 92 studies met the inclusion criteria, including 2721 healthy controls and 2822 schizophrenia spectrum disorder participants. Glu levels were higher in the basal ganglia, frontal cortex and medial prefrontal of first-episode psychosis participants, contrasting overall lower levels in schizophrenia participants. For Gln, strong differences in metabolite levels were evident in the basal ganglia, dorsolateral prefrontal cortex and frontal cortex, with first-episode psychosis showing significantly higher levels in the basal ganglia. In glutamate + glutamine, higher metabolite levels were found across schizophrenia spectrum disorder groups, particularly in the basal ganglia and dorsolateral prefrontal cortex of treatment-resistant schizophrenia participants. Significant relationships were found between metabolite levels and medication status, clinical measures and methodological variables. Conclusion: The review highlights abnormal glutamatergic metabolite levels throughout schizophrenia spectrum disorders and in specific brain regions. The review underscores the importance of standardized future research assessing glutamatergic metabolites using proton magnetic resonance spectroscopy due to considerable literature heterogeneity. [ABSTRACT FROM AUTHOR]

Drawing on the strategic capacity-building perspective, we examine the mediating roles of three innovation strategies, i.e. export formalization, foreign business networking, and proactive competitiveness between managerial capacity and technological and innovation leadership in SME internationalization. Employing a sample of 900 Vietnamese SMEs, we found support for a three-staged internationalization process models allowing for SMEs that export, SMEs with plans to export, and SMEs with no-plans to export. With the identification of the three SME stages, the emphasis on the internationalization process shifts from export performance perspectives to leadership, and this shift has theoretical and practical implications for current knowledge about the SME internationalization process. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine whether the extended bivalent fear of evaluation model (extended BFOE) of Social Anxiety Disorder (SAD) could be used to explain bladder and bowel incontinence anxiety (BBIA). It was hypothesised that the relationship between dysfunctional attitudes (DAs) and BBIA would be mediated by fear of negative evaluation (FNE), fear of positive evaluation (FPE), concerns of social reprisal (CSR), and disqualification of positive social outcomes (DPSO). Three-hundred-and-seventeen undergraduate students (76.7% female; mean age = 31.07 years) completed a cross-sectional online study. A structural equation model (SEM) supported the proposed model ([chi].sup.2p value = .131, CMIN/df = 1.560, CFI = .996, TLI = .990, RMSEA = .042, SRMR = .0245) with significant relationships found between DAs and FNE (p .001), DAs and FPE (p = .002), DAs and CSR (p = .007), FNE and CSR (p < .001), FNE and DPSO (p < .001), FPE and CSR (p < .001), FPE and DPSO (p < .001), CSR and DPSO (p < .001), BBIPSS bladder and bowel with incontinence anxiety (p < .001). These results suggest that DAs, FNE, and DPSO are important contributory factors in BBIA. Given that FNE was the strongest mediator in the model, clinicians may find it advantageous to target FNE in treatment of incontinence-anxiety., Author(s): Kenley L. J. Kuoch [sup.1] , Denny Meyer [sup.2] [sup.3] , David W. Austin [sup.4] , Simon R. Knowles [sup.1] [sup.5] [sup.6] [sup.7] [sup.8] Author Affiliations: (1) grid.1027.4, 0000 [...]

The current study aimed to explore the validity of a single, self-report measure for bladder and bowel anxieties (Bladder and Bowel Anxiety Grouping Item; BABAGI), using two appropriate scales entitled the Shy Bladder and Bowel Scale (SBBS) and the Bladder and Bowel Incontinence Phobia Severity Scale (BBIPSS). This study also aimed to examine the similarities and differences in dysfunctional attitudes (DAs), fear of negative and positive evaluation (FNE and FPE), concerns of social reprisal (CSR), and disqualification of positive social outcomes (DPSO) across individuals who self-identify as having paruresis/parcopresis, incontinence anxiety, or neither condition according to the BABAGI measure. Three-hundred-and-six undergraduate students (77.1% female; mean age = 31.18 years) completed a cross-sectional, online study. The results supported the hypothesis that by using the BABAGI, self-reported paruresis/parcopresis could be reliably identified by SBBS scores of above 6.75 and that self-reported incontinence anxiety could be reliably identified by BBIPSS scores above 15.21. The results also supported the hypothesis that individuals who self-identified as having paruresis/parcopresis or incontinence anxiety would score higher in socio-cognitive processes (DAs, FNE, FPE, CSR, DPSO) compared to individuals who self-identified as having neither condition. Given that the paruresis/parcopresis and incontinence anxiety groups do not significantly differ from each other with respect to socio-cognitive processes, this suggests that both sets of conditions share similar underlying psychosocial processes., Author(s): Kenley L. J. Kuoch [sup.1] , Denny Meyer [sup.2] [sup.3] , David W. Austin [sup.4] , Simon R. Knowles [sup.1] [sup.5] [sup.6] [sup.7] Author Affiliations: (1) grid.1027.4, 0000 0004 [...]

Paruresis has been recognized as a subtype of Social Anxiety Disorder (SAD). A well-established model of SAD is the extended bivalent fear of evaluation model (extended BFOE) which include socio-cognitive processes such as fear of negative and positive evaluation (FNE and FPE), concerns of social reprisal (CSR), and disqualification of positive social outcomes (DPSO). In addition to the extended BFOE, dysfunctional attitudes (DAs) have also been recognized to contribute towards social anxiety symptoms and distress. The aim of this study was to examine whether an extended BFOE model for SAD could be used to explain paruresis and parcopresis symptoms. Three-hundred-and-sixteen undergraduate students (76.6% female; mean age = 31.25 years) completed a cross-sectional online study. A structural equation model (SEM) indicated the data supported the proposed model very well ([chi].sup.2p value = .345, CMIN/df = 1.064, CFI = 1.00, TLI = .999, RMSEA = .014, SRMR = .0107) with significant direct relationships being found between DAs and FNE (p = .002), DAs and FPE (p = .002), FNE and CSR (p = .001), FPE and CSR (p = .001), CSR and paruresis score (p = .045), CSR and DAs (p = .006), FPE and paruresis score (p = .001), FPE and parcopresis score (p = .004), FNE and paruresis score (p = .004), and FNE and parcopresis score (p = .002). Although this research should be replicated, the current study provides evidence that DAs, FNE, FPE and CSR are important contributory factors in paruresis and parcopresis symptoms., Author(s): Kenley L. J. Kuoch [sup.1] , Denny Meyer [sup.2] [sup.3] , David W. Austin [sup.4] , Simon R. Knowles [sup.1] [sup.5] [sup.6] [sup.7] Author Affiliations: (1) grid.1027.4, 0000 0004 [...]