Prevalence of depressive symptoms as elicited by Patient Health Questionnaire (PHQ-9) among medical trainees in Oman

Background Despite the increasing recognition that medical training tends to coincide with markedly high levels of stress and distress, there is a dearth of validated measures that are capable of gauging the prevalence of depressive symptoms among medical residents in the Arab/Islamic part of the world. Objective The aim of the present study is two-fold. First is to examine the diagnostic validity of the Patient Health Questionnaire (PHQ-9) using an Omani medical resident population in order to establish a cut-off point. Second is to compare gender, age, and residency level among Omani Medical residents who report current depressive symptomatology versus those who report as non-depressed according to PHQ-9 cut-off threshold. Results A total of 132 residents (42 males and 90 females) consented to participate in this study. The cut-off score of 12 on the PHQ-9 revealed a sensitivity of 80.6% and a specificity of 94.0%. The rate of depression, as elicited by PHQ-9, was 11.4%. The role of gender, age, and residency level was not significant in endorsing depression. Conclusion This study indicated that PHQ-9 is a reliable measure among this cross-cultural population. More studies employing robust methodology are needed to confirm this finding.

Implementing cognitive remediation therapy : lessons from two public mental health services

Objective: Neurocognitive deficits are a core symptom domain of schizophrenia, occurring in 75 -90 % of people with this diagnosis and influencing long term functional outcomes. This article aims to describe the pilot implementation of cognitive remediation therapy (CRT) in two large public mental health services and detail changes made to the delivery of this therapy after this trial. Conclusions: CRT provides an evidence based approach to targeting cognitive deficits but the translation of this therapy from a research setting to clinical practice has not been well evaluated.

Giving voice to service providers who work with survivors of torture and trauma

Clinicians who support people from refugee and asylum seeking backgrounds are routinely exposed to stories of trauma as part of their work. Hearing these stories can be highly distressing for clinicians, but simultaneously provide opportunities for positive personal growth. Adopting a longitudinal qualitative design, we interviewed twelve service providers at two time points a year apart. We used a semistructured interview protocol and analyzed the data according to interpretative phenomenological analysis. Five superordinate and 19 constituent themes emerged from the analysis at Time 1 and Time 2. We found that participants were both positively and negatively affected by their work, and their experiences remained relatively stable across time. The participants highlighted the use of organizational and personal coping strategies to help minimize distress and maximize wellbeing. Adopting a broad repertoire of such strategies is not only advantageous for the service providers, but ultimately for those people they seek to assist.

Association between maternal depressive symptoms in the early postnatal period and responsiveness in feeding at child age 2 years

Maternal depression is a known risk factor for poor outcomes for children. Pathways to these poor outcomes relate to reduced maternal responsiveness or sensitivity to the child. Impaired responsiveness potentially impacts the feeding relationship and thus may be a risk factor for inappropriate feeding practices. The aim of this study was to examine the longitudinal relationships between self-reported maternal post-natal depressive symptoms at child age 4 months and feeding practices at child age 2 years in a community sample. Participants were Australian first-time mothers allocated to the control group of the NOURISH randomized controlled trial when infants were 4 months old. Complete data from 211 mothers (of 346 allocated) followed up when their children were 2 years of age (51% girls) were available for analysis. The relationship between Edinburgh Postnatal Depression Scale (EPDS) score (child age 4 months) and child feeding practices (child age 2 years) was tested using hierarchical linear regression analysis adjusted for maternal and child characteristics. Higher EPDS score was associated with less responsive feeding practices at child age 2 years: greater pressure [β = 0.18, 95% confidence interval (CI): 0.04–0.32, P = 0.01], restriction (β = 0.14, 95% CI: 0.001–0.28, P = 0.05), instrumental (β = 0.14, 95% CI: 0.005–0.27, P = 0.04) and emotional (β = 0.15, 95% CI: 0.01–0.29, P = 0.03) feeding practices (ΔR2 values: 0.02–0.03, P < 0.05). This study provides evidence for the proposed link between maternal post-natal depressive symptoms and lower responsiveness in child feeding. These findings suggest that the provision of support to mothers experiencing some levels of depressive symptomatology in the early post-natal period may improve responsiveness in the child feeding relationship.

Strategies for developing and delivering a parental physical activity intervention : answers to the what and how

Background Parents are at risk for physical inactivity; however, few studies have designed physical activity (PA) interventions specifically applied to individuals with young children. To ensure the effectiveness of interventions, it may be useful to first elicit the needs from the target population and incorporate salient strategies identified to the design and delivery of a resultant intervention. We aimed to explore strategies for what to include in and how to best deliver a program designed to increase parental PA. Methods Twelve parents (6 mothers, 6 fathers) of children younger than 5 years participated in focus group discussions exploring strategies for an intervention program designed to increase parental PA. Results A range of themes such as Focus on the Children and Flexible Life/Family Plans imbedded in strategies such as persuasion and information, problem-solving, skill building, and environmental approaches were identified. In addition, a range of strategies for how to best deliver a parental PA intervention evidenced in emerging themes such as Diverse and Brief and Individualized Approach was discussed. Conclusions Future research should continue to adopt a ground up, community-based approach to the development and implementation of interventions for this at-risk group to ensure sustained involvement in regular PA.

Psychological determinants and outcomes of sedentary and physical activity behaviours

There is now a large body of literature that supports the protective role of physical activity for both physical and psychological health. Sedentary behaviour was previously considered the functional opposite of physical activity, but 10 years ago, Owen and colleagues highlighted the need to study physical activity and sedentary behaviour as two distinct modes of behaviour that can independently influence health [1]. Since then, there has been growing evidence that participation in sedentary behaviours such as television viewing, computer use and sitting at work are associated with higher risk of chronic disease outcomes (type 2 diabetes, obesity), and leisure-time sitting has recently been associated with increased mortality [2]. Growing research points to the possible synergistic effects of physical activity and sedentary behaviours in contributing to health outcomes

The effects of a woman-focused, woman-held resource on preventive health behaviors during pregnancy : the pregnancy pocketbook

We evaluated the effectiveness of a woman-held pregnancy record ('The Pregnancy Pocketbook') on improving health behaviors important for maternal and infant health. The Pregnancy Pocketbook was developed as a woman-focused preventive approach to pregnancy health based on antenatal management guidelines, behavior-change evidence, and formative research with the target population and health service providers. The Pregnancy Pocketbook was evaluated using a quasi-experimental, two-group design; one clinic cohort received the Pregnancy Pocketbook (n = 163); the other received Usual Care (n = 141). Smoking, fruit and vegetable intake, and physical activity were assessed at baseline (service-entry) and 12-weeks. Approximately two-thirds of women in the Pregnancy Pocketbook clinic recalled receiving the resource. A small, but significantly greater proportion of women at the Pregnancy Pocketbook site (7.6%) than the UC site (2.1%) quit smoking. No significant effect was observed of the Pregnancy Pocketbook on fruit and vegetable intake or physical activity. Few women completed sections that required health professional assistance. The Pregnancy Pocketbook produced small, but significant effects on smoking cessation, despite findings that indicate minimal interaction about the resource between health staff and the women in their care. A refocus of antenatal care toward primary prevention is required to provide essential health information and behavior change tools more consistently for improved maternal and infant health outcomes.

Constructing subjects and making experts : reading the politics of the psychotherapy novel

This paper examines the ideological and political basis of the practice of psychotherapy in contemporary culture. Psychotherapy is argued to be both inherently political and intimately concerned with the construction of subjectivity. These arguments are examined through interrogating the representation of psychotherapy in the works of Lindner ( The Fifty-Minute Hour , Bantam, New York, 1955) and particularly in Yalom's fictional text Lying on the Couch (HarperPerennial, New York, 1996). The implications within psychotherapy for representing normality, negotiating power, and locating and constructing subjectivity are highlighted through the critical treatment of these texts.

The nature and correlates of young women's peer-directed protective behavioral strategies

Objective Recently, a number of studies have identified self-employed Protective Behavioral Strategies (PBS) as effective in decreasing the level of alcohol-related harm among young people. However, much of the published research has ignored important gender differences, such as women's increased tendency to rely on PBS that are social in nature. To further the understanding of women's PBS, the current study sought to investigate the nature and correlates of the strategies young women employ to keep their friends safe when drinking (i.e., peer-directed PBS). Method A scale measuring peer-directed PBS was developed and administered in conjunction with existing measures of alcohol consumption, personal PBS, and peer attachment. Participants consisted of 422 women aged 18–30 years, recruited among psychology students and the general public. Results Exploratory factor analysis revealed two clusters of peer-directed PBS; those that were aimed at reducing intoxication among one's friends and those that were designed to minimize alcohol-related harms. Further analysis found a positive relationship between women's tendency to implement personal and peer-directed PBS and that risky drinkers were less likely to engage in personal or peer-directed PBS (either type). Conclusion Findings indicate that personal and peer-directed PBS are related behaviors that are less frequently adopted by risky drinkers.

Promoting active lifestyles in young children: investigating mothers’ decisions about their child’s physical activity and screen time behaviours

Objectives Given increasing trends of obesity being noted from early in life and that active lifestyles track across time, it is important that children at a very young age be active to combat a foundation of unhealthy behaviours forming. This study investigated, within a theory of planned behaviour (TPB) framework, factors which influence mothers’ decisions about their child’s 1) adequate physical activity (PA) and 2) limited screen time behaviours. Methods Mothers (N = 162) completed a main questionnaire, via on-line or paper-based administration, which comprised standard TPB items in addition to measures of planning and background demographic variables. One week later, consenting mothers completed a follow-up telephone questionnaire which assessed the decisions they had made regarding their child’s PA and screen time behaviours during the previous week. Results Hierarchical multiple regression analyses revealed support for the predictive model, explaining an overall 73% and 78% of the variance in mothers’ intention and 38% and 53% of the variance in mothers’ decisions to ensure their child engages in adequate PA and limited screen time, respectively. Attitude and subjective norms predicted intention in both target behaviours, as did intentions with behaviour. Contrary to predictions, perceived behavioural control (PBC) in PA behaviour and planning in screen time behaviour were not significant predictors of intention, neither was PBC a predictor of either behaviour. Conclusions The findings illustrate the various roles that psycho-social factors play in mothers’ decisions to ensure their child engages in active lifestyle behaviours which can help to inform future intervention programs aimed at combating very young children’s inactivity.

Correlates of female sexual functioning : adult attachment and differentiation of self

Introduction Female sexual functioning is affected by a range of factors including motivation, psychological well-being, and relationship issues. In understanding female sexual dysfunction (FSD), there has been a tendency to privilege diagnostic and medical over relationship issues. Aim To investigate the association between women’s experience of intimacy in close relationships - operationalized in terms of attachment and degree of differentiation of self - and FSD. Methods Two hundred and thirty sexually active Australian women responded to an invitation to complete a set of validated scales to assess potential correlates of sexual functioning. Main Outcome Measures The Female Sexuality Function Index, the Experiences in Close Relationships Scale, the Differentiation of Self Inventory, as well as a set of study-specific questions were subject to hierarchical multiple regression analyses Results Relational variables of attachment avoidance and to a lesser degree, attachment anxiety were associated with FSD. Participants with lower levels of differentiation of self were more likely to report sexual difficulties. The inability to maintain a sense of self in the presence of intimate others was the strongest predictors of sexual problems. A history of sexual abuse in adulthood and higher levels of psychological distress were also associated with sexual difficulties. Conclusions The findings provide support for a relational understanding of female sexual functioning. Attachment avoidance, attachment anxiety, and degree of differentiation of self are shown to be associated with sexual difficulties. The findings support the need to focus on relational and psychological factors in women’s experience of sex.

An interpretative phenomenological analysis of stress and well-being in Emergency Medical Dispatchers

This study explored the stress and wellbeing of Emergency Medical Dispatchers (EMD) who remotely provide crisis intervention to medical emergencies through telehealth support. Semi-structured interviews with 16 EMDs were conducted and Interpretative Phenomenological Analysis was used to identify themes in the data. These results indicated that despite their physical distance from the crisis scene, EMDs can experience vicarious trauma through acute and cumulative exposure to traumatic incidents and their perceived lack of control which can expound feelings of helplessness. Three superordinate themes of operational stress and trauma, organisational stress, and posttraumatic growth were identified. Practical implications are suggested to enable emergency services organisations to counteract this job related stress and promote more positive mental health outcomes.

Relationship between expectation management and client retention in online Cognitive Behavioural Therapy

Background Engaging clients from the outset of psychotherapy is important for therapeutic success. However, there is little research evaluating therapists’ initial attempts to engage clients. This article reports retrospective analysis of data from a trial of online Cognitive Behavioural Therapy (CBT) for depression. Qualitative and quantitative methods were used to evaluate how therapists manage clients’ expectations at the outset of therapy and its relationship with client retention in the therapeutic intervention. Aims To develop a system to codify expectation management in initial sessions of online CBT and evaluate its relationship with retention. Method Initial qualitative research using conversation analysis identified three different communication practices used by therapists at the start of first sessions: no expectation management, some expectation management, and comprehensive expectation management. These findings were developed into a coding scheme that enabled substantial inter-rater agreement (weighted Kappa = 0.78; 95% CI: 0.52 to 0.94) and was applied to all trial data. Results Adjusting for a range of client variables, primary analysis of data from 147 clients found comprehensive expectation management was associated with clients remaining in therapy for 1.4 sessions longer than those who received no expectation management (95% CI: -0.2 to 3.0). This finding was supported by a sensitivity analysis including an additional 21 clients (1.6 sessions, 95% CI: 0.2 to 3.1). Conclusions Using a combination of qualitative and quantitative methods, this study suggests a relationship between expectation management and client retention in online CBT for depression, which has implications for professional practice. A larger prospective study would enable a more precise estimate of retention.

Enhancing sense of recovery and self-reflectivity in people with schizophrenia : a pilot study of Metacognitive Narrative Psychotherapy

Objective This study investigated the effectiveness of an innovative, manualized psychotherapy aimed at enhancing recovery and self-experience in people with schizophrenia, Metacognitive Narrative Psychotherapy. Design Treatment effects were assessed using a mixed methodology. Data were quantitatively assessed using a single sample, pre- and post-therapy design and qualitatively assessed using a case-study methodology. Methods Eleven patients diagnosed with schizophrenia received Metacognitive Narrative Psychotherapy over the course of 11 to 26 months. Therapists were seven supervised postgraduate psychology students. On average patients attended 49 sessions over the course of therapy. Patients completed interview-based and self-report measures for general and treatment-specific outcomes at pre-, mid-, and post-treatment. Results Quantitative analyses showed that patients significantly improved on the general outcome of subjective recovery, as well as the treatment-specific outcome of self-reflectivity, with medium to large effect sizes. Case-study evidence also showed improvements for some patients in symptom severity, and narrative coherence and complexity. Conclusions These results are consistent with previous case-study evidence and suggest that this manualized version of Metacognitive Narrative Psychotherapy produces general and approach-specific improvements for people with schizophrenia. Replication is needed to ascertain its effectiveness with a larger sample size and within a controlled design.

Social support, self-efficacy, trauma and well-being in emergency medical dispatchers

Emergency Medical Dispatchers (EMDs) respond to crisis calls for ambulance; they dispatch paramedics and provide emotional and medical assistance to callers. Despite the stressful nature and exposure to potentially traumatising events in this role, there has been no published research specifically investigating well-being or posttraumatic growth among EMDs. Extrapolating from research conducted among other emergency services workers (e. g., paramedics, police), literature attests to the importance of self efficacy and social support in promoting mental health in emergency service workers. Therefore, this study assessed the impact of self efficacy, and giving and receiving social support on psychological well-being, posttraumatic growth (PTG), and symptoms of posttraumatic stress disorder (PTSD). Sixty EMDs (50% response rate) completed an online questionnaire. Three hierarchical multiple regression analyses were conducted to ascertain predictors of well-being, PTG and PTSD. Receiving social support emerged as a significant positive predictor of well-being and PTG, and a significant negative predictor of PTSD. Self efficacy was found to significantly and positively predict well-being, and shift-work was found to significantly and negatively predict PTSD. These results highlight that self efficacy and receiving social support are likely to be important for enhancing well-being within this population, and that receiving social support is also likely to facilitate positive post-trauma responses. Such findings have implications for the way emergency service personnel are educated with reference to aspects of mental health and how best to support personnel in order to achieve optimal mental health outcomes for all.