Femininity, mental weakness and difference : male students account for anorexia nervosa in men

The purpose of this study was to examine how men account for the diagnosis in men of anorexia nervosa (AN), a condition commonly associated with women. Male students participated in focus group discussions of topics related to AN. Discussions were tape-recorded with participants' consent, transcribed, and then analyzed using discourse analysis. The participants spontaneously constructed AN as a female-specific condition. When asked to account for AN in men, they distanced AN from hegemonic masculinities in ways that sustained both dominant masculine identities and gender-specific constructions of AN. These findings show how issues of health and gender are interlinked in everyday understandings of AN. Future researchers might usefully consider how the construction of gender-specific illness implicates wider notions of both feminine and masculine gender identities.

Understanding body image disturbance in the promotion of mental health : a discourse analytic study

Health care interventions in the area of body image disturbance and eating disorders largely involve individual treatment approaches, while prevention and health promotion are relatively underexplored. A review of health promotion activities in the area of body image in Australia revealed three programmes, the most extensive and longest standing having been established in 1992. The aims of this programme are to reduce body image dissatisfaction and inappropriate eating behaviour, especially among women. Because health promotion is concerned with the social aspects of health, it was hypothesized by the authors that a social understanding of body image and eating disorders might be advanced in a health promotion setting and reflected in the approach to practice. In order to examine approaches to body image in health promotion, 10 health professionals responsible for the design and management of this programme participated in a series of semi-structured interviews between 1997 and 2000. Three discursive themes were evident in health workers' explanations of body image problems: (1) cognitive-behavioural themes; (2) gender themes; and (3) socio-cultural themes. While body image problems were constructed as psychological problems that are particularly experienced by women, their origins were largely conceived to be socio-cultural. The implications of these constructions are critically discussed in terms of the approach to health promotion used in this programme.

A nurse-led model of oncogeriatric assessment

Background There is growing consensus that a multidisciplinary, comprehensive and standardised process for assessing the fitness of older patients for chemotherapy should be undertaken to determine appropriate cancer treatment. Aim This study tested a model of cancer care for the older patient incorporating Comprehensive Geriatric Assessment (CGA), which aimed to ensure that 'fit' individuals amenable to active treatment were accurately identified; 'vulnerable' patients more suitable for modified or supportive regimens were determined; and 'frail 'individuals who would benefit most from palliative regimens were also identified and offered the appropriate level of care. Methods A consecutive-series n=178 sample of patients >65 years was recruited from a major Australian cancer centre. The following instruments were administered by an oncogeriatric nurse prior to treatment: Vulnerable Elders Survey-13; Cumulative Illness Rating Scale (Geriatric); Malnutrition Screening Tool; Mini-mental State Examination; Geriatric Depression Scale; Barthel Index; and Lawton Instrumental Activities of Daily Living Scale. Scores from these instruments were aggregated to predict patient fitness, vulnerability or frailty for chemotherapy. Physicians provided a concurrent (blinded) prediction of patient fitness, vulnerability or frailty based on their clinical assessment. Data were also collected on actual patient outcomes (eg treatment completed as predicted, treatment reduced) during monthly audits of patient trajectories. Data analysis Data analysis is underway. A sample of 178 is adequate to detect, with 90% power, kappa coefficients of agreement between CGA and physician assessments of K>0.90 ("almost perfect agreement"). Primary endpoints comprise a) whether the nurse-led CGA determination of fit, vulnerable or frail agrees with the oncologist's assessments of fit, vulnerable or frail and b) whether the CGA and physician assessments accurately predict actual patient outcomes. Conclusion An oncogeriatric nurse-led model of care is currently being developed from the results. We conclude with a discussion of the pivotal role of nurses in CGA-based models of care.

Pregnancy loss and psychiatric disorders in young women : an Australian birth cohort study

Background Recent evidence has linked induced abortion with later adverse psychiatric outcomes in young women. Aims To examine whether abortion or miscarriage are associated with subsequent psychiatric and substance use disorders. Method A sample (n=1223) of women from a cohort born between 1981 and 1984 in Australia were assessed at 21 years for psychiatric and substance use disorders and lifetime pregnancy histories. Results Young women reporting a pregnancy loss had nearly three times the odds of experiencing a lifetime illicit drug disorder (excluding cannabis): abortion odds ratio (OR)=3.6 (95% CI 2.0–6.7) and miscarriage OR=2.6 (95% CI 1.2–5.4). Abortion was associated with alcohol use disorder (OR=2.1, 95% CI 1.3–3.5) and 12-month depression (OR=1.9, 95% CI 1.1–3.1). Conclusions These findings add to the growing body of evidence suggesting that pregnancy loss per se, whether abortion or miscarriage, increases the risk of a range of substance use disorders and affective disorders in young women.

Predicting depressive and anxiety disorders with the YASR internalising scales (empirical and DSM-oriented)

Background The Achenbach problem behaviour scales (CBCL/YSR) are widely used. The DSM-oriented anxiety and depression scales have been created to improve concordance between Achenbach’s internalising scales and DSM-IV depression and anxiety. To date no study has examined the concurrent utility of the young adult (YASR) internalising scales, either the empirical or newly developed DSM-oriented depressive or anxiety scales. Methods A sample of 2,551 young adults, aged 18–23 years, from an Australian cohort study. The association between the empirical and DSM-oriented anxiety and depression scales were individually assessed against DSMIV depression and anxiety diagnoses derived from structured interview. Odds ratios, ROC analyses and diagnostic efficiency tests (sensitivity, specificity, positive and negative predictive values) were used to report findings. Results YASR empirical internalising scale predicted DSM-IV mood disorders (depression OR = 6.9, 95% CI 5.0–9.5; anxiety OR = 5.1, 95% CI 3.8–6.7) in the previous 12 months. DSM-oriented depressive or anxiety scales did not appear to improve the concordance with DSM-IV diagnosed depression or anxiety. The internalising scales were much more effective at identifying those with comorbid depression and anxiety, with Ors between 10.1 and 21.7 depending on the internalising scale used. Conclusion DSM-oriented scales perform no better than the standard internalising in identifying young adults with DSM-IV mood or anxiety disorder.

PP39 Mental health outcomes of abortion for young women aged 18-23 years, findings from an Australian longitudinal birth cohort study

Background: Few longitudinal studies have examined the mental health outcomes of women after abortion and the results are controversial. Despite falling birth rates, teenage pregnancies remain high and over half (53%) of teenage and a third (36%) of young adult (20_24 years) pregnancies are aborted. Recent findings from a NewZealand longitudinal birth cohort linked abortion and subsequent psychiatric disorders in young women. Limited Australian data is available examining this association. Methods: Data were taken from the Mater-University Study of Pregnancy (MUSP). Running since 1981, this is a prospective birth cohort study of 7223 mothers and children. At the 21-year follow-up 3775 (52.3% of the original cohort) participants were surveyed, of these 1132 young women had complete data on pregnancy outcomes and psychiatric diagnoses from a structured interview. Binary logistic regression examined the association between five lifetime psychiatric disorders (nicotine, alcohol, cannabis, affective and anxiety disorders) and ever having an abortion or birth. Analyses adjusted for age, concurrent and maternal sociodemographic factors, and factors related to adolescent behaviour, previous mental health and family functioning. Results: A quarter of the young women (n_261) reported at least one pregnancy and 32.6% had an abortion. Abortion was significantly associated with age-adjusted OR for all the lifetime disorders. After full adjustment abortion remained significantly associated with nicotine (OR_2.1, 1.2_3.6) and alcohol disorders (OR_2.0, 1.3_3.3). Conclusion: The findings suggest that abortion in young women is independently associated with an increased risk of nicotine and alcohol disorders.

The Large Allen Cognitive Level Screen as an indicator for medication adherence among adults accessing community mental health services

Background: Medication remains the cornerstone treatment for mental illness. Cognition is one of the strongest predictors of non-adherence. The aim of this preliminary investigation was to examine the association between the Large Allen Cognitive Level Screen (LACLS) and medication adherence among a small sample of mental health service users to determine whether the LACLS has potential as a screening tool for capacity to manage medication regimens. Method: Demographic and clinical information was collected from a small sample of people who had recently accessed community mental health services. Participants then completed the LACLS and the Medication Adherence Rating Scale (MARS) at a single time point. The strength of association between the LACLS and MARS was examined using Spearman rank-order correlation. Results: A strong positive correlation between the LACLS and medication adherence (r = 0.71, p = 0.01) was evident. No participants reported the use of medication aids despite evidence of impaired cognitive functioning. Conclusion: This investigation has provided the first empirical evidence indicating that the LACLS may have utility as a screening instrument for capacity to manage medication adherence among this population. While promising, this finding should be interpreted with caveats given its preliminary nature.

The institutional limits to, and possibility of, understanding young people diagnosed with 'mental disorders', within inclusive teacher-student relationships

A persistent pattern of exclusion of young people with ‘mental disorders’ from school systems, despite the best intentions of schools and teachers, has prompted a call for a more reflexive understanding of their behaviours. This thesis, by describing how institutionally recognised ways of understanding can result in otherwise avoidable moral collisions and exclusion, produces new insights into the nature and processes of understanding required to promote inclusion. These insights were produced through an intensive qualitative examination of a violent classroom episode, identifying key points in the interaction that could make the difference between misrecognition and recognition, turning exclusion into inclusion.

Home-based activity program for older people with depressive symptoms: DeLLITE–A randomized controlled trial

PURPOSE We wanted to assess the effectiveness of a home-based physical activity program, the Depression in Late Life Intervention Trial of Exercise (DeLLITE), in improving function, quality of life, and mood in older people with depressive symptoms. METHODS We undertook a randomized controlled trial involving 193 people aged 75 years and older with depressive symptoms at enrollment who were recruited from primary health care practices in Auckland, New Zealand. Participants received either an individualized physical activity program or social visits to control for the contact time of the activity intervention delivered over 6 months. Primary outcome measures were function, a short physical performance battery comprising balance and mobility, and the Nottingham Extended Activities of Daily Living scale. Secondary outcome measures were quality of life, the Medical Outcomes Study 36-item short form, mood, Geriatric Depression Scale (GDS-15), physical activity, Auckland Heart Study Physical Activity Questionnaire, and self-report of falls. Repeated measures analyses tested the differential impact on outcomes over 12 months’ follow-up. RESULTS The mean age of the participants was 81 years, and 59% were women. All participants scored in the at–risk category on the depression screen, 53% had a Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases, Tenth Revision diagnosis of major depression or scored more than 4 on the GDS-15 at baseline, indicating moderate or severe depression. Almost all participants, 187 (97%), completed the trial. Overall there were no differences in the impact of the 2 interventions on outcomes. Mood and mental health related quality of life improved for both groups. CONCLUSION he DeLLITE activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits. Future social and activity interventions should be tested against a true usual care control.

Consumer acceptance of m-wellbeing services : a social marketing perspective

Purpose This study aims to employ the Model of Goal-Directed Behaviour (MGB) to examine the consumer acceptance of technology-based self-service (TBSS) for a credence service instrumental to a social goal. Credence services are increasingly delivered via self-service technology and in social marketing, the achievement of social goals can be contingent on consumer acceptance of these services. However, little is known about the determinants of acceptance and extant marketing literature fails to account for emotional and goal influences which are likely to be important. Design/methodology/approach The authors interviewed 30 young adults with self-reported stress, anxiety or depression as potential users of a self-help mental health service delivered via mobile phone. The data were analysed deductively and inductively with the assistance of NVivo. Findings The findings generally support using the MGB to enhance understanding of consumers' acceptance of TBSS. The paper also found evidence of the importance of maintenance self-efficacy, the self-evaluation of the ability to continue using the service, and a previously ignored element of consumer level competition that arises between alternatives that achieve the same goal. Originality/value This study is the first to examine factors that influence consumers' acceptance of TBSS for credence services aimed at achieving a social goal. It builds on understanding of consumer decision making in social marketing, particularly the influence of self-efficacy and competition. It also contributes to attitudinal research by providing initial evidence for deepening and broadening the MGB in the context of TBSSs.

Predictors of physical and mental health-related quality of life outcomes among myocardial infarction patients

Background Health-related quality of life (HRQoL) is an important outcome for patients diagnosed with coronary heart disease. This report describes predictors of physical and mental HRQoL at six months post-hospitalisation for myocardial infarction. Methods Participants were myocardial infarction patients (n=430) admitted to two tertiary referral centres in Brisbane, Australia who completed a six month coronary heart disease secondary prevention trial (ProActive Heart). Outcome variables were HRQoL (Short Form-36) at six months, including a physical and mental summary score. Baseline predictors included demographics and clinical variables, health behaviours, and psychosocial variables. Stepwise forward multiple linear regression analyses were used to identify significant independent predictors of six month HRQoL. Results Physical HRQoL was lower in participants who: were older (p<0.001); were unemployed (p=0.03); had lower baseline physical and mental HRQoL scores (p<0.001); had lower confidence levels in meeting sufficient physical activity recommendations (p<0.001); had no intention to be physically active in the next six months (p<0.001); and were more sedentary (p=0.001). Mental HRQoL was lower in participants who: were younger (p=0.01); had lower baseline mental HRQoL (p<0.001); were more sedentary (p=0.01) were depressed (p<0.001); and had lower social support (p=0.001). Conclusions This study has clinical implications as identification of indicators of lower physical and mental HRQoL outcomes for myocardial infarction patients allows for targeted counselling or coronary heart disease secondary prevention efforts. Trial registration Australian Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, CTRN12607000595415. Keywords: Myocardial infarction; Secondary prevention; Cardiac rehabilitation; Telephone-delivered; Health-related quality of life; Health coaching; Tele-health

Depressive symptoms during pregnancy: Exploring the role of sitting

Statement of problem: Studies exploring relationships between sitting and mental health have been conducted in child and adult, but not pregnant populations. Depression during pregnancy is associated with deleterious outcomes for mothers and children, and shortcomings have been identified in current management strategies. Modifiable lifestyle behaviors may provide more acceptable alternatives to current management strategies if shown to be important. The aim of this study was to explore the relationship between sitting behavior and depressive symptoms in a population of pregnant Australian women. Methods: This pilot cross-sectional study included 81 pregnant women in Brisbane, Australia. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS). Sitting behavior was measured using the Australian Women's Activity Survey (AWAS). Several potential covariates were also assessed. Linear regression analyses were used to explore the relationship between sitting and depressive symptoms, whilst controlling for known covariates. Results: The model investigating “total sitting time” showed no association with depressive symptoms (F = .77, p = 0.38). The model investigating “planned leisure sitting time” was statistically significant (F = 4.42, p = 0.04): significant contributors to the model variance were HADS anxiety score (p = 0.003) and number of existing children (p = 0.02). “Planned leisure sitting time” showed a statistical trend toward significance (p = 0.06). Conclusions: This study suggests further investigation of the relationship between sitting, particularly planned leisure sitting, and depression during pregnancy is warranted. Future research should include a larger sample and an objective measure of leisure time sitting.

Recognising facial expressions with noisy data

Techniques to improve the automated analysis of natural and spontaneous facial expressions have been developed. The outcome of the research has applications in several fields including national security (eg: expression invariant face recognition); education (eg: affect aware interfaces); mental and physical health (eg: depression and pain recognition).

Inpatients had mostly negative experiences of seclusion during short term treatment in a mental health facility

Design Semi-structured interviews. Setting 2 open, acute care units of a large tertiary mental health facility in Queensland, Australia. Patients 12 patients (58% men) who were 18–52 years of age and were secluded in the previous 7 days (mean duration 3.4 h). Methods Semi-structured, thematically organised interviews were audiotaped and transcribed. Transcripts were checked for errors against the audiotaped versions and were analysed using the process of meaning categorisation. Themes were identified and coded to produce categories. All members of the research team agreed on the final categorisations. These broad categories were further analysed, and themes were used to reflect patients' experiences of seclusion. Main findings 5 recurrent themes emerged. (1) Patients described the use of seclusion. Some patients thought that seclusion was used inappropriately and that the seclusion period was of more benefit to …

Depression scores predict adherence in a dietary weight loss intervention trial

Background & aims Depression has a complex association with cardiometabolic risk, both directly as an independent factor and indirectly through mediating effects on other risk factors such as BMI, diet, physical activity, and smoking. Since changes to many cardiometabolic risk factors involve behaviour change, the rise in depression prevalence as a major global health issue may present further challenges to long-term behaviour change to reduce such risk. This study investigated associations between depression scores and participation in a community-based weight management intervention trial. Methods A group of 64 overweight (BMI > 27), otherwise healthy adults, were recruited and randomised to follow either their usual diet, or an isocaloric diet in which saturated fat was replaced with monounsaturated fat (MUFA), to a target of 50% total fat, by adding macadamia nuts to the diet. Subjects were assessed for depressive symptoms at baseline and at ten weeks using the Beck Depression Inventory (BDI-II). Both control and intervention groups received advice on National Guidelines for Physical Activity and adhered to the same protocol for food diary completion and trial consultations. Anthropometric and clinical measurements (cholesterol, inflammatory mediators) also were taken at baseline and 10 weeks. Results During the recruitment phase, pre-existing diagnosed major depression was one of a range of reasons for initial exclusion of volunteers from the trial. Amongst enrolled participants, there was a significant correlation (R = −0.38, p < 0.05) between BDI-II scores at baseline and duration of participation in the trial. Subjects with a baseline BDI ≥10 (moderate to severe depression symptoms) were more likely to dropout of the trial before week 10 (p < 0.001). BDI-II scores in the intervention (MUFA) diet group decreased, but increased in the control group over the 10-week period. Univariate analysis of variance confirmed these observations (adjusted R2 = 0.257, p = 0.01). Body weight remained static over the 10-week period in the intervention group, corresponding to a relative increase in the control group (adjusted R2 = 0.097, p = 0.064). Conclusions Depression symptoms have the potential to affect enrolment in and adherence to dietbased risk reduction interventions, and may consequently influence the generalisability of such trials. Depression scores may therefore be useful for characterising, screening and allocating subjects to appropriate treatment pathways.