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.

Pregnancy loss and mental health

Between 8 and 20 percent of depression in young men and women aged 18-23 is associated with pregnancy loss, according to a recent analysis of the 30 year Mater Hospital longitudinal study of mothers and children. Dr Kaeleen Dingle from the University of Queensland explains the study and discusses the implications for both men and women.

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.

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

Hepatitis C, mental health and equity of access to antiviral therapy : a systematic narrative review

Introduction Access to hepatitis C (hereafter HCV) antiviral therapy has commonly excluded populations with mental health and substance use disorders because they were considered as having contraindications to treatment, particularly due to the neuropsychiatric effects of interferon that can occur in some patients. In this review we examined access to HCV interferon antiviral therapy by populations with mental health and substance use problems to identify the evidence and reasons for exclusion. Methods We searched the following major electronic databases for relevant articles: PsycINFO, Medline, CINAHL, Scopus, Google Scholar. The inclusion criteria comprised studies of adults aged 18 years and older, peer-reviewed articles, date range of (2002--2012) to include articles since the introduction of pegylated interferon with ribarvirin, and English language. The exclusion criteria included articles about HCV populations with medical co-morbidities, such as hepatitis B (hereafter HBV) and human immunodeficiency virus (hereafter HIV), because the clinical treatment, pathways and psychosocial morbidity differ from populations with only HCV. We identified 182 articles, and of these 13 met the eligibility criteria. Using an approach of systematic narrative review we identified major themes in the literature. Results Three main themes were identified including: (1) pre-treatment and preparation for antiviral therapy, (2) adherence and treatment completion, and (3) clinical outcomes. Each of these themes was critically discussed in terms of access by patients with mental health and substance use co-morbidities demonstrating that current research evidence clearly demonstrates that people with HCV, mental health and substance use co-morbidities have similar clinical outcomes to those without these co-morbidities. Conclusions While research evidence is largely supportive of increased access to interferon by people with HCV, mental health and substance use co-morbidities, there is substantial further work required to translate evidence into clinical practice. Further to this, we conclude that a reconsideration of the appropriateness of the tertiary health service model of care for interferon management is required and exploration of the potential for increased HCV care in primary health care settings.

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.

Community health workers' response to violence against women

This paper reports on a qualitative study of community health workers from a predominantly rural based region in Queensland. The purpose of this study was to determine the community health worker barriers to identification, assessment and intervention on the issue of violence against women. The qualitative research method comprised five structured focus group interviews with 28 community health workers using open-ended questions to explore their perceptions. Analysis of the focus group data revealed that community health workers expressed reluctance to become involved in cases of violence against women. The reasons they provided are grouped under three main themes: barriers to identification; barriers to assessment; and barriers to intervention. Training programs offered to rural community health workers need to be aware of the barriers to identifying, assessing and intervening in cases of violence against women that are highlighted by this study. Further studies are needed to assess the wider relevance of these findings to other groups of community health workers in rural and non-rural settings.

Worrying and anxiety are some of the biggest mental health problems facing children today

People often assume children have no worries or nothing to be stressed about. However, children, like adults, do worry about a range of things. There may be times during periods of stress or change when children worry more intensely about things than usual.

Design and ethics in digital mental health promotion

This chapter presents a case study of Participatory Design as a design framework for developing interactive digital tools for promoting children’s resilience. The author argues for a participatory methodology as an ethical approach that involves children as co-designers in the process from which they are traditionally excluded, namely the creative design process and the process of mental health promotion.

Screening for risk of later mental health problems : a longitudinal study

Purpose: This is one of the first studies to report that the Achenbach internalising scales were much more effective at identifying those with current comorbid depression and anxiety, rather than individual mood disorder. Introduction: The Achenbach behaviour checklists (YSR,YASR) are widely used, low cost screening tools used to assess problem behaviour. Several studies report good association between the checklists and psychiatric diagnoses; although with varying degrees of agreement. Most are cross-sectional studies involving adolescents referred to mental health services; few are in large community-based studies. This study examined the usefulness of the Achenbach internalising scales in the primary screening (both predictive and concurrent)for depression and anxiety. Methods: The sample was 2400 young adults from an Australian population-based prospective birth cohort study. The association between the empirical anxiety and depression scales were individually assessed against DSM-IV depression and anxiety diagnoses. Odds ratios and diagnostic efficiency tests report the findings. Results: Adolescents with internalising symptoms were twice (OR 2.3, 95%CI 1.7 to 3.1) as likely to be diagnosed with later DSM-IV depression. YASR 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. The internalising scales were much more effective at identifying those with comorbid depression and anxiety. Conclusions: Adolescence and early adulthood are key risk periods for the onset of anxiety and depression. This study found that young people with internalising behaviour problems were more likely to have comorbid depression and anxiety DSM-IV disorder.

Investigating well-being and mental health in Queensland fire-fighters

This thesis used survey and interview methods to examine how organisational and interpersonal factors impact on the mental health of fire and rescue workers. It was the first published research to assess and predict multiple indicators of mental health; psychological distress, well-being, posttraumatic growth and posttraumatic stress disorder symptoms. The results provide valuable information for supporting fire and rescue workers through psychoeducation and proactive intervention programs.

Autism : an introduction to behavioural therapy models used for autism and nursing the person with autism in the primary care setting

Childhood autism falls under the guise of autism spectrum disorders and is generally found in children over two years of age. There are of course variations in severity and clinical manifestations, however the most common features being disinterest in social interaction and engagement in ritualistic and repetitive behaviours. In Singapore the incidence of autism is on the rise as parents are becoming more aware of the early signs of autism and seek healthcare programmes to ensure the quality of life for their child is optimised. Two such programmes, Applied Behaiour Analysis and Floortime approach have proven successful in alleviating some of the behavioural and social skills problems associated with autism. Using positive behaviour reinforcement both Applied Behaviour Analysis and Floortime approach reward behaviour associated with positive social responses.

Insider comes out : an artist's inquiry and narrative about the relationship of art and mental health

Background Through an account of prevailing experiences of art and mental illness, this paper aims to raise awareness, open dialogue and create agency about art created by people with experience of mental illness. Methods This paper draws on personal narrative and inquiry by an artist with mental illness and data collected as part of a larger participatory action research project that investigated understandings of identity, art and mental illness. Result An inquiry through art raised awareness and attentiveness to the importance of choice in identity construction and exposed frequent dichotomies in art and mental illness that were negotiated to eschew prescribed social stratification. As an artist, the first author challenged values present in one idea and absent in the other, and the options and concessions available to authorise her own dialogue and agency of being an artist. Conclusion Constructing an identity is an important part of being human, the labels that we choose or are chosen for us attribute to our identity. Reflections and recommendations are offered to consider expanded ways of thinking about art and mental illness and the functions that art play in identity construction.

The importance of social support for students with intellectual disability : an intervention to promote mental health and well-being

Children and adolescents with intellectual disability have higher rates of mental health problems compared with there typically developing peers. Social support has been identified as an important protective factor for psychological well - being. In this paper we discuss the benefits of social support networks, and consider approaches for promoting children’s perceptions of the availability of social support. We describe an evidence-based intervention that has been specially adapted and implemented for students with intellectual disability in school settings. In a randomised controlled trial, the Aussie Optimism Resilience Skills Program was associated with improved perceptions of social support following a 10-week intervention. Educators need to be aware of the increased vulnerability of students with intellectual disability to the development mental health problems and the proactive ways in which they can promote psychological well - being within their classrooms.

Self-regulation from birth to age seven : associations with maternal mental health, parenting, and social, emotional and behavioural outcomes for children

Self-regulation refers to our individual capacities to regulate our behaviours, emotions, and thoughts, with these skills developing rapidly across early childhood. This thesis examined sleep, emotional, and cognitive regulation development, and related parental influences, for children participating in the Longitudinal Study of Australian Children. Important longitudinal associations among children's self-regulation, maternal mental health, parenting, and later behaviour problems for children were also investigated. A unique contribution of this research was a prevalence estimate of early childhood self-regulation problems in Australian children that was documented for the first time.