Severely compromised quality of life in women and those of lower socioeconomic status waiting for joint replacement surgery

Objective
To determine health-related quality of life (HRQOL), psychological distress, physical function, and self efficacy in persons waiting for lower-limb joint replacement surgery.

Methods
A total of 214 patients on a waiting list for unilateral primary total knee or hip replacement at a large Australian public teaching hospital completed questionnaires after entry to the list. HRQOL and psychological distress were compared with available population norms.

Results
Average HRQOL was extremely poor (mean ± SD 0.39 ± 0.24) and much lower (>2 SD) than the population norm. Near death-equivalent HRQOL or worse than death-equivalent HRQOL were reported by 15% of participants. High or very high psychological distress was up to 5 times more prevalent in the waiting list sample (relative risk 5.4 for participants ages 75 years and older; 95% confidence interval 3.3, 9.0). Women had significantly lower HRQOL, self efficacy, and physical function scores than men. After adjusting for age and sex, significant socioeconomic disparities were also found. Participants who received the lowest income had the poorest HRQOL; those with the least education or the lowest income had the highest psychological distress. Low self efficacy was moderately associated with poor HRQOL (r = 0.49, P < 0.001) and more strongly associated with high psychological distress (r = -0.55, P < 0.001).

Conclusion
Patients waiting for joint replacement have very poor HRQOL and high psychological distress, especially women and those from lower socioeconomic backgrounds. Lengthy waiting lists mean patients can experience extended and potentially avoidable morbidity. Interventions to address psychological distress and self efficacy could reduce this burden and should target women and lower socioeconomic groups.

Depression and anxiety in patients with cancer and their families

This thesis identified aspects of family relationships and the patients' illness that were associated with depression and anxiety in patients and their relatives after a cancer diagnosis and during treatment. It also tested the ability of a measure of family relationships to identify psychological distress in these families.

The relationship between primary and secondary control and eating behaviour

Two studies were conducted investigating Australian women's management of their life goals. Although engagement with goals was generally positive for psychological well-being, the propensity to disengage from appearance-related goals was beneficial for body image and protective against disordered eating, suggesting strategies for promoting goal disengagement in women with eating disordered behaviour. The portfolio presents four case studies reviewing empirical research demonstrating the efficacy of adjuvant psychological therapy in relieving psychological distress in cancer patients.

Sociometer model of self-esteem : a clinical investigation

This thesis examines the importance of self-esteem, its dominant role in psychological research, and how low self-esteem is implicated in a wide variety of emotional and behavioural disorders. The Sociometry Model of Self-esteem is used to explain the relationship between self-esteem and psychological distress and portrays self-esteem as a guage by which people monitor their level of social inclusion. Four case-studies are presented.

Psychometric properties of the DASS-21 in Malaysia

The use of scales to measure constructs in populations or contexts other than that in which they were normed is highly controversial. Despite this, the use of scales without reference to 'local' norms is still widespread. In this study we examine the reliability, factor structure and convergent validity of the short form of the Depression, Anxiety and Stress Scales (DASS-21), in a convenience sample of 191 people recruited from the general population in Malaysia. Confirmatory factor analysis suggests that a three factor solution provides an acceptable fit, however these three factors are highly correlated. Scores on the depression, anxiety, and stress scales of the DASS-21 correlate with the BDI-II at only moderate levels, suggesting that convergent validity of the depression scale is weak, and that there are not differential relationships between the BDI-II and the three DASS scales. Issues related to the possible role of cultural factors in response patterns, and the need for a greater understanding of the manifestations of psychological distress and how it relates the DASS-21 scales in Malaysia are discussed.

Effects of parental perception of neighbourhood deprivation and family environment characteristics on pro-social behaviours among 4-12 year old children

Objective : To assess the effect family environment stressors (e.g. poor family functioning and parental psychological distress) and neighbourhood environment on child prosocial behaviour (CPB) and child difficulty behaviour (CDB) among 4-to-12 year old children.

Methods : Analysis of the 2006 Victorian Child Health and Wellbeing Survey (VCHWS) dataset derived from a statewide cross-sectional telephone survey, with a final total sample of 3,370 children.

Results : Only family functioning, parental psychological distress, child gender, and age were associated with CPB, explaining a total of 8% of the variance. Children from healthily functioning families and of parents without any psychological distress exhibited greater prosocial behaviours than those from poorly functioning families and of parents with mental health problems. Neighbourhood environment was not found to contribute to CPB. A total of eight variables were found to predict CDB, explaining a total of 16% of the variance. Poor family and parental psychological functioning as well as poor access to public facilities in the neighbourhood were associated with conduct problems in children.

Conclusion : Our results point to the importance of the family environment in providing a context that fosters the development of empathic, caring and responsible children; and in buffering children in exhibiting behaviour difficulties during the formative years of life. Programs aimed at promoting prosocial behaviours in children need to target stressors on the family environment.

Farming fit? Dispelling the Australian agrarian myth.

Background: Rural Australians face a higher mental health and lifestyle disease burden (obesity, diabetes and
cardiovascular disease) than their urban counterparts. Our ongoing research reveals that the Australian farming
community has even poorer physical and mental health outcomes than rural averages. In particular, farm men and
women have high rates of overweightness, obesity, abdominal adiposity, high blood pressure and psychological
distress when compared against Australian averages. Within our farming cohort we observed a significant
association between psychological distress and obesity, abdominal adiposity and body fat percentage in the
farming population.
Presentation of hypothesis: This paper presents a hypothesis based on preliminary data obtained from an
ongoing study that could potentially explain the complex correlation between obesity, psychological distress and
physical activity among a farming population. We posit that spasmodic physical activity, changing farm practices
and climate variability induce prolonged stress in farmers. This increases systemic cortisol that, in turn, promotes
abdominal adiposity and weight gain.
Testing the hypothesis: The hypothesis will be tested by anthropometric, biochemical and psychological analysis
matched against systemic cortisol levels and the physical activity of the subjects.
Implications of the hypothesis tested: Previous studies indicate that farming populations have elevated rates of
psychological distress and high rates of suicide. Australian farmers have recently experienced challenging climatic
conditions including prolonged drought, floods and cyclones. Through our interactions and through the media it is
not uncommon for farmers to describe the effect of this long-term stress with feelings of ‘defeat’. By gaining a
greater understanding of the role cortisol and physical activity have on mental and physical health we may
positively impact the current rates of psychological distress in farmers.

Caring for individuals with an eating disorder

A longitudinal study indicated that carers experienced long-term moderate levels of psychological distress and burden. High levels of negative expressed emotion, use of maladaptive coping strategies and unmet needs predicted burden longitudinally. Further, eating disorder sufferers underestimate the burden experienced by carers. The results support the use of carer-based intervention.

Mixed methods evaluation research for a mental health screening and referral clinical pathway

Rationale: This study is an exemplar of mixed method evaluation research for development of a clinical pathway.

Aim: To develop and evaluate an evidence-based, feasible mental health screening and referral clinical pathway for Department of Veterans’ Affairs-funded community nursing care of war veterans and war widows in the Australian context.

Methods: Mixed methods were applied to formulate and clinically evaluate an appropriate pathway. The pathway was applied at urban and rural sites for the nursing care of 97 war veteran and war widow clients. Evaluative data were collected from clients, their informal carers, community nurses, and general practitioners. Chart auditing and pre-post measures were undertaken. Collaboration occurred with an interdisciplinary design team.

Results: The final modified six-page pathway includes use of validated screening tools (Kessler Psychological Distress Scale [K10]) and Alcohol Use Disorder Identification Test, appropriate referral information, directions for support and health-promoting education, and evidence-based guidelines. Implications for Practice: The clinical pathway is a useful, tested, evidence-based guide for generalist community nurses to identify and suitably respond to common mental healthcare needs of war veterans and war widows. The pathway provides outcomes acceptable to clients and their carers, nurses and doctors.

Conclusions: This study provides an evaluated clinical pathway for generalist community nurses to screen for mental health difficulties, make appropriate referrals as required and to support war veteran and war widow clients. However, the study also shows how research can be used to develop and evaluate
practical, evidence-based clinical pathways.

The impact of bullying on health care administration staff : reduced commitment beyond the influences of negative affectivity

Background: Investigations of workplace bullying in health care settings have tended to focus on nurses or other clinical staff. However, the organizational and power structures enabling bullying in health care are present for all employees, including administrative staff.

Purposes: The purpose of this study was to specifically focus on health care administration staff and examine the prevalence and consequences of workplace bullying in this occupational group.

Methodology/Approach: A cross-sectional study was conducted based on questionnaire data from health care administration staff who work across facilities within a medium to large health care organization in Australia. The questionnaire included measures of bullying, negative affectivity (NA), job satisfaction, organizational commitment, well-being, and psychological distress. The three hypotheses of the study were that (a) workplace bullying will be linked to negative employee outcomes, (b) individual differences on demographic factors will have an impact on these outcomes, and (c) individual differences in NA will be a significant covariate in the analyses. The hypotheses were tested using t tests and analyses of covariances.

Findings: A total of 150 health care administration staff completed the questionnaire (76% response rate). Significant main effects were found for workplace bullying, with lower organizational commitment and well-being with the effect on commitment remaining over and above NA. Main effects were found for age on job satisfaction and for employment type on psychological distress. A significant interaction between bullying and employment type for psychological distress was also observed. Negative affectivity was a significant covariate for all analyses of covariance.

Practice Implications: The applications of these results include the need to consider the occupations receiving attention in health care to include administration employees, that bullying is present across health care occupations, and that some employees, particularly part-time staff, may need to be managed slightly differently to the full-time workforce.

Living with prostate cancer: randomised controlled trial of a multimodal supportive care intervention for men with prostate cancer

Background: Prostate cancer is the most common male cancer in developed countries and diagnosis and treatment carries with it substantial morbidity and related unmet supportive care needs. These difficulties may be amplified by physical inactivity and obesity. We propose to apply a multimodal intervention approach that targets both unmet supportive care needs and physical activity.

Methods/design: A two arm randomised controlled trial will compare usual care to a multimodal supportive care intervention “Living with Prostate Cancer” that will combine self-management with tele-based group peer support. A series of previously validated and reliable self-report measures will be administered to men at four time points: baseline/recruitment (when men are approximately 3-6 months post-diagnosis) and at 3, 6, and 12 months after recruitment and intervention commencement. Social constraints, social support, self-efficacy, group cohesion and therapeutic alliance will be included as potential moderators/mediators of intervention effect. Primary outcomes are unmet supportive care needs and physical activity levels. Secondary outcomes are domain-specific and healthrelated quality of life (QoL); psychological distress; benefit finding; body mass index and waist circumference. Disease variables (e.g. cancer grade, stage) will be assessed through medical and cancer registry records. An economic evaluation will be conducted alongside the randomised trial.

Discussion: This study will address a critical but as yet unanswered research question: to identify a populationbased way to reduce unmet supportive care needs; promote regular physical activity; and improve disease-specific and health-related QoL for prostate cancer survivors. The study will also determine the cost-effectiveness of the intervention.

Personality and the effort-reward imbalance model of stress : individual differences in reward sensitivity

The Effort-Reward Imbalance (ERI) model comprises both situational components (i.e. effort and reward) and a person-specific component (overcommitment). The aims of this study were to investigate the role of theoretically and historically linked personality variables (i.e. overcommitment and Type A personality) within the ERI model and to expand and extend the ERI model by investigating the contribution of individual reward components to both psychological (i.e. psychological distress) and attitudinal (i.e. affective commitment) employee strain indicators. A total of 897 police officers from a large Australian police agency participated in the study. The results provided no evidence of an interaction effect of effort or reward with overcommitment. The Type A variables did, however, make significant contributions and were involved in a number of interactions, suggesting that the person-specific component of the ERI model could be extended with the Type A personality profile. The findings also suggest that the esteem component of reward has the greatest relevance to employee outcomes, although tangible aspects of reward are more likely to act as a buffer of perceived work demand.

A randomised trial of robotic and open prostatectomy in men with localised prostate cancer

Background
Prostate cancer is the most common male cancer in the Western world however there is ongoing debate about the optimal treatment strategy for localised disease. While surgery remains the most commonly received treatment for localised disease in Australia more recently a robotic approach has emerged as an alternative to open and laparoscopic surgery. However, high level data is not yet available to support this as a superior approach or to guide treatment decision making between the alternatives. This paper presents the design of a randomised trial of Robotic and Open Prostatectomy for men newly diagnosed with localised prostate cancer that seeks to answer this question.

Methods
200 men per treatment arm (400 men in total) are being recruited after diagnosis and before treatment through a major public hospital outpatient clinic and randomised to 1) Robotic Prostatectomy or 2) Open Prostatectomy. All robotic prostatectomies are being performed by one surgeon and all open prostatectomies are being performed by one other surgeon. Outcomes are being measured pre-operatively and at 6 weeks and 3, 6, 12 and 24 months post-surgery. Oncological outcomes are being related to positive surgical margins, biochemical recurrence +/ the need for further treatment. Non-oncological outcome measures include: pain, physical and mental functioning, fatigue, summary (preference-based utility scores) and domain-specific QoL (urinary incontinence, bowel function and erectile function), cancer specific distress, psychological distress, decision-related distress and time to return to usual activities. Cost modelling of each approach, as well as full economic appraisal, is also being undertaken.

Discussion
The study will provide recommendations about the relative benefits of Robotic and Open Prostatectomy to support informed patient decision making about treatment for localised prostate cancer; and to assist in treatment services planning for this patient group. Trial Registration ACTRN12611000661976

Depression as a predictor of work resumption following myocardial infarction (MI): a review of recent research evidence

Background Depression often coexists with myocardial infarction (MI) and has been found to impede recovery through reduced functioning in key areas of life such as work. In an era of improved survival rates and extended working lives, we review whether depression remains a predictor of poorer work outcomes following MI by systematically reviewing literature from the past 15 years.

Methods Articles were identified using medical, health, occupational and social science databases, including PubMed, OVID, Medline, Proquest, CINAHL plus, CCOHS, SCOPUS, Web of Knowledge, and the following pre-determined criteria were applied: (i) collection of depression measures (as distinct from 'psychological distress') and work status at baseline, (ii) examination and statistical analysis of predictors of work outcomes, (iii) inclusion of cohorts with patients exhibiting symptoms consistent with Acute Coronary Syndrome (ACS), (iv) follow-up of work-specific and depression specific outcomes at minimum 6 months, (v) published in English over the past 15 years. Results from included articles were then evaluated for quality and analysed by comparing effect size.

Results Of the 12 articles meeting criteria, depression significantly predicted reduced likelihood of return to work (RTW) in the majority of studies (n = 7). Further, there was a trend suggesting that increased depression severity was associated with poorer RTW outcomes 6 to 12 months after a cardiac event. Other common significant predictors of RTW were age and patient perceptions of their illness and work performance.

Conclusion Depression is a predictor of work resumption post-MI. As work is a major component of Quality of Life (QOL), this finding has clinical, social, public health and economic implications in the modern era. Targeted depression interventions could facilitate RTW post-MI.

Better access to mental health program : influence of mental health occupational therapy

Background/aim

The Better Access to Mental Health program has enabled eligible occupational therapists to provide services to people with a mental health condition. No studies have yet reported the influence of occupational therapy under this scheme. The aim of this study was to investigate whether attending an occupational therapist under this initiative influences change in psychological distress of clients as measured by the Kessler Psychological Distress Scale (K10).
Method

A quasi-experimental pretest–posttest design, using pre-existing data collected in the process of regular treatment was used. Data from a total of 31 clients (mean = 17.13 years, SD = 3.603) were accessed for this study. Pre- and post-intervention scores on the K10 were used to determine if psychological distress had changed over the course of intervention.
Results

Highly significant improvements (P < 0.001) were found between the K10 pre-intervention score (mean = 25.68, SD = 9.944) and the K10 post-intervention score (mean = 21.00, SD = 9.212). Male K10 post-intervention scores (mean = 17.64, SD = 5.3) significantly improved (P = 0.05), whereas results for females were not statistically significant. Medication use, diagnosis, age, number of sessions and prior contact with health services did not influence the results. Results from specific evidence-based interventions were not able to be considered in this study.
Conclusion

The results of this study demonstrate effectiveness of occupational therapy services for adolescents and provide support for the ongoing participation of occupational therapists in this scheme.