Cultural diversity and mental health : the relationship between leisure experiences and wellbeing in an ageing Italian community in Australia

One of the population health implications for Australia’s ageing population is that a larger proportion of the Australian community will be retired and have more time for leisure pursuits. Meaningful leisure activities for this group are thought to be a factor in promoting positive mental health. However, a search of health literature revealed a paucity of research on how older adults make use of their leisure time, what meaning these pursuits have to them, and whether their chosen leisure activities are health enhancing and promote wellbeing. Australia’s population is diverse with many cultures represented. As the population ages, mental health workers will be called upon to provide culturally-appropriate mental health services to clients from a range of ethnic groups. Literature on how people of culturally diverse backgrounds understand leisure activities is also limited. This paper reports on a study carried out in an Italian community in a large regional centre. The participants were selected based on the following criteria; aged 65 years and over, born in Italy, independently living in the community, ambulant, and retired from paid workforce. This study explored how a well-elderly group from an ethnic community derived meaning from their leisure activities and how this impacted on their mental health. Establishing the relationship between leisure and mental health in an ageing ethnic community is important because it sheds light on potential intervention strategies that can be used to maintain the mental health of people living independently in the community. Participants were interviewed using semi-structured questions about their perceptions of leisure, the meanings they derived from these activities, and their perceived impact of these activities on their health. Participant observation was also used to add trustworthiness to the data. Themes arising from the interviews and participant observation will be related to the participants’ sense of health. Results also revealed how older Italians engaged in leisure activities. Implications of the research findings will be directed towards mental health practice with older ethnic clients in community settings. The promotion of healthy lifestyles and positive mental health for Australia’s ageing population will also be discussed.

Associations of neighbourhood greenness with physical and mental health : do walking, social coherence and local social interaction explain the relationships?

Background: Studies have shown associations between health indices and access to “green” environments but the underlying mechanisms of this association are not clear.

Objectives: To examine associations of perceived neighbourhood “greenness” with perceived physical and mental health and to investigate whether walking and social factors account for the relationships.

Methods: A mailed survey collected the following data from adults (n  =  1895) in Adelaide, Australia: physical and mental health scores (12-item short-form health survey); perceived neighbourhood greenness; walking for recreation and for transport; social coherence; local social interaction and sociodemographic variables.

Results: After adjusting for sociodemographic variables, those who perceived their neighbourhood as highly green had 1.37 and 1.60 times higher odds of better physical and mental health, respectively, compared with those who perceived the lowest greenness. Perceived greenness was also correlated with recreational walking and social factors. When walking for recreation and social factors were added to the regression models, recreational walking was a significant predictor of physical health; however, the association between greenness and physical health became non-significant. Recreational walking and social coherence were associated with mental health and the relationship between greenness and mental health remained significant.

Conclusions: Perceived neighbourhood greenness was more strongly associated with mental health than it was with physical health. Recreational walking seemed to explain the link between greenness and physical health, whereas the relationship between greenness and mental health was only partly accounted for by recreational walking and social coherence. The restorative effects of natural environments may be involved in the residual association of this latter relationship.

Are perceptions of the local environment related to neighbourhood satisfaction and mental health in adults?

Background: Perceptions of environmental attributes can influence satisfaction with where people live and mental health status. We examined the association between perceived environmental characteristics, neighbourhood satisfaction, and self-rated mental health.

Methods: We report cross-sectional data from the Physical Activity in Localities and Community Environments (PLACE) study in Australia (n = 2194). Self-report data included socio-demographics, perceived attributes of the environment, neighbourhood satisfaction (NS) and mental health status. Neighbourhood SES was obtained through census data. Factor analysis was used to identify dimensions of NS. Generalized linear models were used to examine associations between NS and perceived environment characteristics and whether aspects of NS were independently associated with mental health.

Results: NS factors identified were safety and walkability, access to destinations, social network, travel network, and traffic and noise. Perceived environmental characteristics of aesthetics and greenery, land use mix – diversity, street connectivity, traffic safety, infrastructure for walking, access to services and barriers to walking were found to be positively associated with these factors. Traffic load and crime were negatively associated. Three NS factors (safety and walkability, social network, and traffic and noise) were independent predictors of mental health.

Conclusions: Neighbourhood satisfaction may mediate the association between perceived environmental characteristics and measures of mental health in adults.

Nutrition and mental health research in Australia and New Zealand: A review of progress and directions for the future

This review summarises nutrition and mental health research in Australia and New Zealand between 1986 and 2006. The method used to identify papers for inclusion was a search of computerised databases: Medline, Cinahl and Meditext 1986–2006, with subsequent bibliographical review. Key search words were nutrition, diet, mental disorder, mental illness, weight, physical health, Australia and New Zealand. Inclusion criteria included: English language, original data in peer reviewed journals, and examination of some component of nutrition in people with a mental illness. The review of thirteen papers found that the evidence base for dietetic practice in mental health has developed through small assessment and interventional research, often with multidisciplinary collaboration. Future research should include quality and outcome measures with intersectoral partnerships. Dietitians are well positioned to lead and participate in mental health research and to implement research findings to improve the nutritional status of this vulnerable group.

Identifying the health and mental health information needs of people with coronary heart disease, with and without depression

Objective:
To identify the health and mental health information needs of people with coronary heart disease (CHD), with and without comorbid depression.

Design and setting:
A qualitative study conducted in Melbourne in 2006, using thematic analysis of semi-structured interviews on the types of health information that patients with CHD considered useful to assist with the management of their illness. Structured clinical interviews were used to assess current and prior depressive episodes in these patients.

Participants:
14 general practice patients (eight with current or prior history of major depression) who had experienced myocardial infarction, coronary artery bypass graft surgery, angioplasty or angina (confirmed via testing).

Results:
Four themes relating to information on how patients could manage their cardiovascular health and improve their psychosocial wellbeing emerged: psychosocial; physical activity; medical; and information for family. The most prominent information needs included identification and management of risk-related physical symptoms, and psychosocial information, most notably to enhance patients’ social support. Patients considered this information important for alleviating health anxiety and negative affect.

Conclusion:
This small patient sample endorsed the need for health and mental health information on a range of psychosocial and physical health topics. Participants desired specific types of information to assist with the self-management of their health and to assuage their health concerns.

Doctoral graduates in mental health nursing in Victoria, Australia : the doctoral experience and contribution to scholarship

The last decade has seen a substantial increase in the number of psychiatric or mental health nurses in Victoria, Australia who hold doctoral qualifications. The literature refers to the importance of scholarship for the professional development and recognition of nursing as a discipline. However, there is a paucity of literature addressing the contribution of nursing doctoral graduates to scholarship in mental health nursing or indeed the broader nursing profession. This paper presents the findings from a survey of psychiatric nurse doctoral graduates currently residing in the State of Victoria. A questionnaire was developed by the authors and distributed to the known doctoral graduates. The main findings demonstrate considerable variation in the discipline and topic of inquiry and in the extent to which doctoral studies had led to dissemination of research findings and engagement in further scholarly activity. The strengthening of mental health nursing knowledge requires scholarship and doctoral graduates are expected to make a major contribution, through research and the dissemination of findings. This paper presents a descriptive overview of doctoral graduates in one State of Australia with a particular focus on research and scholarship.

Buffering effect of leisure self-determination on the mental health of older adults

Leisure self-determination was tested for its capacity to buffer the effects of life stress on the level of depression of older adults. A direct association between leisure-self-determination and level depression was also tested. A sample of 152 individuals aged 49 years and over completed a questionnaire which included measures of stress, leisure self-determination, and depression. Hierarchical multiple regression analysis incorporating an interaction component to represent the buffering effect was used to analyse the data. Higher levels of leisure self-determination were significantly associated with lower levels of depression regardless of life stress. Leisure self-determination also acted as a buffer of the association between life stress and depression. The study has significant theoretical and practical implications. Theoretically, it supports the stress buffering hypothesis of Coleman and Iso-Ahola (1993) when applied to a sample of older adults. The practical implications of the empirical evidence focus on the importance of fostering leisure self-determination dispositions through leisure practices, policies, and leadership styles that facilitate and support older adult autonomy in leisure experiences.

Practical application of the Delphi technique in a bicultural mental health nursing study in New Zealand

Background. Numerous studies have employed the Delphi technique to seek expert opinion about aspects of clinical practice. When researching literature on the Delphi technique, however, we discovered discrepancies in its application, and a lack of detail when reporting design, administration, and analysis methods. Such lack of specificity hinders the replicability and assessment of the clinical and cultural validity and reliability of Delphi studies.

Aim. The aim of this paper is to detail the practical application of the Delphi technique as a culturally and clinically valid means of accessing expert opinion on the importance of clinical criteria.

Methods. Reference is made to a bicultural New Zealand mental health nursing clinical indicator study that employed a three-round reactive Delphi survey. Equal proportions of Maori and non-Maori nurses (n = 20) and consumers (n = 10) rated the importance of 91 clinical indicator statements for the achievement of professional practice standards. Additional statements (n = 21) suggested by Delphi participants in round 1 were included in subsequent rounds. In round 2, participants explained the rating they applied to statements that had not reached consensus in round 1, and summarized responses were provided to participants in round 3. Consensus was considered to have been achieved if 85% of round 3 ratings lay within a 2-point bracket on the 5-point Likert-scale overall, or in one of the Maori nurse, non-Maori nurse, or consumer groups. A mean rating of 4·5 after round 3 was set as the importance threshold.

Findings. Consensus occurred overall on 75 statements, and within groups on another 24. Most statements (n = 86) reached the importance benchmark.

Conclusions. When rigorous methods of participant selection, group composition, participant feedback, and determination of consensus and importance are employed, the Delphi technique is a reliable, cost-effective means of obtaining and prioritizing experts judgements.

Development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand

This paper reports the three-stage development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand. In Study 1, clinical indicator statements (n = 99) generated from focus group data, which were considered to be unobservable in the nursing documentation in consumer case notes, were included in a three-round Delphi process. Consensus of ratings occurred for the mental health nurse and academic participants (n = 7) on 83 clinical indicator statements. In Study 2, the clinical indicator statements (n = 67) that met importance and consensus criteria were incorporated into a questionnaire, which was piloted at a New Zealand mental health service. The questionnaire was then modified for use in a national field study. In Study 3, the national field study, registered mental health nurses (n = 422) from 11 New Zealand District Health Board mental health services completed the questionnaire. Five categories of nursing practice were identified: professional and evidence-based practice; consumer focus and reflective practice; professional development and integration; ethically and legally safe practice; and culturally safe practice. Analyses revealed little difference in the perceptions of nurses from different backgrounds regarding the regularity of the nursing practices. Further research is needed to calibrate the scores on each clinical indicator statement with behaviour in clinical practice.