An individualized psychosocial approach for "treatment resistant" behavioral symptoms of dementia among aged care residents

Background: Behavioral symptoms of dementia are common among residents in mainstream aged care settings, and have a substantial impact on residents and professional caregivers. This study evaluated the impact of individualized psychosocial interventions for behavioral symptoms through a small preliminary study.
Method: Interventions were delivered to a patient group of 31 psychogeriatric aged care residents who presented with behavioral symptoms of dementia that had failed to respond to pharmacological treatment approaches. Outcome data on severity of behaviors, health service utilization and staff burden of care were collected.
Results: A modest but significant reduction in staff ratings of the severity of aggressive and verbally agitated behavioral symptoms was found, with an associated reduction in their perceptions of the burden of caring for these patients. Reduced behavioral disturbance was associated with a reduction in the requirement for primary care consultations, and all participants were able to continue to reside in mainstream aged care facilities, despite an increase in the severity of dementia.
Conclusions: This study supported the use of individualized psychological strategies for behavioral symptoms at all stages of dementia. Methodological limitations of this preliminary study are discussed.

Putting woman-centered care into practice : a new (ANEW) approach to psychosocial risk assessment during pregnancy

Background: When antenatal care is provided, identification and management of challenging problems, such as depression, domestic violence, child abuse, and substance abuse, are absent from traditional midwifery and medical training. The main objective of this project was to provide an alternative to psychosocial risk screening in pregnancy by offering a training program (ANEW) in advanced communication skills and common psychosocial issues to midwives and doctors, with the aim of improving identification and support of women with psychosocial issues in pregnancy.

Methods: ANEW used a before‐and‐after survey design to evaluate the effects of a 6‐month educational intervention for health professionals. The setting for the project was the Mercy Hospital for Women in Melbourne, Australia. Surveys covered issues, such as perceived competency and comfort in dealing with specific psychosocial issues, self‐rated communication skills, and open‐ended questions about participants' experience of the educational program.

Results: Educational program participants (n = 22/27) completed both surveys. After the educational intervention, participants were more likely to ask directly about domestic violence (p = 0.05), past sexual abuse (p = 0.05), and concerns about caring for the baby (p = 0.03). They were less likely to report that psychosocial issues made them feel overwhelmed (p = 0.01), and they reported significant gains in knowledge of psychosocial issues, and competence in dealing with them. Participants were highly positive about the experience of participating in the program.

Conclusions:The program increased the self‐reported comfort and competency of health professionals to identify and care for women with psychosocial issues.

Excessive gestational weight gain: a psychosocial and behaviour change approach

Briony’s findings indicate that gaining excess weight during pregnancy can be influenced by depressive symptoms, body image, confidence, and motivation. Prevention of excessive pregnancy weight gain needs to be addressed by identifying women at risk and incorporating psychological and behaviour change intervention into broader health system and prevention programs.

A cluster analytic approach to identifying predictors and moderators of psychosocial treatment for bipolar depression: results from STEP-BD

Background We sought to address how predictors and moderators of psychotherapy for bipolar depression - identified individually in prior analyses - can inform the development of a metric for prospectively classifying treatment outcome in intensive psychotherapy (IP) versus collaborative care (CC) adjunctive to pharmacotherapy in the Systematic Treatment Enhancement Program (STEP-BD) study. Methods We conducted post-hoc analyses on 135 STEP-BD participants using cluster analysis to identify subsets of participants with similar clinical profiles and investigated this combined metric as a moderator and predictor of response to IP. We used agglomerative hierarchical cluster analyses and k-means clustering to determine the content of the clinical profiles. Logistic regression and Cox proportional hazard models were used to evaluate whether the resulting clusters predicted or moderated likelihood of recovery or time until recovery. Results The cluster analysis yielded a two-cluster solution: 1) "less-recurrent/severe" and 2) "chronic/recurrent." Rates of recovery in IP were similar for less-recurrent/severe and chronic/recurrent participants. Less-recurrent/severe patients were more likely than chronic/recurrent patients to achieve recovery in CC (p=.040, OR=4.56). IP yielded a faster recovery for chronic/recurrent participants, whereas CC led to recovery sooner in the less-recurrent/severe cluster (p=.034, OR=2.62). Limitations Cluster analyses require list-wise deletion of cases with missing data so we were unable to conduct analyses on all STEP-BD participants. Conclusions A well-powered, parametric approach can distinguish patients based on illness history and provide clinicians with symptom profiles of patients that confer differential prognosis in CC vs. IP.

Emotional toil: psychosocial care in rural settings for patients with cancer

Aim. This paper is a report of a study to identify experienced rural nurses' perceptions of key issues related to the provision of effective psychosocial care for people with cancer in rural settings.

Background. A cancer diagnosis has a major impact on psychological and emotional wellbeing, and psychosocial support provided by nurses is an integral part of ensuring that people with cancer have positive outcomes. Although, ideally, people with cancer should be managed in specialist settings, significant numbers are cared for in rural areas.

Methods. Using a qualitative descriptive approach, three focus groups were conducted in 2005 with 19 nurses in three hospitals in rural Victoria, Australia.

Findings. Participants indicated that a key issue in providing psychosocial care to patients with cancer in the rural setting was their own 'emotional toil'. This Global Theme encapsulated three Organizing Themes– task vs. care, dual relationships and supportive networks – reflective of the unique nature of the rural environment. Nurses in rural Australia are multi-skilled generalists and they provide care to patients with cancer without necessarily having specialist knowledge or skill. The fatigue and emotional exhaustion that the nurses described often has a major impact on their own well-being.

Conclusion. In the rural context, it is proposed that clinical supervision may be an important strategy to support clinicians who face emotional exhaustion as part of their cancer nursing role.

Psychosocial issues facilitating recovery post-CABG surgery

Background
The acute illness phase following coronary artery bypass graft (CABG) surgery is a difficult time for patients as they try to adjust to the physical and emotional changes brought about by surgery.
Aims
To conduct an indepth examination of psychosocial issues experienced by patients post-CABG surgery and how patients manage these psychosocial issues during their recovery.
Methods
A qualitative research approach, naturalistic inquiry, guided the study. Thirty patients were interviewed 4–5 weeks following discharge from hospital after CABG surgery and at 12 months after the initial interview.
Results
esults found that adjusting to life after surgery was difficult, and patients experienced some form of physical pain or change. An unexpected finding was the extent to which many of the patients were attuned to their post-operative physical adjustments. Patients spoke of mental and emotional changes, and coming to terms with lifestyle adjustments.
Conclusion
Study findings suggest the need for a re-examination of hospital discharge preparation and further provision and monitoring of home support services.

The role of peer support in facilitating psychosocial adjustment to chronic illness in adolescence

This article describes a Chronic Illness Peer Support (ChIPS) programme designed to assist young people in their adjustment to life with a chronic medical condition. The ChIPS programme takes a non-categorical approach to participation, recognizing that young people with different medical conditions experience many similar concerns. Support groups are facilitated by a health professional and peer co-leader. Groups meet weekly for 8 weeks and typically include between six and eight young people. Young people can choose to remain involved in broader social, educational and recreational activities following completion of the 8-week programme. We discuss nine psychosocial mechanisms by which peer support groups such as ChIPS might act to improve resilience and well-being among participants. We also discuss some theoretical risks in running support groups for chronically ill young people, which emphasize the importance of training and support of group leaders, including the peer co-leaders. The article concludes with a personal testimony by a ChIPS participant that was prepared for the 2003 Australian and New Zealand Adolescent Health Conference.

Women's views and outcomes of an educational intervention designed to enhance psychosocial support for women during pregnancy

Background: Identification of psychosocial issues in pregnant women by screening is difficult because of the lack of accuracy of screening tools, women's reluctance to disclose sensitive issues, and health care practitioner's reluctance to ask. This paper evaluates if a health professional education program, a new (ANEW) approach, improves pregnant women's ratings of care and practitioner's listening skills and comfort to disclose psychosocial issues.

Methods: Midwives and doctors from Mercy Hospital for Women, Melbourne, Australia, were trained from August to December 2002. English-speaking women (< 20 wks' gestation) were recruited at their first visit and mailed a survey at 30 weeks (early 2002) before and after (2003) the ANEW educational intervention. Follow-up was by postal reminder at 2 weeks and telephone reminder 2 weeks later.

Results: Twenty-one midwives and 5 doctors were trained. Of the eligible women, 78.2 percent (584/747) participated in a pre-ANEW survey and 73.3 percent (481/657) in a post-ANEW survey. After ANEW, women were more likely to report that midwives asked questions that helped them to talk about psychosocial problems (OR 1.45, CI 1.09–1.98) and that they would feel comfortable to discuss a range of psychosocial issues if they were experiencing them (coping after birth for midwives [OR 1.51, CI 1.10–2.08] and feeling depressed [OR 1.49, 1.16–1.93]; and concerns relating to sex [OR 1.35, CI 1.03–1.77] or their relationships [OR 1.36, CI 1.00–1.85] for doctors).

Conclusions: The ANEW program evaluation suggests trends of better communication by health professionals for pregnant women and should be evaluated using rigorous methods in other settings.

A validity-driven approach to the understanding of the personal and societal burden of low back pain : development of a conceptual and measurement model

Introduction: While the importance and magnitude of the burden of low back pain upon the individual is well recognized, a systematic understanding of the impact of the condition on individuals is currently hampered by the lack of an organized understanding of what aspects of a person’s life are affected and the lack of comprehensive measures for these effects. The aim of the present study was to develop a conceptual and measurement model of the overall burden of low back pain from the individual’s perspective using a validity-driven approach.
Methods: To define the breadth of low back pain burden we conducted three concept-mapping workshops to generate an item pool. Two face-to-face workshops (Australia) were conducted with people with low back pain and clinicians and policy-makers, respectively. A third workshop (USA) was held with international multidisciplinary experts. Multidimensional scaling, cluster analysis, participant input and thematic analyses organized participants’ ideas into clusters of ideas that then informed the conceptual model.
Results: One hundred and ninety-nine statements were generated. Considerable overlap was observed between groups, and four major clusters were observed - Psychosocial, Physical, Treatment and Employment - each with between two and six subclusters. Content analysis revealed that elements of the Psychosocial cluster were sufficiently distinct to be split into Psychological and Social, and a further cluster of elements termed Positive Effects also emerged. Finally, a hypothesized structure was proposed with six domains and 16 subdomains. New domains not previously considered in the back pain field emerged for psychometric verification: loss of independence, worry about the future, and negative or discriminatory actions by others.
Conclusions: Using a grounded approach, an explicit a priori and testable model of the overall burden of low back pain has been proposed that captures the full breadth of the burden experienced by patients and observed by experts.

Psychosocial antecedents of communication, trust, and relationship effectiveness in new product development projects : a functional manager perspective

The basic differences between marketing managers and their technically trained counterpart managers [e.g., research and development (R&D), engineering, and manufacturing managers] in terms of work experience, training, and differing decision-making styles have often been suggested as a source of conflict, which acts as a barrier to effective working relationships and integration during new product development (NPD) work. In this paper, we empirically explore this issue by developing and testing a model of psychosocial differences (thought worlds and psychological distance) between the two groups of managers and their effect on communication, trust, and relationship effectiveness during NPD projects. We find that while thought world differences do still matter, it was from a marketing perspective that they had a stronger effect. These findings have implications for top management trying to manage the functional manager interface during NPD projects. We propose a semi-formalized approach to relationship building that may speed up the acquisition of social data that is often necessary to elevate working relationships to trusting ones and improve the efficiency of NPD work. Our model is tested using data from two samples, 184 technically trained managers and 145 marketing managers from Australian companies involved in NPD work.

Managing borderline personality disorder and substance use : an integrated approach

Background : Although substance use is a common feature of borderline personality disorder, regular use is associated with greater levels of psychosocial impairment, psychopathology, self harm and suicidal behaviour and leads to poorer treatment outcomes. Management of co-occurring substance use disorder and borderline personality disorder within primary care is further compounded by negative attitudes and practices in responding to people with these conditions, which can lead to a fractured patient-doctor relationship.

Objective : This article provides an overview of how the general practitioner can provide effective support for patients with co-occurring borderline personality disorder and substance use disorder, including approaches to assessment and treatment, the therapeutic relationship, referral pathways and managing risk and chronic suicidality.

Discussion : Despite the complexities associated with this population, GPs are ideally placed to engage patients with co-occurring borderline personality disorder and substance use disorder in a long term therapeutic relationship, while also ensuring timely referral to other key services and health professionals. To provide the most effective responses to this patient group, GPs need to understand borderline personality disorder and its relationship to substance use, develop an ‘explanatory framework’ for challenging behaviours, implement mechanisms for reflective practice to manage negative countertransference, as well as learn skills to respond adequately to behaviours which jeopardise treatment retention.

An integrated approach to workplace mental health : an Australian feasibility study

We developed and implemented an integrated workplace mental health promotion intervention combining job stress reduction with a workplace mental health literacy program. The intervention was evaluated using an uncontrolled design, with organizationorganisation-wide census employee surveys of working conditions and mental health literacy pre-intervention, followed by a 1-year action planning and intervention period, then a post-intervention survey. All employees were invited to be surveyed, and all respondents were included in analysis, independent of participation in intervention activities or employment status (44% response rate at baseline, 37% at final). No significant changes were observed in the targeted psychosocial working conditions – job control, job demands, and social support at work. In contrast, significant improvements in some aspects of mental health literacy were observed, particularly in helping behaviours. Acknowledging the limitations of this being an uncontrolled pilot study, our results suggest that it is feasible to integrate job stress and mental health literacy intervention, as well as evidence of sustained improvements in mental health literacy and the need for more intensive and sustained efforts to improve psychosocial working conditions.