Rates of attendance at a smoking cessation clinic within a cardiac rehabilitation service

Objectives: Smoking cessation has been shown to be an important intervention for preventing cardiovascular events and improving the health of patients with heart disease. However, unaided quit attempts in these patients often leads to high rates of failure and a return to smoking. Outpatient smoking cessation clinics using face-to-face counseling, ongoing behavioral support, advice on smoking pharmacotherapy and objective monitoring, have been found to be one of the most effective interventions for improving quit smoking rates. An outpatient smoking cessation clinic was trialed within a cardiac rehabilitation service in order to explore its effects on smoking rates for patients with or at risk of heart disease. Attendance rates to the clinic were also monitored. Methods: A descriptive exploratory design was used for this newly developed clinic. Patients who currently smoked tobacco and who had a history of either coronary artery disease, heart failure, atrial fibrillation or those seen under a chest pain assessment service were invited to an outpatient ‘Cardiac Patients Smokers Clinic’. Initially patients were offered up to 10 clinic visits over a 3 month period. Follow-up clinic visits were conducted at 3, 6 and 12 months. A portable carbon monoxide meter was used to objectively measure levels of smoking and validate smoking abstinence. Primary outcomes included rates of attendance. Results: Preliminary findings showed 24 per cent of participants (N = 6) completed all their clinic visits and remained smoke free as measured by their ongoing expired carbon monoxide readings. Clinic attendance rates appeared lowest for those with significant mental health issues such as schizophrenia or substance abuse. However, rates of attendance were improved by having an administration officer make reminder telephone calls prior to clinic visits. Conclusions: Early findings indicate the feasibility of providing a specialist smoking cessation clinic within a cardiac rehabilitation service. Further, that reminder telephone calls prior to appointments improved attendance rates in patients with heart disease to this type of clinic. However, future investigations are warranted.

Women as victims and offenders : incarcerated for murder in the Australian criminal justice system

This study was undertaken in an effort to contribute to the limited knowledge of women who commit murder. Women account for approximately 10% of the total Australian homicides and according to Mouzos (2000), 20% of these female perpetrated homicides result in murder convictions. In her extensive study of female homicide offending in England, Brookman (2005) asserts that nearly two thirds of the victims of women who kill are intimates, to include violent partners and their own children. The other third of the victims consist largely of acquaintances and to lesser degree strangers (Brookman, 2005). This study strives to introduce further knowledge regarding women convicted of murder; the smaller subgroup of female homicide offenders of which less is known. It is comprised of women who killed intimates and non-intimates to include acquaintances. The study engages the narratives of seven women, all of whom were convicted of murder and serving lengthy sentences at the Dame Phyllis Frost Centre, a medium and maximum security prison that is located on the outskirts of Melbourne, Australia. The seven women fall largely outside of the characteristics of female homicide offenders as revealed in the studies from Australia’s National Homicide Monitoring Program (NHMP, 2007), from Canada by Hoffmann, Lavigne, and Dickie (1998) and research from the United States by Scott and Davies (2002). In this study there were no Indigenous women represented. Only one of the women had a previous criminal charge. The women were older on average than the prevailing demographics from western nations. Two of the women had substance abuse and co-occurring mental illness, which reflects a significant lower rate than the literature suggests. This study expands the current understanding of the phenomenon of women who murder. It communicates the narratives of seven women charged and convicted of murder as they attempt to understand their lives and identities. It moves the dialogue beyond the preponderance of feminist criminological research that examines motive and the relationship the woman has with her victim to the social discourses which dominate in her identity formation. This research found that in their attempt to create a favourable identity the women needed to engage with the master script of normative femininity through the feminisation of victimisation, motherhood and domesticity.

FP01-5 Pregnancy loss and psychiatric disorders in young men and women : results from Australian longitudinal cohort study

Recent evidence has linked induced abortion with later adverse psychiatric outcomes in young women. Little is known about later adverse psychiatric outcomes in young men whose partners have fallen pregnant and either go on to have a child, have an abortion or miscarry. 1223 women and 1159 men, from an Austrailan cohort born between 1981 and 1984, were assessed at 21 years for psychiatric and substance misuse and lifetime pregnancy histories. Young women reporting a pregnancy loss (either miscarriage or abortion) had nearly three times the odds of experiencing a illicit drug disorder (excluding cannabis), and nearly twice the odds of an alcohol misuse compared to never pregnant women. Young men whose partner had an abortion, but not a miscarriage, had nearly twice the odds of cannabis disorder, illicit drug disorder, and mood disorder compared to men that had never fathered a pregnancy. Young women who have lost a pregnancy have an increased risk of developing alcohol or substance abuse in later life. Young men whose partner aborted a pregnancy only had an increased of substance abuse and mood disorder in later life. These findings add to the growing body of evidence suggesting that pregnancy loss per se increases the risk of a range of substance use disorders in young women. The findings for young men are novel and raise the possibility that the associations measured may be due to common unmeasured factors associated with early pregnancy in young people rather than pregnancy loss.

Randomized controlled trial of MICBT for co-existing alcohol misuse and depression : outcomes to 36-months

Integrated psychological treatment addressing co-existing alcohol misuse and depression has not been compared with single-focused treatment. This trial evaluates changes over 36 months following randomization of 284 outpatients to one of four motivational interviewing and cognitive-behavior therapy (MICBT) based interventions: (1) brief integrated intervention (BI); or BI plus 9 further sessions with (2) an integrated-, (3) alcohol-, or (4) depression-focus. Outcome measures included changes in alcohol consumption, depression (BDI-II: Beck Depression Inventory) and functioning (GAF: Global Assessment of Functioning), with average improvements from baseline of 21.8 drinks per week, 12.6 BDI-II units and 8.2 GAF units. Longer interventions tended to be more effective in reducing depression and improving functioning in the long-term, and in improving alcohol consumption in the short-term. Integrated treatment was at least as good as single-focused MICBT. Alcohol-focused treatment was as effective as depression-focused treatment at reducing depression and more effective in reducing alcohol misuse. The best approach seems to be an initial focus on both conditions followed by additional integrated- or alcohol-focused sessions.

Royal Commissions and Criminal Justice : Behind the Ideal

Royal commissions are approached not as exercises in legitimation and closure but as sites of struggle that are heavily traversed by power holders yet are open to the voices of alternative and unofficial social groups, social movements, and individuals. Three case studies are discussed that highlight the hegemony of the legal methodology and discourse that dominate many inquiries. The first case, involving a single-case miscarriage inquiry, involves a man who was accused, convicted, and served a prison sentence for the murder of his wife. Nineteen years following the murder another man confessed to the crime. The official inquiry found that nothing had gone wrong in the criminal justice process; it had operated as it should. Thus, in the face of evidence that the criminal justice process may be flawed, the discursive strategy became one of silence; no explanation was offered except for the declaration that nothing had gone wrong. The fallibility of the criminal justice system was thus hidden from public view. The second case study examines the Wood Royal Commission into corruption charges within the NSW Police Service. The royal commission revealed a bevy of police misconduct offenses including process corruption, improper associations, theft, and substance abuse, among others. The author discusses the ways in which the other criminal justice players, the judiciary and prosecuting attorneys, emerge only briefly as potential ethical agents in relation to police misconduct and corruption and then abruptly disappear again. Yet, these other players are absolved of any responsibility for police misconduct. The third case study involves a spin-off inquiry into the facts surrounding the Leigh Leigh rape and murder case. This case illustrates how official inquires can seek to exclude non-traditional viewpoints and methodologies; in this case, the views of a feminist criminologist. The third case also illustrates how the adversarial process within the legal system allows those with power to subjugate the viewpoints of others through the legitimate use of cross-examination. These three case studies reveal how official inquiries tend to speak from an “idealized conception of justice” and downplay any viewpoint that questions this idealized version of the truth.

Survival models of community tenure and length of hospital stay for the seriously mentally ill : a 10-year perspective

Objective: To examine the effects of personal and community characteristics, specifically race and rurality, on lengths of state psychiatric hospital and community stays using maximum likelihood survival analysis with a special emphasis on change over a ten year period of time. Data Sources: We used the administrative data of the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services (DMHMRSAS) from 1982-1991 and the Area Resources File (ARF). Given these two sources, we constructed a history file for each individual who entered the state psychiatric system over the ten year period. Histories included demographic, treatment, and community characteristics. Study Design: We used a longitudinal, population-based design with maximum likelihood estimation of survival models. We presented a random effects model with unobserved heterogeneity that was independent of observed covariates. The key dependent variables were lengths of inpatient stay and subsequent length of community stay. Explanatory variables measured personal, diagnostic, and community characteristics, as well as controls for calendar time. Data Collection: This study used secondary, administrative, and health planning data. Principal Findings: African-American clients leave the community more quickly than whites. After controlling for other characteristics, however, race does not affect hospital length of stay. Rurality does not affect length of community stays once other personal and community characteristics are controlled for. However, people from rural areas have longer hospital stays even after controlling for personal and community characteristics. The effects of time are significantly smaller than expected. Diagnostic composition effects and a decrease in the rate of first inpatient admissions explain part of this reduced impact of time. We also find strong evidence for the existence of unobserved heterogeneity in both types of stays and adjust for this in our final models. Conclusions: Our results show that information on client characteristics available from inpatient stay records is useful in predicting not only the length of inpatient stay but also the length of the subsequent community stay. This information can be used to target increased discharge planning for those at risk of more rapid readmission to inpatient care. Correlation across observed and unobserved factors affecting length of stay has significant effects on the measurement of relationships between individual factors and lengths of stay. Thus, it is important to control for both observed and unobserved factors in estimation.

Drinking games participation among female students at a regional Australian university

Participation in drinking games (DGs) by university students is often associated with heavy drinking and negative social and health impacts. Although research in Australia indicates that university students tend to drink at risky levels, there is paucity of literature on DGs among students, especially those residing at regional universities. This research examined drinking among female college students of white background. Eighteen female students participated in face-to-face in-depth interviews to describe their DG experiences. Most women played DGs for social and monetary reasons, with many drinking high volumes of alcohol during the game. Excessive drinking was linked with the type of beverage consumed. Despite knowing the health risks associated with DGs, there was a strong social imperative for these young women to play these games. Research and public health initiatives to better understand and address problematic drinking activities in rural and regional Australia have tended to ignore women and the dominant white populations whose heavy drinking has been largely restricted to private spheres.

Bullying in children and adolescents : a modifiable risk factor for mental illness

It is a serious concern to health practitioners and policymakers that, in spite of substantial investment, there has been no meaningful decline in the prevalence of mental illness in Australia (Slade et al., 2009). It is now understood that a complex array of biopsychosocial factors confer varying degrees of risk of mental illness. Genetic predisposition, obstetric complications, environmental toxins, poverty, developmental delay, substance abuse, exposure to loss and trauma, chaotic family environments with accompanying abuse and neglect, chronic physical illness and maladaptive interpersonal interactions all contribute to an increased risk of developing mental disorders (Kieling et al., 2011). Bullying in childhood and adolescence is an identified risk factor for mental disorders, suicide attempts and drug and alcohol problems (Copeland et al., 2013; Moore et al., 2013)...

Autonomy supportive curriculum design : a salient factor in promoting law students' wellbeing

There is increasing awareness and concern about law students' elevated distress levels amongst members of the Australian legal academy and the broader legal community. Disproportionately high levels of psychological distress, including depression, anxiety, and substance abuse, have been consistently documented in decades of research on American law student samples. Questions about whether these trends were an American phenomenon, and due to 'differences in demographics, pedagogy and culture' may not apply to Australian law students, began to be empirically addressed with the publication of the Brain and Mind Research Institute's Courting the Blues monograph in 2009. Amongst other findings, the comprehensive research in this monograph indicated that more than one-third of the surveyed law students from Australian universities experience high levels of psychological distress. Recent empirical research at a number of individual Australian law schools reveals similar trends, suggesting that aspects of the legal education experience may contribute to widespread distress levels amongst law students in Australia, as in the United States.

Is group more cost effective than individual cognitive behaviour therapy? The evidence is not solid yet

This paper critically evaluates the empirical evidence of 36 studies regarding the comparative cost-effectiveness of group and individual cognitive behaviour therapy (CBT) as a whole, and also for specific mental disorders (e.g. depression, anxiety, substance abuse) or populations (e.g. children). Methods of calculating costs, as well as methods of comparing treatment outcomes were appraised and criticized. Overall, the evidence that group CBT is more cost-effective than individual CBT is mixed, with group CBT appearing to be more cost effective in treating depression and children, but less cost effective in treating drugs and alcohol dependence, anxiety and social phobias. In addition, methodological weaknesses in the studies assessed are noted. There is a need to improve cost calculation methodology, as well as more solid and a greater number of empirical cost-effectiveness studies before a firm conclusion can be reached that group CBT is more cost effective then individual CBT.

Unlocking the learning potential of incarcerated Indigenous and low SES young people; Mathematics outcomes for future success: a discussion paper

This presentation provides a beginning discussion about what the literature reports about incarcerated young people. Incarcerated Indigenous and low SES young people typically have very low literacy and mathematics skills which precludes them from future education and or employment opportunities, thus continuing the cycle of disadvantage, exclusion and despair(Payne, 2007). Being locked out of learning, they are stuck in a cycle of underachievement, a scenario which contributes to unacceptably high levels of recidivism(ACER, 2014). Success at education is considered an important protective factor against delinquent behaviours such as offending, substance abuse and truancy. Youth education and training centres provide educational opportunities for the incarcerated Indigenous youth but achievement continues to be lower than expected, particularly in mathematics. This presentation provides an introductory literature review focusing on incarcerated young people and education. It is also the preliminary writing for a small pilot project currently being conducted in one Youth Education and Training Centre in Australia.

Students’ well-being and social connections

Description of Workshop/Poster Presentation This presentation will showcase CORE Connections – ‘Creating Opportunities for Resilience and Engagement’ – which is a whole-school approach to mental health promotion. While initially designed to prevent adolescent depression and substance abuse, current thinking suggests that competency enhancement (e.g., autonomy, competence, supportive networks) more widely improves students’ well-being, educational engagement, and learning outcomes. In the presentation, we will provide an overview of the CORE project, describe the CORE intervention, which is conceptualized as a dynamic and penetrating process of social practices, present some preliminary findings from the pilot phase of CORE, and conclude our presentation with an interactive section with the participants. This project will highlight a wellness focus that addresses social engagement within whole school cultures. Purpose of the Presentation Student mental and physical well-being has gained increasing attention. Our presentation will introduce the CORE project, which has a potential to decrease student depression, anxiety, and substance use, and to increase student self-esteem and learning outcomes. In this vein, our presentation will raise the public awareness of the salient role of social connection in student well-being. Specifically, a group of presenters will discuss the impact of social connection on students’ anxiety, mathematics achievement, and perceived racial discrimination. • We will present participants with an alternative way to conceptualize and approach mental health promotion within a school context. In contrast to prescribed programs that are commonly used in today’s schools, CORE is a whole-school approach that is flexibly integrated into all aspects of the classroom and school environment. Our aim is to illustrate the intervention principles of CORE while highlighting examples of mental health outcomes/transformation. • Underutilized in mental health promotion research, social network analysis provides critical information in understanding relationships between social cohesion (e.g., a student’s connectedness to others) and mental health outcomes. This session will showcase how focusing on and strengthening social connections in and out of school can contribute to student well-being, achievement, and mental health. Educational Objectives By the end of the presentation, participants will • obtain a general overview of the CORE program, • understand how psychological health and school performance relate to student well-being, • and understand how social connections in and out of school can contribute to student well-being. Interactive / Participatory Component We will invite audience members to discuss inhibitors and contributors to student well-being and the best ways for schools to help students feel safe, connected, and valued. Presentation Key Points • Overview of the CORE project • Theorization of social connection • Some empirical studies emerging from CORE • Presenter-audience interaction Evidence of Relevance and Utility to Participants Potential participants are adults with significant relationships with students, either as family members, community neighbors, educators, scholars, service providers, or policy makers. Our presentation will inspire these significant adults to construct a welcoming society to help improve student well-being.

An analysis of ethical issues in using wastewater analysis to monitor illicit drug use

Aims To discuss ethical issues that may arise in using WWA to monitor illicit drug use in the general population and in entertainment precincts, prisons, schools and work-places. Method Review current applications of WWA and identify ethical and social issues that may be raised with current and projected future uses of this method. Results Wastewater analysis (WWA) of drug residues is a promising method of monitoring illicit drug use that may overcome some limitations of other monitoring methods. When used for monitoring purposes in large populations, WWA does not raise major ethical concerns because individuals are not identified and the prospects of harming residents of catchment areas are remote. When WWA is used in smaller catchment areas (entertainment venues, prisons, schools or work-places) their results could, possibly, indirectly affect the occupants adversely. Researchers will need to take care in reporting their results to reduce media misreporting. Fears about possible use of WWA for mass individual surveillance by drug law enforcement officials are unlikely to be realized, but will need to be addressed because they may affect public support adversely for this type of research. Conclusions Using wastewater analysis to monitor illicit drug use in large populations does not raise major ethical concerns, but researchers need to minimize possible adverse consequences in studying smaller populations, such as workers, prisoners and students.

Cognitive Functioning in Young Adults with Depression, Anxiety Disorders, or Burnout Symptoms : Findings from a Population-based Sample

Background. Evidence of cognitive dysfunction in depressive and anxiety disorders is growing. However, the neuropsychological profile of young adults has received only little systematic investigation, although depressive and anxiety disorders are major public health problems for this age group. Available studies have typically failed to account for psychiatric comorbidity, and samples derived from population-based settings have also seldom been investigated. Burnout-related cognitive functioning has previously been investigated in only few studies, again all using clinical samples and wide age groups. Aims. Based on the information gained by conducting a comprehensive review, studies on cognitive impairment in depressive and anxiety disorders among young adults are rare. The present study examined cognitive functioning in young adults with a history of unipolar depressive or anxiety disorders in comparison to healthy peers, and associations of current burnout symptoms with cognitive functioning, in a population-based setting. The aim was also to determine whether cognitive deficits vary as a function of different disorder characteristics, such as severity, psychiatric comorbidity, age at onset, or the treatments received. Methods. Verbal and visual short-term memory, verbal long-term memory and learning, attention, psychomotor processing speed, verbal intelligence, and executive functioning were measured in a population-based sample of 21-35 year olds. Performance was compared firstly between participants with pure non-psychotic depression (n=68) and healthy peers (n=70), secondly between pure (n=69) and comorbid depression (n=57), and thirdly between participants with anxiety disorders (n=76) and healthy peers (n=71). The diagnostic procedure was based on the SCID interview. Fourthly, the associations of current burnout symptoms, measured with the Maslach Burnout Inventory General Survey, and neuropsychological test performance were investigated among working young adults (n=225). Results. Young adults with depressive or anxiety disorders, with or without psychiatric comorbidity, were not found to have major cognitive impairments when compared to healthy peers. Only mildly compromised verbal learning was found among depressed participants. Pure and comorbid depression groups did not differ in cognitive functioning, either. Among depressed participants, those who had received treatment showed more impaired verbal memory and executive functioning, and earlier onset corresponded with more impaired executive functioning. In anxiety disorders, psychotropic medication and low psychosocial functioning were associated with deficits in executive functioning, psychomotor processing speed, and visual short-term memory. Current burnout symptoms were associated with better performance in verbal working memory and verbal intelligence. However, lower examiner-rated social and occupational functioning was associated with problems in verbal attention, memory, and learning. Conclusions. Depression, anxiety disorders, or burnout symptoms may not be associated with major cognitive deficits among young adults derived from the general population. Even psychiatric comorbidity may not aggravate cognitive functioning in depressive or anxiety disorders among these young adults. However, treatment-seeking in depression was found to be associated with cognitive deficits, suggesting that these deficits relate to increased distress. Additionally, early-onset depression, found to be associated with executive dysfunction, may represent a more severe form of the disorder. In anxiety disorders, those with low symptom-related psychosocial functioning may have cognitive impairment. An association with self-reported burnout symptoms and cognitive deficits was not detected, but individuals with low social and occupational functioning may have impaired cognition.