Discourses of anxiety in nursing practice : a psychoanalytic case study of the change-of-shift handover ritual

This paper reports on the findings of a study that considered how anxiety might function to organise nurses' practice. With reference to psychoanalytic theory this paper analyses field notes taken during a series of nursing change-of-shift handovers. The handover practices analysed met all the criteria for a ritual, as understood in psychoanalytic theory, and functioned to alleviate anxiety in the short term while symbolically expressing a forbidden and unknown knowledge. We argue that the handover ritual contained certain prohibitions, yet allowed some expression of the prohibited knowledge in a disguised way. The prohibition concerned how the patient affected the nurse, that is, moved the nurse to love and hate the patient. We argue that this prohibition is expressed, in disguise, via the displacement of affection for the patient onto other nurses and through negative stereotyping of some patients. We also argue that these prohibitions of the handover mirror broader prohibitions within nursing, and thus the rituals of the handover become an expression of how professional prohibitions are enacted in practice. We conclude that the important implicit function of the handover ritual is to keep anxiety at bay, thereby enabling the nurse to commence practice rather than being immobilised by the effect of potentially overwhelming anxiety.

Effects of comorbid ADHD with learning disabilities on anxiety, depression, and aggression in adults

Objective: ADHD and learning disabilities (LD) frequently coexist and there are indications that comorbidity may increase the risk of psychopathology.

Method: The current study examined the gender distribution and frequency of comorbidity and its impact on the prevalence of symptoms of anxiety,  depression, and aggression in a clinic sample of 80 adults with ADHD, aged 18 to 58 years. More individuals were diagnosed with ADHD+LD than ADHD only, with no difference in this distribution according to gender.

Results: A factorial multivariate analysis of variance indicated that females with ADHD+LD displayed more cognitive depression than females with ADHD only and than males with ADHD+LD and ADHD only. However,individuals with ADHD only and individuals with ADHD+LD did not differ on overall anxiety, depression or aggression. Likewise, males and females did not differ on measures of psychopathology.

Conclusion: This study lays the foundation for continued research into the characteristics and comorbidities of adults with ADHD.

A literature review of the application of the geriatric depression scale, depression anxiety stress scales and post-traumatic stress disorder checklist to community nursing cohorts

Aims and objectives. To explore through literature review the appropriateness of three common tools for use by community nurses to screen war veteran and war widow(er) clients for depression, anxiety and post-traumatic stress disorder.

Background. War veterans and, to a lesser extent, war widow(er)s, are prone to mental health challenges, especially depression, anxiety and post-traumatic stress disorder. Community nurses do not accurately identify such people with depression and related disorders although they are well positioned to do so. The use of valid and reliable self-report tools is one method of improving nurses' identification of people with actual or potential mental health difficulties for referral to a general practitioner or mental health practitioner for diagnostic assessment and treatment. The Geriatric Depression Scale, Depression Anxiety Stress Scales and Post-traumatic Stress Disorder Checklist are frequently recommended for mental health screening but the appropriateness of using the tools for screening war veteran and war widow(er) community nursing clients who are often aged and have functional impairment, is unknown.

Design. Systematic review.

Conclusions. Current literature informs that the Geriatric Depression Scale accurately predicts a diagnosis of depression in community nursing cohorts. The three Depression Anxiety Stress Scales subscales of depression, anxiety and stress are valid; however, no studies were identified that compared the performance of the Depression Anxiety Stress Scales in predicting diagnoses of depression or anxiety. The Post-traumatic Stress Disorder Checklist predicts post-traumatic stress disorder in community cohorts although no studies meeting the selection criteria included male participants.

Relevance to clinical practice. This review provides recommendations for the use of the Geriatric Depression Scale, Depression Anxiety Stress Scales and The Post-traumatic Stress Disorder Checklist based on examination of the published evidence for the application of these screening tools in samples approximated to community nursing cohorts. Findings and recommendations would guide community nurses, managers and health planners in the selection of mental health screening tools to promote holistic community nursing care.

Depressive and anxiety symptoms through late pregnancy and the first year post birth : an examination of prospective relationships

One hundred and fifty-nine women were measured for depressive and anxiety symptoms from late pregnancy through to 12 months postpartum. Partial correlations revealed stability of depressive and anxiety symptoms across time. Depressive symptoms did not predict anxiety at any time point. Anxiety predicted increases in depressive symptoms from late pregnancy to early postpartum, but not from early postpartum to mid postpartum. Anxiety predicted depressive symptoms from mid postpartum to late postpartum, however, not when social support in late pregnancy was controlled for.

Age-specific norms and determinants of anxiety and depression in 731 women with breast cancer recruited through a population-based cancer registry

The aim of this study was to determine population norms and determinants of anxiety and depression in a population-based sample of 731 women with breast cancer (aged 23–60 years) with the Hospital Anxiety and Depression scale (HADS). The prevalence of ‘probable’ psychological morbidity due to anxiety was 23% and due to depression was 3%. When the women identified as ‘possible’ cases were included, the respective proportions were 45 and 12%. Higher anxiety was present in younger, less educated women not born in Australia. There was no clear pattern of risk factors for depression. These population-based findings highlight the need for clinicians to be aware that age, education and country of birth may identify a particularly vulnerable subgroup. While brief scales such as the HADS are limited in their ability to accurately predict a clinical diagnosis, high scores identify those who may warrant referral for clinical evaluation.

Understanding anxiety and depression : a dimensional and categorical approach

Three studies were conducted to understand the strong relationship between anxiety and depression. Common indicators of each disorder including critical attitudes towards self and others, negative childhood experiences, low social support and use of emotion as a coping strategy were found. Another important finding is that unremitted anxiety leads to depression in approximately 50% of cases. Implications of these findings for intervention and treatment were presented.

Impact of social anxiety on quality of life : a longitudinal study

This thesis found that individuals with social anxiety had high levels of co-morbid depression, reduced quality of life, poorer health and wellbeing, and they used maladaptive coping strategies. The negative effects of social anxiety and social anxiety co-morbid depression could be predicted over a 6-month time period. The portfolio argues the impact of poor attachment style, poor parenting behaviour and negative environmental influences as contributors to individuals' longer term psychological functioning with four case studies highlighting the contributing role of these early influences on later functioning.

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.

Anger and aggression in the presence of anxiety and depression

This portfolio considers major theories of aggression and relates them to four individual case studies. Each client has difficulties with anger and aggression and all had additional emotional difficulties, specifically depression and anxiety.

Effects of physical activity on depression and anxiety in children

This thesis study examined the direct and indirect effects of physical activity, self-efficacy and peer relations in depression and anxiety in children. No direct relationships between physical activity and symptoms of depression or anxiety were found for either sex. The portfolio, using four clinical health psychology case studies, provides an illustration of the clinical application of the transtheoretical model to four different health issues.

Case study demonstration of the family context of anxiety disorders across the lifespan and the effectiveness of cognitive-behavioural interventions

This portfolio aims to explore some of the issues related to the treatment of anxiety disorders in clinical practice by reviewing the literature on anxiety disorders across the lifespan and presenting four clinical case studies of individuals with different anxiety disorders.