Gender differences in attitudes among those at risk for Huntington's disease

This report presents and discusses selected findings regarding gender differences from an Australian-based study that investigated attitudes of individuals at risk for Huntington's disease (HD) towards genetic risk and predictive testing. Clear gender differences emerged regarding perceived coping capacity with regard to predictive testing, as well as disclosure of the genetic risk for HD to others. Female participants were more likely to disclose their genetic risk to others, including their medical practitioners, while male participants were three times more fearful of disclosing their genetic risk to others. These findings are of interest in light of gender differences that have consistently been reported regarding the uptake of predictive testing for HD, other genetic conditions, and health services more generally. While gender differences cannot provide a fully explanatory framework for differential uptake of predictive genetic testing, men and women may experience and respond differently to the genetic risk for HD and possibly other inherited disorders. The meanings of genetic risk to men and women warrants further exploration, given anticipated increases in genetic testing for more common conditions, especially if post-test interventions are possible. These issues are also relevant within the context of individuals' concerns about the potential for discrimination on the basis of genetic risk or genetic test information.

Predictive genetic test decisions for Huntington's disease: Elucidating the test/no-test dichotomy

Predictive genetic testing for serious, mature-onset genetic illness represents a unique context in health decision making. This article presents findings from an exploratory qualitative Australian-based study into the decision making of individuals at risk for Huntington's disease (HD) with regard to predictive genetic testing. Sixteen in-depth interviews were conducted with a range of at-risk individuals. Data analysis revealed four discrete decision-making positions rather than a 'to test' or not to test' dichotomy. A conceptual dimension of (non-)openness and (non-)engagement characterized the various decisions. Processes of decision making and a concept of 'test readiness' were identified. Findings from this research, while not generalizable, are discussed in relation to theoretical frameworks and stage models of health decision making, as well as possible clinical implications.

Interagency collaboration between child protection and mental health services: Practices, attitudes and barriers

Objective: The aim of this paper is to examine some of the factors that facilitate and hinder interagency collaboration between child protection services and mental health services in cases where there is a parent with a mental illness and there are protection concerns for the child(ren). The paper reports on agency practices, worker attitudes and experiences, and barriers to effective collaboration. Method: A self-administered, cross-sectional survey was developed and distributed via direct mail or via line supervisors to workers in statutory child protection services, adult mental health services, child and youth mental health services, and Suspected Child Abuse and Neglect (SCAN) Teams. There were 232 completed questionnaires returned, with an overall response rate of 21%. Thirty-eight percent of respondents were statutory child protection workers. 39% were adult mental health workers, 16% were child and youth mental health workers, and 4% were SCAN Team medical officers (with 3% missing data). Results: Analysis revealed that workers were engaging in a moderate amount of interagency contact, but that they were unhappy with the support provided by their agency. Principle components analysis and multivariate analysis of variance (MANOVA) on items assessing attitudes toward other workers identified four factors, which differed in rates of endorsement: inadequate training, positive regard for child protection workers, positive regard for mental health workers, and mutual mistrust (from highest to lowest level of endorsement). The same procedure identified the relative endorsement of five factors extracted from items about potential barriers: inadequate resources, confidentiality, gaps in interagency processes, unrealistic expectations, and professional knowledge domains and boundaries. Conclusions: Mental health and child protection professionals believe that collaborative practice is necessary; however, their efforts are hindered by a lack of supportive structures and practices at the organizational level. (c) 2005 Published by Elsevier Ltd.

Critical health psychology - Who benefits?

This commentary deals with two issues raised by Hepworth (this issue). Concerning definitions, it argues that critical health psychology needs to be more explicit in defining itself as politically left-wing, and that its central defining characteristic should be that it is research and practice which aims primarily to benefit the participants, regardless of any specific method or epistemology. Concerning the value of critical health psychology, it argues that work which has improved health on a global scale and which aims to reduce inequities is being done, but not by critical psychologists, and suggests a need for more action and less rhetoric.

The credentialing of counselling in Australia

Counselling is an unregulated activity in Australia. No statutory regulation currently exists. As a result, different counselling organizations are promoting different voluntary standards for the practice of counselling. This has led to a credentialing dilemma in which counsellors and the public are confronted with a number of counselling qualification choices. This dilemma poses a number of questions: Should counselling become more regulated in Australia? At what level should counselling be regulated? Should there be various levels of counsellor regulation? This article provides an overview of the credentialing dilemma facing counselling in Australia, compares and contrasts two main Australian accreditation efforts, and proposes cooperation as a way of navigating said dilemma. The implications for counselling as a profession are discussed along with suggestions for its development as a profession. This includes a discussion regarding the relative advantages and disadvantages of greater regulation of counselling as a professional activity in Australia. Specifically, what is and is not generally considered a profession is reviewed, different forms of credentialing are outlined, and general arguments for and against accreditation efforts are presented. The efforts of the Australian Counselling Association (ACA) and the Psychotherapy and Counselling Federation of Australia (PACFA) are compared and are shown to have common ground. Consequently, ways in which the main counselling organizations may best work in conjunction to promote counselling as a profession in Australia are proposed. These suggestions include good communication, collaboration, and the avoidance of turf wars. Specifically, that the ACA and PACFA collaborate on developing a combined independent registration list that is supported by both organizations or, minimally, that both organizations have mutual recognition on each other's register lists.

The diagnostic interview for psychoses (DIP): development, reliability and applications

Background. We describe the development, reliability and applications of the Diagnostic Interview for Psychoses (DIP), a comprehensive interview schedule for psychotic disorders. Method. The DIP is intended for use by interviewers with a clinical background and was designed to occupy the middle ground between fully structured, lay-administered schedules, and semi-structured., psychiatrist-administered interviews. It encompasses four main domains: (a) demographic data; (b) social functioning and disability; (c) a diagnostic module comprising symptoms, signs and past history ratings; and (d) patterns of service utilization Lind patient-perceived need for services. It generates diagnoses according to several sets of criteria using the OPCRIT computerized diagnostic algorithm and can be administered either on-screen or in a hard-copy format. Results. The DIP proved easy to use and was well accepted in the field. For the diagnostic module, inter-rater reliability was assessed on 20 cases rated by 24 clinicians: good reliability was demonstrated for both ICD-10 and DSM-III-R diagnoses. Seven cases were interviewed 2-11 weeks apart to determine test-retest reliability, with pairwise agreement of 0.8-1.0 for most items. Diagnostic validity was assessed in 10 cases, interviewed with the DIP and using the SCAN as 'gold standard': in nine cases clinical diagnoses were in agreement. Conclusions. The DIP is suitable for use in large-scale epidemiological studies of psychotic disorders. as well as in smaller Studies where time is at a premium. While the diagnostic module stands on its own, the full DIP schedule, covering demography, social functioning and service utilization makes it a versatile multi-purpose tool.

Does timing and sequencing of transitions to adulthood make a difference? Stress, smoking, and physical activity among young Australian women

The major changes of the transition to adulthood are argued to be stressful, and health-related behaviors such as smoking and physical activity may be adopted, consolidated, or abandoned at this time. On the other hand, research has suggested that the normative transitions of emerging adulthood, although involving considerable change, may be associated with low stress because they are perceived as both positive and normal at this life stage. This article examines relations between the timing and sequencing of life transitions and stress and health-related behaviors, focusing on the transition to young adulthood among Australian women. A total of 853 women aged 22 to 27 provided information about the timing and sequencing of 6 life transitions: moving out of home, stopping full-time education, starting full-time work, having the first live-in relationship, marriage, and motherhood-and stress, smoking, and physical activity. Most had moved out of home, stopped full-time education, and started full-time work, but only 14% had undertaken all 6 transitions. Overall, 70% of participants had made transitions in order Overall, the findings suggest that the relations between timing and sequencing of transitions, and indicators of health, are moderate for smoking, but small for stress and for physical activity. These effects remained after controlling for socioeconomic status of the participants' families of origin. Matching current social norms for the timing and sequencing of life changes may be of less importance for women's well-being than is commonly believed. Although the significant relations between early or out of order transitions and smoking are of concern, the smaller relations with stress and with sedentariness suggest that such transitions may have limited negative consequences, and support the view that individuals are active in choosing the life path that is appropriate for them and their circumstances.

Models of psychological service provision under Australia's better outcomes in mental health care program

The Access to Allied Psychological Services component of Australia's Better Outcomes in Mental Health Care program enables eligible general practitioners to refer consumers to allied health professionals for affordable, evidence-based mental health care, via 108 projects conducted by Divisions of General Practice. The current study profiled the models of service delivery across these projects, and examined whether particular models were associated with differential levels of access to services. We found: 76% of projects were retaining their allied health professionals under contract, 28% via direct employment, and 7% some other way; Allied health professionals were providing services from GPs' rooms in 63% of projects, from their own rooms in 63%, from a third location in 42%; and The referral mechanism of choice was direct referral in 51% of projects, a voucher system in 27%, a brokerage system in 24%, and a register system in 25%. Many of these models were being used in combination. No model was predictive of differential levels of access, suggesting that the approach of adapting models to the local context is proving successful.

Introducing evidence-based family assessment and therapy in child and youth mental health services: Applying systemic principles to maintain, sustain and build capacity

The purpose of this article is to overview the context of the mental health service in which we work, and family therapy's status prior to and after the impact of changes wrought by the introduction of the National Mental Health Policy. We then explore some key issues that we think contribute to the persistence of the occlusion of family therapy in child psychiatric services; and the strategies that we developed and are continuing to develop to support change, finally, we describe the use of a family assessment instrument that we believe is central to our change strategy.

The management of stress amongst professional carers within a social services department

This thesis considers four broad areas:(i) ANALYSIS OF THE STRESS FIELD.(a) research studies, relevant to the British Social Services considering the cultural setting, and the rigor with which they were conducted; (b) models of stress, specifically examining the theoretical soundness and practical application of the Medical, Engineering and Transactional models;(c) organisational models of stress relating specifically to human service organisations.(ii) QUALITATIVE AND QUANTITATIVE RESEARCH METHODOLOGIES.(a) the appropriate application of each respective methodology and the particular usefulness of qualitative research designs; (b) the relevance of understanding the language and terminology associated with the subject area prior to the implementation of survey methods; (iii) FIELDWORK.(a) Phase 1. By use of focus groups, in-depth interviews and diary keeping amongst a small range of teams and managers, the Researcher develops a basic conceptual framework of stress within a Social Services context. In addition a small scale personality inventory was administered to participants.(b) Phase 2. This consisted of three key elements: 6 case studies in which the Researcher implements and appraises the impact of a range of intervention strategies designed to assist teams and their managers in dealing more effectively with stress; the administration of a large scale survey to all the field social work teams within the Social Services Department; an analysis of the user role within the stress process by way of two focus groups.(iv) THEORETICAL DEVELOPMENT.

Predicting adult occupational environments from childhood personality traits

To test aspects of a theory of the role of personality and gender on the development of vocational interests and their subsequent effects on adult occupational choices, the authors of this study examined associations among childhood personality traits, gender, and occupational environments more than 40 years later. Participants (N = 587) were assessed on the Big Five by their teachers when the participants were between 6 and 12 years old. In middle-age (late 40s), the participants reported their occupation. Holland's (1997) RIASEC vocational types (Realistic, Investigative, Artistic, Social, Enterprising, Conventional) were used to characterize the job environments of reported occupations. Childhood Openness/Intellect and Conscientiousness, but no other Big Five traits, were associated with occupational environments. For the most strongly sex-typed work environments, associations with Openness/Intellect were moderated by gender. These findings suggest that the roots of the strongest gender-stereotyping effects in occupations may be found not only in the social factors associated with gender but also in the individual differences of children related to Openness/Intellect.

Perceptions of family environment, body image and self-esteem of eating disordered and non-eating disordered women

This study explored the perceptions of family environment, body image and self esteem of women who suffer from anorexia nervosa, bulimia nervosa, and depression. Using a nonequivalent control group design, one hundred and fifty women with anorexia nervosa (n = 50), bulimia nervosa (n = 50), and depression (n = 50) were given the Family Environment Scale (FES) and the Eating Disorders Inventory-2 (EDI-2). The objectives of this study were to: (1) study how women with anorexia nervosa and bulimia nervosa perceive their family environment as measured by the FES; (2) compare and contrast perceptions of family environment of women with anorexia nervosa and bulimia nervosa with the control group; (3) compare and contrast perceived levels of self esteem and body image as measured by the EDI-2 of women with anorexia nervosa and bulimia nervosa with the control group; and (4) examine the perceived family environments of eating disordered and non-eating disordered women with regard to body image and self esteem. Results suggested, women who suffered from anorexia nervosa or bulimia nervosa scored significantly lower (p $<$.021) on the Expressiveness, Intellectual-Cultural Orientation, and Active-Recreational subscales of the FES. The results also indicated that women who suffered from bulimia nervosa scored significantly higher (p $<$.015) than women who suffered from anorexia nervosa on the Conflict and Independence subscales of the FES. The results of studying these three populations reflected that women who suffered from anorexia nervosa scored significantly different (p $<$.000) than women who suffered from bulimia nervosa on many of the subscales of the EDI-2. The findings of the study confirmed that women who suffered from anorexia nervosa or bulimia nervosa scored significantly different (p $<$.000) on the subscales of the EDI-2 compared to women who suffered from depression. It was also confirmed that a relationship does exist between perceptions of body image and self esteem and perceptions of family environment amongst women with anorexia nervosa and bulimia nervosa as compared to depressed women. The findings of the study indicated that women who suffered from anorexia nervosa tended to: be less expressive and independent; handle conflict less openly; have a greater drive for thinness; have greater body dissatisfaction; be more perfectionistic; and struggle more intensely with fears around maturity and social insecurity than did women who suffered from bulimia nervosa or depression. In addition, the findings of the study also suggested that women who suffered from bulimia nervosa tended to: be raised in homes where openly expressed anger is permitted amongst family members; have a lesser drive for thinness; have less body dissatisfaction; be less perfectionistic; and not struggle as intensely with fears around maturity and social insecurity as do women who suffered from anorexia nervosa, but more than women who suffer from depression. Treatment implications that may assist community college professors and counselors in meeting the special needs of this special group of women were also discussed. (Abstract shortened by UMI.) ^