Prevalence of psychological distress, anxiety and depression in rural communities in Australia

Objective: To describe the prevalence of psychological distress, depression and anxiety in three Australian rural settings and to identify the levels of risk by gender and age.

Design and setting: Three cross-sectional surveys in the Greater Green Triangle area covering the south-east of South Australia (Limestone Coast), and south-west (Corangamite Shire) and north-west (Wimmera) of Victoria.

Participants: A total of 1563 people, aged 25–74 years, randomly selected from the electoral roll.

Main outcome measures: Psychological distress assessed by the Kessler 10, and anxiety and depression assessed by the Hospital Anxiety and Depression Scale.

Results: The prevalence of psychological distress was 31% for both men and women with two-thirds reporting moderate and one-third high levels of psychological distress. The prevalence of depression and anxiety was approximately 10%. The highest rate of psychological distress, anxiety and depression occurred in the 45–54 years age group. There were no consistent gender or area differences in the prevalence of psychological distress, depression or anxiety.

Conclusions: A third of the rural population reported psychological distress, with the highest prevalence observed in middle-aged men and women. Thus, health professionals should attend not only to physical health, but also to mental health status in this age group. It is also important to target prevention strategies at the 20% who reported moderate levels of psychological distress in order to prevent the development of more serious conditions.

The factor structure of the strengths and difficulties questionnaire

The Strengths and Difficulties Questionnaire (SDQ) has been widely adopted as a measure of child and adolescent mental health and behavioral problems. However, despite an impressive number of studies demonstrating its psychometric properties, appropriate analyses of the instrument's underlying structure have not been reported. We conducted confirmatory factor analyses on matched data obtained from a large community sample of 7-17-year-olds, their parents, and their teachers. The analyses indicated that the reputed factor structure was not supported, with none of the subscales being unidimensional. Further, each informant group appeared to respond differently to the questionnaire. Considering the findings in relation to the stringency of the tests used to evaluate the SDQ, its utility, and previous research on its clinical validity, it is suggested that the SDQ be used with caution and in conjunction with other forms of assessment.

A psychological perspective on Australia's asylum policies

This paper discusses mental and psychological impacts of Australia's temporary protection visa (TPV) policy on individual asylum seekers. The paper is based on personal narratives constructed by individual asylum seekers during one-on-one interviews and aims principally to sketch the discursive manifestations of stressful events in the lives of TPV holders. The fact that refugees exhibit signs of Post Traumatic Stress Disorder (PTSD) is not entirely new or surprising given the level of trauma, and in many cases torture and persecution, endured in the pre-migration phase.

What is particularly revealing among many TPV holders is the fact that their pre-migration traumatic experiences are compounded by a post-migration condition of being in indefinite "temporary" protection. This is further exacerbated by an awareness of the exclusionary discourses and policies advocated by the host government. Past trauma and persecution, combined with present family separation and social exclusion, further compounded by uncertainty about the future, results in almost chronic states of anxiety and depression among a significant number of TPV holders.

Pursuit of the muscular ideal: Physical and psychological consequences and putative risk factors

Developing a lean muscular figure for the purposes of sports and/or appearance has become a central issue for males. Concern has been raised because the desire to develop such a body build may lead to the adoption of numerous health-threatening behaviors. Consequently, this review presents a comprehensive analysis of the physical and psychological consequences that result from the use of steroids (legal and illegal), ephedrine, and deleterious dieting strategies specific to males. Putative risk factors for these behaviors will be identified, and the clinical disorder associated with the extreme abuse of these behaviors, muscle dysmorphia, will be examined.

Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder

Objective: To assess from a health sector perspective the incremental cost-effectiveness of interventions for generalized anxiety disorder (cognitive behavioural therapy [CBT] and serotonin and noradrenaline reuptake inhibitors [SNRIs]) and panic disorder (CBT, selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]).

Method: The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analyses of randomised controlled trials. An assessment on second stage filters ('equity', 'strength of evidence', 'feasibility' and 'acceptability to stakeholders') is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are calculated for a period of one year for the eligible population (prevalent cases of generalized anxiety disorder/panic disorder identified in the National Survey of Mental Health and Wellbeing, extrapolated to the Australian population in the year 2000 for those aged 18 years and older). Simulation modelling techniques are used to present 95% uncertainty intervals (UI) around the incremental cost-effectiveness ratios (ICERs).

Results: Compared to current practice, CBT by a psychologist on a public salary is the most cost-effective intervention for both generalized anxiety disorder (A$6900/DALY saved; 95% UI A$4000 to A$12 000) and panic disorder (A$6800/DALY saved; 95% UI A$2900 to A$15 000). Cognitive behavioural therapy results in a greater total health benefit than the drug interventions for both anxiety disorders, although equity and feasibility concerns for CBT interventions are also greater.

Conclusions: Cognitive behavioural therapy is the most effective and cost-effective intervention for generalized anxiety disorder and panic disorder. However, its implementation would require policy change to enable more widespread access to a sufficient number of trained therapists for the treatment of anxiety disorders.

An exploration of sense of community, part 3: dimensions and predictors of psychological sense of community in geographical communities

Within the discipline of community psychology there remains considerable debate as to the latent structure of psychological sense of community (PSOC). One of the few theoretical discussions is that of McMillan and Chavis (1986), who hypothesized four dimensions: Belonging; Fulfillment of Needs; Influence; and Shared Connections. Discussion has also emerged in the literature regarding the role of identification within PSOC. However few studies have empirically investigated the role of identification in PSOC. The current study explored PSOC in a sample of residents of rural, regional and urban geographical communities (N = 669). In an endeavor to clarify the underlying dimensions of PSOC, a test battery included several measures of PSOC as well as measures of identification with the community. The study also examined the role of demographic factors in predicting PSOC. Results provided support for McMillan and Chavis' (1986) four dimensions of PSOC. Further, a fifth dimension emerged, that of Conscious Identification, suggesting that identification is separate to existing dimensions of PSOC. The demographic factors significantly associated with PSOC were type of region, with rural participants displaying higher PSOC than their urban counterparts; participation in local organizations; having children; and a vision of one’s neighborhood as broader than just a street or block. These results, and the implications for PSOC research, are discussed.

Psychological and biochemical mechanisms of schizoprenia

Schizophrenia is a disease whose physical cause is unknown despite the attempts of several research teams to discover a physical basis for it. Some success has been gained in genetic studies which indicate that schizophrenia is an inherited disability. However, since research tools are at present so sadly inadequate, the value of pursuing a genetic line of reasoning is questionable. To compensate for the lack of biochemical certainties in treating mental illness, psychological theories have been constructed to explain the schizophrenia syndrome. Normal personality is seen as the resultant of environmental and inherited influences. Involved in the formation of personality are the processes of differentiation and integration, maturation of inherited traits, and the learning processes. As personality develops. consciousness of the self, inferiority feelings, and compensatory mechanisms, and the transformation of interests into drives exert a decided influence upon personality growth. Finally, in the mature personality, an integrating philosophy of life, a large variety of interests, and the possibility of self-objectification become evident.

Using job strain and psychological contract theories to predict employee wellbeing in a reformed public sector agency

This study investigates the Issues that contribute to employee wellbeing in a public sector agency having undergone substantial reform The research is based on a model that is initially demand-oriented, and is expanded to incorporate psychological contract breach and organisational justice. Hierarchical regression analyses were conducted on the 1,010 completed surveys The results confirm the value of the Job strain model (JSM) and that the inclusion of breach and fairness were worthwhile extensions of the JSM Future research may wish to extend this approach and incorporate more of the social aspects of the work situation m studies of employee wellbeing.

Psychological and interpersonal dimensions of sexual function and dysfunction.

To highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction; to offer a four-tiered paradigm for understanding the evolution and maintenance of sexual symptoms; and to offer recommendations for clinical management and research.