Health risk behaviours and health care needs among people with psychiatric illness

This paper presents findings from two studies. Study 1 explored differences between people with psychiatric illness (PPI) (N=144) and the general population (N=151) in levels of low-fat diet, exercise and smoking. Study 2 investigated barriers and health care needs of PPI (N=60). The prevalence of overweight, cigarette smoking and sedentary lifestyle were significantly greater among PPI than the general population. Major predictors were limited social support, knowledge of correct dietary principles, lower self-efficacy, psychiatric symptomatology and various psychotropic drugs. The findings demonstrated that PPI over-used medical services but under-used preventive services due to inaccessibility, lower satisfaction and knowledge of services.

People, places and public health : evaluating the benefits of civic environmentalism in an urban local government context

Recent political, economic and social trends pose threats to the sustainability both of ecosystems and of human health. Australia’s environmental management record is poor, and while by international standards Australians enjoy good health, this is variable (AIHW, 2000). Within developed nations, heart disease, depression, alcohol dependence and stroke are major health issues (Mathers et al. 2002). In Australia, mental disorder is the number one contributor to the disease burden (Vos & Mathers 2000). Recent research has highlighted the role of social capital as a key determinant of health (Kawachi et al., 1997). Despite this, Putnam (1995) observes that social connectedness and civic engagement are in decline. People have less time for leisure and for volunteering, as many juggle paid work and caring for children. Anecdotal evidence suggests that engagement in civic environmentalism has human health benefits, relating to a combination of exposure to natural environments and increased social capital (Maller, Brown, Townsend & St. Leger, 2002). This link is supported by Furnass (1996) who defines well-being as including: satisfactory human relationships, meaningful occupation, opportunities for contact with nature, creative expression, and making a positive contribution to human society. Research conducted by Deakin University confirms the efficacy of linking people and places through civic environmentalism for addressing both ecosystem sustainability and human health and wellbeing. The research has included a pilot study to explore the human health benefits of membership of a local parkland ‘Friends’ group, and a more detailed follow-up study. The aims of the pilot study included:- To identify the range of motivations for joining the Friends group;- To document members’ perceptions of the benefits gained from membership of the group;- To assess the potential for Friends groups to be used as an ‘upstream’ health promotion measure.Face-to-face interviews were conducted with eleven members of a ‘Friends’ group in the eastern suburbs of Melbourne. Data was analysed thematically and key findings included:- Motivations: environmental; social; and pragmatic.- General benefits: community belonging; personal satisfaction; learning opportunities; physical activity; and better environment.- Health benefits: physical health; mental health; and social support. There was unanimous support for the use of ‘Friends’ groups as a tool for health promotion.The follow-up study, in the western suburbs of Melbourne, expanded on the pilot study by measuring the group’s social capital and by collecting self-report data on levels of health service usage. Data was collected through face-to-face interviews and a questionnaire. The findings were similar to the pilot study in relation to the motivations, benefits and the health promotion potential of such groups. However, health service usage data highlighted an apparent anomaly: while respondents perceived significant health benefits, some were nevertheless utilising health services at a relatively high level. This poses some questions requiring further exploration: Is this due to the poorer baseline health of the high health service usage members compared with their fellow members? Does involvement in the group offer health benefits that enable people who would otherwise be too unhealthy to participate in community groups to continue such involvement?If this is the case, then we may do well to look to locally-based mechanisms for promoting ecological sustainability as a tool also for promoting human health. Instead of prescribing a pill, connecting people and places through engagement with a local friends group may address our health problems at the same time as addressing local environmental problems.

Maternal postpartum adjustment in Victoria's south west : a rural perspective

Aims & Rationale/Objectives
This study examined maternal postpartum adjustment in the first 12 months. Firstly, we were interested in examining whether Parental Functioning would be affected by living or not living in a major South West regional centre. Secondly, we were interested in whether Parental Functioning would differ as a function of infants being under or over 6 months of age. Thirdly, we were interested in whether Parental Functioning would differ as a function of pregnancy and birth complications. Finally, we were interested in whether postpartum perceptions of Role Competence/Satisfaction and Social Support would be associated with the Postnatal Depression.

Methods
The (preliminary) sample included 69 rural mothers recruited from across five shire regions within South West Victoria. Indicators of Parental Functioning were assessed using self-report questionnaires. Demographic and medical information was also collected. Respondents to the study were mailed a questionnaire pack which was returned in a reply-paid envelope.

Principal Findings
The results regarding geographical location were non-significant. There were significant differences in Wellbeing but not Role Competence/Satisfaction, or Social Support as a function of infant age. There were significant differences in Wellbeing, Role Competence/Satisfaction, and Social Connectedness (but not actual social support) as a function of Pregnancy Complications but not Birth Complications. Finally, Role Competence/Satisfaction and Social Connectedness (but not actual social support) significantly contributed to the variance in Postnatal Depression.

Discussion
Findings suggest that mothers did not differ as a function of their geographical location. Overall, mothers had higher levels of parental functioning when their infants were over 6 months of age, and also, if they did not experience pregnancy complications (physical, emotional, both). Additionally, findings suggest that perceptions of competence in and satisfaction with the parenting role, and also feelings of 'connectedness' to social others, are protective factors against the development of postpartum adjustment disorders.

Implications
Given that depressive episodes are common during childbearing years, and have both short- and long-term developmental effects on the infant, these findings support a need for the development and examination of a perinatal and infant mental health programme for rural mothers and infants.

Birds, buffers and bicycles : a review and case study of wetland buffers

Wetland buffers separate wetlands from surrounding land uses that are incompatible with wetland values. Buffers are established to fulfil a variety of needs. However, not all functions which are attributed to buffers are mutually compatible. In particular, their use as major recreational zones is not necessarily compatible with reducing disturbance to wetland wildlife, such as birds. This paper examines the buffer around an urban wetland at Altona, Victoria, which is extensively used by recreationists. The presence of a bicycle trail within the buffer might effectively reduce its size and effectiveness, and cause ‘buffer creep’ whereby the effective separation distance between people and birds is reduced. It might also unintentionally facilitate unauthorised access into an otherwise ‘off-limits’ wetland. While social support is critical for wetland conservation, the existence of recreation in buffers does not automatically confer high awareness of local wetlands. The success of buffers as a conservation tool will depend upon setting a clear objective for buffers, careful design and management, and evaluation of effectiveness to optimise the potential benefits for wetlands and their fauna.

How socio-economic status contributes to participation in leisure-time physical activity

The aim of this cross-sectional study was to identify individual, social, and environmental contributors (mediators) to individual- and area-level differences in leisure-time physical activity across socio-economic groups. A two-stage stratified sampling design was used to recruit 20–65 year old adults (N = 2194) living in 154 census collection districts of Adelaide, Australia (overall response rate: 12%). Participants completed two surveys six months apart (response rate on the second survey: 83%). Individual-level socio-economic status (SES) was assessed using self-report measures on educational attainment, household income, and household size. Area-level SES was assessed using census data on median household income and household size for each selected census district. Bootstrap generalized linear models were used to examine associations between SES, potential mediators, and leisure-time physical activity. The product-of-coefficient test was used to estimate mediating effects. All SES measures were independently associated with potential individual and social mediators of the SES-activity relationships. Individual- and area-level income was also associated with perceived neighborhood attributes. Self-efficacy and social support for physical activity explained virtually all of the differences in physical activity across educational attainment groups. Physical barriers to walking and access to public open space contributed in part to the explanation of differences in recreational walking across income groups. Yet, self-efficacy and social support were the key mediators of the observed relationships between individual- and area-level income and physical activity. This study suggests that in order to increase physical activity participation in the more disadvantaged segments of the population, comprehensive, multilevel interventions targeting activity-related attitudes and skills as well as social and physical environments are needed.

Does family intervention for adolescent substance use impact parental mental health? A systematic review

Adolescent substance abuse is a prevalent problem and both individual and group family interventions are increasingly being used to assist families to cope. A literature review was conducted to identify whether individual and group family interventions for adolescent substance abuse enhance the mental health of parents and other family members. The review also sought to identify direct and indirect effects of family intervention processes on depressive symptoms and general distress. Based on quality criteria a total of nine studies were included. Of these, six quantitatively examined family intervention outcomes on family member mental health, with all six reporting positive effects. Four of the nine studies measured levels of depressive symptoms and three of these four studies reported significant direct effects of family intervention on parental depression. The positive effects were also found in the three qualitative studies included in the review. Indirect therapeutic mechanisms that contributed to mental health improvements included: reduction of stress symptoms, improved coping, improved family functioning, more effective parenting behaviours, attitude changes, perceived changes in relative’s substance use, and improved social support. The available literature suggests that a number of determinants of family mental health may potentially be impacted through family intervention for adolescent substance abuse. However, definitive conclusions cannot be made at this point as the literature is mostly descriptive and there have been few longitudinal studies or randomised controlled trials.

The impact of neurological illness on marital relationships

The current study investigated the impact of neurological illness on marital relationship satisfaction. Participants numbered 423 patients and 335 carers from motor neurone disease (MND), Huntington's disease (HD), Parkinson's, and multiple sclerosis (MS). The results demonstrated that patients and carers with HD had a significantly lower level of relationship satisfaction and sex life satisfaction than the other three illness groups. Further, patients with HD indicated a significantly higher level of relationship satisfaction than their carers. For MS and MND patients, social support predicted marital relationship satisfaction, and for Parkinson's patients, social support and sex life satisfaction predicted marital relationship satisfaction.

Staying connected : the lived experiences of volunteers and older adults

Many housebound older adults lack meaningful social relationships. In this study we explore the phenomenon of social connectedness in the volunteer-older adult relationship through the experiences of frail and isolated older adults and volunteers. We conceptualise this relationship as a journey whereby each traveller plays an active role in its direction and outcome. The emergent phenomenological essence of social connectedness from these dyad’s narratives provides meaning for both differences and similarities into the way the construct is conceptualised. When volunteers maintain the boundaries of the relationship through structured conversation and visits, it is described as friendly. Transgressing the boundaries involves doing extra for the elder and is both a function of the dyad’s compatibility, and the volunteer’s sense of ongoing agency and lack of elder expectations. The sense of social connectedness inherent in these relationships often feels like that of friendship or family, and these relationships are perceived as meaningful and close for both parties. Social connectedness in family-like relationships is a function of the playing out of an otherwise missing family role. However, if volunteer volition is compromised, this results in feelings of obligation and responsibility, similar to the dynamic between blood relatives. Participants’ narratives suggest that when the boundaries of the relationship are mutually negotiated, this serves to strengthen the relationship’s socioemotional quality, and potential for the continuity of the unique sense of social connectedness that has already been established.

Happy to talk.... to a point : bereaved young men and emotional disclosure

This study focuses upon the social experiences of bereaved young men, with particular emphasis on the social costs of bereavement-related personal disclosure. Participants' experiences of regulating their social behaviour were suggestive of the persistence of 'traditional' notions of masculine identity (e.g. hegemonic masculinity). While this study cautions that opportunities for emotional disclosure should not be viewed as the only form of social support for bereaved young men, its principal assertion is the necessity for emotional disclosure to be socially recognised as a legitimate form of male social expression.

Identifying the health and mental health information needs of people with coronary heart disease, with and without depression

Objective:
To identify the health and mental health information needs of people with coronary heart disease (CHD), with and without comorbid depression.

Design and setting:
A qualitative study conducted in Melbourne in 2006, using thematic analysis of semi-structured interviews on the types of health information that patients with CHD considered useful to assist with the management of their illness. Structured clinical interviews were used to assess current and prior depressive episodes in these patients.

Participants:
14 general practice patients (eight with current or prior history of major depression) who had experienced myocardial infarction, coronary artery bypass graft surgery, angioplasty or angina (confirmed via testing).

Results:
Four themes relating to information on how patients could manage their cardiovascular health and improve their psychosocial wellbeing emerged: psychosocial; physical activity; medical; and information for family. The most prominent information needs included identification and management of risk-related physical symptoms, and psychosocial information, most notably to enhance patients’ social support. Patients considered this information important for alleviating health anxiety and negative affect.

Conclusion:
This small patient sample endorsed the need for health and mental health information on a range of psychosocial and physical health topics. Participants desired specific types of information to assist with the self-management of their health and to assuage their health concerns.

Job stress in the law enforcement sector: comparing the linear, non-linear and interaction effects of working conditions

This study addresses a gap in much of the research involving stress among high-risk occupations by investigating the effects of linear, non-linear and interaction models in a law enforcement organization that has undertaken a series of efficiency-driven organizational reforms. The results of a survey involving 2085 police officers indicated that the demand-control-support model provided good utility in predicting an officer's satisfaction, commitment and well-being. In particular, social support and job control were closely associated with all three outcome variables. Although the demand × control/support interactions were not identified in the data, there was some support for the curvilinear effects of job demands. The results have implications for the organizational conditions that need to be addressed in contemporary policing environments where new public management strategies have had widespread affects on the social and organizational context in which policing takes place.

Baseline assessment of organizational capacity for health promotion within regional health authorities in Alberta, Canada

This paper provides a baseline profile of organizational capacity for (heart) health promotion in Alberta's regional health authorities (RHAs); and examines differences in perceived organizational health promotion capacity specific to modifiable risk factors across three levels of staff and across capacity levels. Baseline data were collected from a purposive sample of 144 board members, senior/middle managers and service providers from 17 RHAs participating in a five-year time-series repeated survey design assessing RHA capacity for (heart) health promotion. Results indicate low levels of capacity to take health promotion action on the broader determinants of health and risk conditions like poverty and social support. In contrast, capacity for health promotion action specific to physiological and behavioural risk factors is considerably higher. Organizational "will" to do health promotion is noticeably more present than is both infrastructure and leadership. Both position held within an organization as well as overall level of organizational capacity appear to influence perceptions of organizational capacity. Overall, results suggest that organizational "will", while necessary, is inadequate on its own for health promotion implementation to occur, especially in regard to addressing the broader determinants of health. A combination of low infrastructure and limited leadership may help explain a lack of health promotion action.

Family physical activity and sedentary environments and weight change in children

Objective. To examine associations between family physical activity and sedentary environment and changes in body mass index (BMI) z-scores among 10-12-year-old children over three years.
Method. Design. Longitudinal (three-year follow-up). Subjects. In total, 152 boys and 192 girls aged 10-12 years at baseline.
Measurements. Measured height and weight at baseline and follow-up (weight status, BMI z-scores); aspects of the family physical activity and sedentary environment (parental and sibling modelling, reinforcement, social support, family-related barriers, rules/restrictions, home physical environment) measured with a questionnaire completed by parents at baseline.
Results. At baseline, 29.6% of boys and 21.9% of girls were overweight or obese, and mean (standard deviation, SD) BMI z-scores were 0.44 (0.99) and 0.28 (0.89), respectively. There was a significant change in BMI z-score among girls (mean change=0.19, SD=0.55, p<0.001), but not boys. Among boys, the number of items at home able to be used for sedentary behaviour (B=0.11, p=0.037) was associated with relatively greater increases in BMI z-score. Among girls, sibling engagement in physical activity at least three times/wk (B=-0.17, p=0.010) and the number of physical activity equipment items at home (B=-0.05, p=0.018) were associated with relatively greater decreases in BMI z-score.
Conclusion. Sibling physical activity and environmental stimuli for sedentary behaviours and physical activity within the home may be important targets for prevention of weight gain during the transition from childhood to adolescence.

Officer wellbeing, satisfaction and commitment : job conditions of Australian law enforcement personnel

Excessive job stress caused by unreasonably high employer demands, low control over one's own work and limited support can have far-reaching effects for the individual, organisation and community. The present study sought to investigate the relationship between officer working conditions and their self-reported levels of wellbeing, satisfaction and commitment using a well-known job strss model, the demand-control-support (DCS) model. Using a large (N= 2085) sample of law enforcement personnel, findings indicated that social support from work sources was the best predictor, whilst job control and workload both had significant influences on levels of employee wellbeing, satisfaction and commitment. Additionally, non-linear relationships were found between workload and wellbeing and satisfaction, indicating that both high and low levels of workload can produce negative outcomes. The results have implications for job design and management training programs, particularly in reference to social support training and workload models.