A fully automated self-help biopsychosocial transdiagnostic digital intervention to reduce anxiety and/or depression and improve emotional regulation and well-being: pre-follow-up single-arm feasibility trial
- Authors: Klein, Britt , Nguyen, Huy , McLaren, Suzanne , Andrews, Brooke , Shandley, Kerrie
- Date: 2023
- Type: Text , Journal article
- Relation: JMIR Formative Research Vol. 7, no. (2023), p.
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- Description: Background: Anxiety disorders and depression are prevalent disorders with high comorbidity, leading to greater chronicity and severity of symptoms. Given the accessibility to treatment issues, more evaluation is needed to assess the potential benefits of fully automated self-help transdiagnostic digital interventions. Innovating beyond the current transdiagnostic one-size-fits-all shared mechanistic approach may also lead to further improvements. Objective: The primary objective of this study was to explore the preliminary effectiveness and acceptability of a new fully automated self-help biopsychosocial transdiagnostic digital intervention (Life Flex) aimed at treating anxiety and/or depression, as well as improving emotional regulation; emotional, social, and psychological well-being; optimism; and health-related quality of life. Methods: This was a real-world pre-during-post-follow-up feasibility trial design evaluation of Life Flex. Participants were assessed at the preintervention time point (week 0), during intervention (weeks 3 and 5), at the postintervention time point (week 8), and at 1- and 3-month follow-ups (weeks 12 and 20, respectively). Results: The results provided early support for the Life Flex program in reducing anxiety (Generalized Anxiety Disorder 7), depression (Patient Health Questionnaire 9), psychological distress (Kessler 6), and emotional dysregulation (Difficulties in Emotional Regulation 36) and increasing emotional, social, and psychological well-being (Mental Health Continuum-Short Form); optimism (Revised Life Orientation Test); and health-related quality of life (EQ-5D-3L Utility Index and Health Rating; all false discovery rate [FDR] < .001). Large within-group treatment effect sizes (range |d|=0.82 to 1.33) were found for most variables from pre- to postintervention assessments and at the 1- and 3-month follow-up. The exceptions were medium treatment effect sizes for EQ-5D-3L Utility Index (range Cohen d=
Efficacy of a digital mental health biopsychosocial transdiagnostic intervention with or without therapist assistance for adults with anxiety and depression : adaptive randomized controlled trial
- Authors: Andrews, Brooke , Klein, Britt , Nguyen, Huy , Corboy, Denise , McLaren, Suzanne , Watson, Shaun
- Date: 2023
- Type: Text , Journal article
- Relation: Journal of Medical Internet Research Vol. 25, no. (2023), p.
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- Description: Background: Digital mental health (DMH) interventions incorporating elements that adapt to the evolving needs of consumers have the potential to further our understanding of the optimal intensity of therapist assistance and inform stepped-care models. Objective: The primary objective was to compare the efficacy of a transdiagnostic biopsychosocial DMH program, with or without therapist assistance for adults with subthreshold symptoms or a diagnosis of anxiety or depression. Methods: In a randomized adaptive clinical trial design, all participants had access to the DMH program, with eligibility to have their program augmented with therapist assistance determined by program engagement or symptom severity. Participants who met stepped-care criteria were randomized to have their treatment program augmented with either low-intensity (10 min/week of video chat support for 7 weeks) or high-intensity (50 min/week of video chat support for 7 weeks) therapist assistance. A total of 103 participants (mean age 34.17, SD 10.50 years) were assessed before (week 0), during (weeks 3 and 6), and after the intervention (week 9) and at the 3-month follow-up (week 21). The effects of 3 treatment conditions (DMH program only, DMH program+low-intensity therapist assistance, and DMH program+high-intensity therapist assistance) on changes in the 2 primary outcomes of anxiety (7-item Generalized Anxiety Disorder Scale [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were assessed using the Cohen d, reliable change index, and mixed-effects linear regression analyses. Results: There were no substantial differences in the outcome measures among intervention conditions. However, there were significant time effect changes in most outcomes over time. All 3 intervention conditions demonstrated strong and significant treatment effect changes in GAD-7 and PHQ-9 scores, with absolute Cohen d values ranging from 0.82 to 1.79 (all P<.05). The mixed-effects models revealed that, in the Life Flex program–only condition at week 3, mean GAD-7 and PHQ-9 scores significantly decreased from baseline by 3.54 and 4.38 (all P<.001), respectively. At weeks 6, 9, and 21, GAD-7 and PHQ-9 scores significantly decreased from baseline by at least 6 and 7 points (all P<.001), respectively. Nonresponders at week 3 who were stepped up to therapist assistance increased program engagement and treatment response. At the postintervention time point and 3-month follow-up, 67% (44/65) and 69% (34/49) of the participants, respectively, no longer met diagnostic criteria for anxiety or depression. Conclusions: The findings highlight that early detection of low engagement and non–treatment response presents an opportunity to effectively intervene by incorporating an adaptive design. Although the study findings indicate that therapist assistance was no more effective than the DMH intervention program alone for reducing symptoms of anxiety or depression, the data highlight the potential influence of participant selection bias and participant preferences within stepped-care treatment models. ©Brooke Andrews, Britt Klein, Huy Van Nguyen, Denise Corboy, Suzanne McLaren, Shaun Watson.
Evaluation of various support intensities of digital mental health treatment for reducing anxiety and depression in adults : protocol for a mixed methods, adaptive, randomized clinical trial
- Authors: Andrews, Brooke , Klein, Britt , McLaren, Suzanne , Watson, Shaun , Corboy, Denise
- Date: 2023
- Type: Text , Journal article
- Relation: JMIR Research Protocols Vol. 12, no. (2023), p.
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- Description: Background: Anxiety and depression are leading causes of disease worldwide, requiring timely access to evidence-based treatment. Digital mental health (dMH) interventions increase accessibility to evidence-based psychological services delivered in a variety of web-based formats (eg, self-help and therapist-assisted interventions). Robust and rigorous studies of adaptive web-based intervention designs are scarce. No identified randomized clinical trial has investigated the efficacy of a 2-stage adaptive design, whereby the program-only condition or no support dMH treatment program is augmented by either low or high therapist assistance, if a participant does not improve or engage in the program-only condition. Objective: The primary objective is to assess whether low or high therapist-assisted support delivered via video chat is more effective in reducing anxiety and depressive symptoms compared with a dMH program–only condition. The secondary objective is to evaluate the role of motivation; self-efficacy; and preferences in participant engagement, adherence, and clinical outcomes (anxiety and depression symptoms) among the 3 treatment conditions (program only, low-intensity therapist assistance, and high-intensity therapist assistance). A mixed methods analysis of factors affecting participant attrition, participant reasons for nonengagement and withdrawal, and therapist training and implementation of dMH interventions will be completed. Qualitative data regarding participant and therapist experiences and satisfaction with video chat assessment and treatment will also be analyzed. Methods: Australian adults (N=137) with symptoms or a diagnosis of anxiety or depression will be screened for eligibility and given access to the 8-module Life Flex dMH treatment program. On day 15, participants who meet the augmentation criteria will be stepped up via block randomization to receive therapist assistance delivered via video chat for either 10 minutes (low intensity) or 50 minutes (high intensity) per week. This adaptive trial will implement a mixed methods design, with outcomes assessed before the intervention (week 0), during the intervention (weeks 3 and 6), after the intervention (week 9), and at the 3-month follow-up (week 21). Results: The primary outcome measures are for anxiety (Generalized Anxiety Disorder–7) and depression severity (Patient Health Questionnaire–9). Measures of working alliance, health status, health resources, preferences, self-efficacy, and motivation will be used for secondary outcomes. Qualitative methods will be used to explore participant and therapist experiences of video chat assessment and treatment, participant reasons for withdrawal and nonengagement, and therapist training and implementation experiences. Data collection commenced in November 2020 and was completed at the end of March 2022. Conclusions: This is the first mixed methods adaptive trial to explore the comparative efficacy of different intensity levels of self-help and a therapist-assisted dMH intervention program delivered via video chat for adults with anxiety or depression. Anticipated results may have implications for the implementation of dMH interventions. © Brooke Andrews, Britt Klein, Suzanne McLaren, Shaun Watson, Denise Corboy. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 28.04.2023.
Suicidality among older Australian adults
- Authors: Klein, Britt , Shandley, Kerrie , McLaren, Suzanne , Clinnick, Lisa , Nguyen, Huy
- Date: 2023
- Type: Text , Journal article
- Relation: Frontiers in Public Health Vol. 10, no. (2023), p.
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- Description: Background: Vulnerability to suicidality is a concern among older adults, particularly as this proportion of the population is growing. Determining what factors contribute to suicidality will help to create a framework for understanding and assessing suicidal risk among older adults and developing effective treatments. This study examined suicidality among older Australian adults. Methods: This study forms part of a larger study to trial a survey to collect cross-sectional data on the mental and physical health of older Australian adults across time. One hundred and fourteen Australian residents aged 65 years and over completed an anonymous survey online or by returning a paper-and-pencil version of the survey by post. The survey took approximately 25 min to complete and comprised of (1) sociodemographic questions (e.g., age, gender, education), (2) validated questionnaires measuring depression, general anxiety, psychological distress, insomnia, substance dependence, problem gambling, and stress, and (3) mental and physical health and wellbeing items (e.g., religiosity, assistance with daily tasks, and mental health service usage in the last 12-months). The dependent variable, suicidality, was measured by asking participants whether they had ever seriously thought about committing suicide. Results: Associations with suicidality were analyzed using Chi-squares and independent samples t-tests. The results found suicidality to be significantly associated with lower levels of satisfaction with the frequency of seeing and/or communicating with friends, and inadequate levels of community engagement. Conclusion: The results of this survey reinforce the importance of social connectedness as a central and significant protective factor against suicidality among older adults. Copyright © 2023 Klein, Shandley, McLaren, Clinnick and Nguyen.
Therapist training in video chat technology for use in an adaptive digital mental health intervention: Challenges, facilitators and implications for training models
- Authors: Andrews, Brooke , Klein, Britt , Corboy, Denise , McLaren, Suzanne , Watson, Shaun
- Date: 2023
- Type: Text , Journal article
- Relation: Counselling and Psychotherapy Research Vol. 23, no. 3 (2023), p. 818-829
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- Description: Objective: This qualitative study investigated therapist training experiences, elements of skill acquisition, and barriers and facilitators associated with conducting assessments, and the delivery of low- and high-intensity therapist assistance delivered via video chat technology, adjunctive to a transdiagnostic digital mental health intervention programme for anxiety and depression. Methodology: In total, 34 semistructured interviews were conducted with 20 therapists. Twenty interviews explored experiences of training to administer a clinical assessment tool, and 14 additional interviews explored training experiences of delivering low- and high-intensity therapist assistance via video chat technology. Results: Reflexive thematic analysis identified three themes: video chat skill acquisition, competencies transferrable to video chat and video chat service quality. Training and supervision were identified as important to scaffold skill development, and therapists described surprise that their skill set was transferrable to video chat. The most cited barrier to the adoption of video chat was the management of risk and distress, along with environmental suitability. Frequently cited facilitators to the adoption of video chat included stable Internet connection, protocols and resources. Conclusion: The benefits of video chat technology and digital mental health interventions can be maximised through the expansion and integration of training into existing teaching curricula. If therapists are familiarised and competent to deliver mental health services via the Internet, as well as in person, the future adoption of blended and stepped-care models is likely to be increased. © 2023 The Authors. Counselling and Psychotherapy Research published by John Wiley & Sons Ltd on behalf of British Association for Counselling and Psychotherapy.
Video chat therapist assistance in an adaptive digital intervention for anxiety and depression : reflections from participants and therapists
- Authors: Andrews, Brooke , Klein, Britt , Corboy, Denise , McLaren, Suzanne , Watson, Shaun
- Date: 2023
- Type: Text , Journal article
- Relation: Professional psychology, research and practice Vol. 54, no. 6 (2023), p. 418-429
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- Description: The purpose of this article is to qualitatively explore participant and therapist experiences of the therapeutic alliance, perceived benefits, challenges, and areas for improvement when using video chat as a mode of therapist assistance within an adaptive digital mental health intervention. In total, 74 semistructured interviews were completed with participants and therapists who participated in an adaptive clinical trial. The participant interviews explored experiences of attending a clinical assessment via video chat and experiences of receiving low- or high-intensity therapist assistance via video chat. Interviews completed with therapists explored their experience of administrating a clinical assessment tool and delivering therapist assistance, both via video chat. Reflexive thematic analysis identified four themes: using video chat, characteristics of therapeutic relationships, task-specific experiences, and utility and adoption of video chat. Both participants and therapists were able to adapt to the modality of video chat and develop positive therapeutic alliances. They reported satisfaction with video chat for conducting clinical assessments and delivering therapist assistance. Concerns were identified by both participants and therapists with low-intensity therapist assistance. This study identified elements of task-specific experiences and human characteristics as more influential in participant and therapist experience than the modality of video chat technology. Implications for assessing suitability for the modality of video chat and low- and high-intensity models of therapist assistance are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Source: journal abstract)
Dispositional optimism and suicide among trans and gender diverse adults
- Authors: Snooks, Matthew Paul , McLaren, Suzanne
- Date: 2022
- Type: Journal article
- Relation: Death Studies Vol. 46, no. 8 (2022), p. 1954-1962
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- Description: Trans and gender diverse adults are at increased suicide risk. Optimism protects against suicide across multiple populations. Applying the Interpersonal-Psychological Theory of Suicide (IPTS), we examined both factors among 237 adults recruited via social media and online platforms, 79.3% of whom reported serious suicide ideation. Dispositional optimism predicted suicidal ideation and behaviors (SIB), but did not moderate the relationship between the IPTS components and SIB. After controlling for depressive symptoms, hormone therapy and gender-affirming surgery did not predict SIB. Promoting dispositional optimism within a therapeutic framework may reduce SIB in this vulnerable population.
The relations between the positive and negative components of self-compassion and depressive symptoms among sexual minority women and men
- Authors: Shakeshaft, Rhianydd , McLaren, Suzanne
- Date: 2022
- Type: Text , Journal article
- Relation: Mindfulness Vol. 13, no. 1 (2022), p. 57-65
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- Description: Objectives: The experience of depression among sexual minority adults is a cause for concern. Research into protective factors is lacking. Self-compassion is considered to promote adaptive coping strategies and is associated with fewer depressive symptoms. The aim of this study was to investigate whether self-compassion and its components were associated with depressive symptoms among sexual minority adults and whether these relations were moderated by gender. Methods: A sample of 499 sexual minority women aged 18 to 77 years (M = 29.45, SD = 9.97) and 457 sexual minority men aged 18 to 79 years (M = 27.05, SD = 9.12) completed the Center for Epidemiology-Depression Scale and the Self-Compassion Scale. Results: Higher levels of self-compassion, self-kindness, common humanity, and mindfulness and lower levels of self-judgement, isolation, and over-identification were associated with lower levels of depressive symptoms. When all six components were entered simultaneously into a regression model, only the negative components predicted levels of depressive symptoms. Gender moderated the common humanity-depressive symptoms relation, with this relation being stronger for women than men. Conclusions: Results indicate that the negative components of self-compassion are associated with depressive symptoms among sexual minority adults and that the strength of the relations are not conditional on gender. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Resilience among trans and gender-diverse adults : the protective role of dispositional hope in the perceived burdensomeness-suicide relationship
- Authors: Snooks, Matthew , McLaren, Suzanne
- Date: 2021
- Type: Text , Journal article
- Relation: Psychology of Sexual Orientation and Gender Diversity Vol. 8, no. 1 (2021), p. 57-67
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- Description: Trans and gender-diverse (TGD) adults are at increased risk for suicide. A wealth of evidence supports perceived burdensomeness as an independent key risk factor for suicide. Few studies have investigated dispositional hope or its components (agency and pathways) as a psychological resilience factor within the TGD population. The present study investigated the role of dispositional hope as a moderator in the relationship between perceived burdensomeness and suicidal ideation and behaviors among TGD adults. An international sample of 848 TGD adults aged 18 to 80 years (Mage= 26.27, SD = 7.70), who identified as male (n = 197), female (n = 614), or gender nonbinary (n = 37), completed the online questionnaires. Results demonstrated that dispositional hope, agency, and pathways were significant moderators, strengthening the perceived burdensomeness-suicidal ideation and behaviors relationship. Closer examination of the moderation effects suggests that higher levels of dispositional hope and its components may be protective against suicidal ideation and behaviors among TGD adults experiencing lower, but not higher, levels of perceived burdensomeness. Future research is urgently warranted within this population to help inform specialized interventions that may protect TGD adults who experience higher levels of perceived burdensomeness and are at high risk for suicidal ideation and behaviors. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Public Significance Statement—This study indicates that interventions which enhance hope may be related to lower levels of suicidal thoughts and behaviors among trans and gender-diverse adults with low, but not high, levels of perceived burdensomeness. It also highlights the urgent need for research aimed at identifying protective factors that may reduce suicidal thoughts and behaviors among trans and gender-diverse adults with high levels of perceived burdensomeness. (PsycInfo Database Record (c) 2021 APA, all rights reserved) © 2020 American Psychological Association
The relationships between self-compassion, rumination, and depressive symptoms among older adults : the moderating role of gender
- Authors: Hodgetts, Jessica , McLaren, Suzanne , Bice, Bridget , Trezise, Alexandra
- Date: 2021
- Type: Text , Journal article
- Relation: Aging and Mental Health Vol. 25, no. 12 (2021), p. 2337-2346
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- Description: Objectives: Depression is a significant mental health issue for older adults. Rumination is a key risk factor for depressive symptoms, and self-compassion is a protective factor. The aim of the current study was to test the processes by which self-compassion might act as a protective factor among older adults by investigating a mediation model, and whether the model is conditional on gender. It was hypothesised that self-compassion and its six components (self-kindness, common humanity, mindfulness, self-judgement, isolation, and over-identification) would be indirectly associated with depressive symptoms via rumination. Method: A sample of 135 older Australian women and 106 older Australian men aged between 65 and 89 years completed the Centre for Epidemiologic Studies Depression Scale, the Ruminative Thought Style Questionnaire, and the Self-Compassion Scale. Results: Results supported the mediation models for self-compassion for both men and women, however, support for the models involving the individual components of self-compassion varied according to gender. The mediation effects were stronger for women than men. Conclusion: Interventions aimed at increasing self-compassion might have benefits for older adults. Future research investigating whether tailoring interventions according to gender of participants is efficacious is needed. © 2020 Informa UK Limited, trading as Taylor & Francis Group.
Cognitive behaviour therapy for insomnia and depression : qualitative reflections from older adults who participated in a randomised controlled trial
- Authors: Sadler, Paul , McLaren, Suzanne , Klein, Britt , Jenkins, Megan
- Date: 2020
- Type: Text , Journal article
- Relation: Aging and Mental Health Vol. 24, no. 6 (2020), p. 932-938
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- Description: Objectives: To explore the experiences of older adults who participated in a randomised controlled trial (RCT) that tested cognitive behaviour therapy for insomnia and depression. Methods: Focus groups were conducted post treatment for older adults (M age = 75 years; 61% female) who participated in a RCT that tested two experiential interventions targeting comorbid insomnia and depression (cognitive behaviour therapy for insomnia, CBT-I; cognitive behaviour therapy for insomnia plus positive mood strategies, CBT-I+). Six semi-structured focus group interviews (N = 31) were analysed using a qualitative thematic analysis. Results: Interview data were transcribed into 424 sentences and 60 codes were extracted. Thirty-four initial themes emerged, which were transformed into 3 themes and 10 subthemes. The three primary themes were (1) positive experiences, (2) negative experiences, and (3) suggested modifications. The positive subthemes were (1a) therapists, (1b) togetherness, (1c) use of strategies reduced symptoms, and (1d) acceptance. The negative subthemes were (2a) persistent symptoms, (2b) program too condensed, and (2c) attendance obstacles. The suggested modifications were (3a) lengthen program, (3b) multi-dimensional learning, and (3c) multi-modal delivery options. Conclusion: The experiences and suggestions identified in this study strengthen the foundation to advance therapeutic program development for older adults with comorbid insomnia and depression. Future CBT-I programs for older adults may be improved by increasing the length of therapy (e.g. 8 sessions to 12 sessions), adding multi-dimensional learning opportunities (e.g. visual/audio/mentorship), and offering various modes of treatment delivery (e.g. group, individual, internet, telephone). © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.
- Description: Federation University Australia and the Australian Government Research Training Program Scholarship
The relationship between a sense of belonging to the LGBTIQ + community, internalized heterosexism, and depressive symptoms among bisexual and lesbian women
- Authors: McLaren, Suzanne , Castillo, Paola
- Date: 2020
- Type: Text , Journal article
- Relation: Journal of Bisexuality Vol. 21, no. 1 (2020), p. 1-23
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- Description: Depressive symptoms are a significant health concern among sexual minority women, with bisexual women at a higher risk than lesbian women. Internalized heterosexism is a key risk factor for depression among sexual minority women. Sense of belonging to the LGBTIQ + community is protective for lesbian women, but the limited research among bisexual women has shown inconsistent results. The current study investigated whether a sense of belonging to the LGBTIQ + community was directly related to fewer depressive symptoms and indirectly related via lower levels of internalized heterosexism, and whether the indirect effect was similar for bisexual and lesbian women. A sample of 175 self-identified bisexual women and 311 self-identified lesbian women aged 18 to 61 years (M = 31.91, SD = 11.38) completed the Psychological subscale of the Sense of Belonging Instrument, the Internalized Homophobia Scale, and the Center for Epidemiologic Studies Depression Scale. Bisexual women reported higher levels of depressive symptoms and internalized heterosexism, and lower levels of a sense of belonging to the LGBTIQ + community, than lesbian women. A sense of belonging to the LGBTIQ + community was directly associated with lower depressive symptoms and indirectly related via lower internalized heterosexism. However, sexual orientation moderated the indirect relationship. The indirect effect of a sense of belonging to the LGBTIQ + community on depressive symptoms was significant for lesbian women but not bisexual women. Results imply that increasing a sense of belonging to the LGBTIQ + community may be beneficial for bisexual and lesbian women, but the pathways by which protection is afforded will differ. © 2020 Taylor & Francis Group, LLC.
The relationship between living alone, sense of belonging, and depressive symptoms among older men: the moderating role of sexual orientation
- Authors: McLaren, Suzanne
- Date: 2020
- Type: Text , Journal article
- Relation: Aging & Mental Health Vol. 24, no. 1 (Jan 2020), p. 103-109
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- Description: Objectives: Living alone is a risk factor for depressive symptoms among older men, and is likely to occur due to belongingness needs being unmet. It is proposed the living alone-sense of belonging and living alone-depressive symptoms relations are stronger for gay men than heterosexual men, due to different family circumstances. This research tested a moderated mediation model, specifically whether the relationship between living alone and depressive symptoms is mediated by sense of belonging, and whether the living alone-sense of belonging and living alone-depressive symptoms relationships are moderated by sexual orientation. Method: A community sample of 169 Australian gay men aged 65 to 93 years and 187 Australian heterosexual men aged 65 to 94 years completed the Psychological subscale of the Sense of Belonging Instrument and the Center for Epidemiologic Studies Depression Scale. Results: Results supported the simple mediation model, with living alone being associated directly and indirectly with depressive symptoms via sense of belonging. The conditional indirect effect of living alone on depressive symptoms via sense of belonging was not significant, and therefore the moderated mediation model was not supported. Conclusion: Results imply that older men who live alone are at increased risk of depressive symptoms directly and indirectly via lower levels of sense of belonging.
What about me? Sense of belonging and depressive symptoms among bisexual women
- Authors: McLaren, Suzanne , Castillo, Paolo
- Date: 2020
- Type: Text , Journal article
- Relation: Journal of Bisexuality Vol. 20, no. 2 (2020), p. 166-182
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- Description: Depression is a significant mental health issue for bisexual women. While theory and research indicates that sense of belonging is important for mental health, limited research has investigated this in relation to bisexual women belonging to the LGBTQ + community. Existing research indicates that identification and involvement with the LGBTQ + community is not protective for the mental health of bisexual women. The protective nature of the extent to which bisexual women feel valued and needed within the lesbian community has not been examined. The current study examined the relationships between sense of belonging to the lesbian and heterosexual communities and depressive symptoms among bisexual women. A sample of 306 Australian self-identified bisexual women completed the Center for Epidemiologic Studies Depression Scale and the psychological subscale of the Sense of Belonging Instrument. Results indicated that sense of belonging to each community was related to lower levels of depressive symptoms. Further, levels of belonging to each community interacted, indicating that sense of belonging to the lesbian community was protective for bisexual women with lower, but not higher, levels of sense of belonging to the heterosexual community. Results imply that increasing belonging to the lesbian community is important for bisexual women who do not feel they belong in the heterosexual community. The challenge is how to increase sense of belonging of bisexual women in the lesbian community, where they are exposed to negative attitudes about their sexuality. © 2020 Taylor & Francis Group, LLC.
Exercise, mood, self-efficacy, and social support as predictors of depressive symptoms in older adults : Direct and interaction effects
- Authors: Miller, Kyle , Mesagno, Christopher , McLaren, Suzanne , Grace, Fergal , Yates, Mark , Gomez, Rapson
- Date: 2019
- Type: Text , Journal article
- Relation: Frontiers in Psychology Vol. 10, no. (2019), p. 1-11
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- Description: Background: Depression is a chronic condition that affects up to 15% of older adults. The healthogenic effects of regular exercise are well established, but it is still unclear which exercise-related variables characterise the antidepressant effects of exercise. Thus, the purpose of this study was to examine the extent to which exercise-related variables (exercise behaviour, exercise-induced mood, exercise self-efficacy, and social support) can predict depressive symptoms in a cohort of community-dwelling older adults. Methods: This study employed a cross-sectional analysis of questionnaire data from a sample of 586 community-dwelling older Australians aged 65 to 96 years old. Participants completed the Center for Epidemiologic Studies Depression Scale, modified CHAMPS Physical Activity Questionnaire for Older Adults, Four-Dimension Mood Scale, Self-Efficacy for Exercise Scale, and Social Provisions Scale - Short Form. Bivariate correlations were performed, and hierarchical multiple regression was subsequently used to test the regression model. Results: Exercise behaviour, exercise-induced mood, exercise self-efficacy, and social support were all negatively associated with depressive symptoms (r = -0.20 to -0.56). When the variables were entered as predictors into the hierarchical multiple regression model, social support was the strongest predictor of depressive symptoms (beta = -0.42), followed by exercise-induced mood (beta = -0.23), and exercise self-efficacy (beta = -0.07). Exercise behaviour did not explain any additional variance in depressive symptoms. A modest interaction effect was also observed between exercise-induced mood and social support. Conclusion: These findings indicate that social support is the strongest predictor of depressive symptomology in community-dwelling older adults, particularly when combined with positive exercise-induced mood states. When addressing the needs of older adults at risk of depression, healthcare professionals should consider the implementation of exercise programmes that are likely to benefit older adults by improving mood, enhancing self-efficacy, and building social support.
Relationship Status and Suicidal Behavior in Gay Men: The Role of Thwarted Belongingness and Hope
- Authors: Riley, Kym , McLaren, Suzanne
- Date: 2019
- Type: Text , Journal article
- Relation: Suicide and Life-Threatening Behavior Vol. 49, no. 5 (Oct 2019), p. 1452-1462
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- Description: ObjectiveLevels of suicidal behavior among gay men are a significant concern. The Interpersonal Theory of Suicide proposes that being unpartnered is a risk factor for suicidal behavior due to thwarted belongingness; however, this has yet to be tested empirically. Recent studies also indicate that the two components of hope, agency and pathways, may be protective against suicidal behavior. The first aim of the current study was to investigate whether thwarted belongingness mediates the relationship between relationship status and suicidal behavior in gay men. The study also examined whether agency and pathways weaken the association between relationship status and thwarted belongingness, and whether agency weakens the relation between thwarted belongingness and suicidal behavior. MethodA sample of 370 self-identified gay men aged from 18 to 66 years old (M = 26.13, SD = 8.02) completed the Suicidal Behaviors Questionnaire-Revised, the Interpersonal Needs Questionnaire-Revised, and the Adult Dispositional Hope Scale. ResultsResults showed that thwarted belongingness mediated the relationship between relationship status and suicidal behavior. The hypothesized moderated-mediation models were not supported. ConclusionsThese findings have implications for the development of interventions that aim to reduce suicidal behaviors in gay men.
Self-reliance and stoicism as predictors of distress following radical prostatectomy in the context of place of residence
- Authors: Corboy, Denise , Meier, Jasmine , McLaren, Suzanne
- Date: 2019
- Type: Text , Journal article
- Relation: Psychology of Men & Masculinity Vol. 20, no. 4 (2019), p. 637-646
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- Description: A common form of treatment for Australian men with prostate cancer is a radical prostatectomy (RP). Although sociodemographic and medical factors have been found to be predictive of psychological distress following RP, the traditional masculine norms of self-reliance and stoicism are also implicated in poor psychological outcomes. The strength of the relationship between these masculine norms and distress may vary according to place of residence-specifically, living in regional/remote versus urban areas. The aim of the current study was to investigate these masculine norms as predictors of psychological distress among a sample of men who had received the same treatment for prostate cancer, in the context of place of residence. Participants were 447 men, aged between 42 and 77 years (M = 63.1, SD = 6.4), all of whom had undergone a RP within the previous 6 months. Participants completed self-report measures of psychological distress, physical functioning, self-reliance, and stoicism. As hypothesized, self-reliance and stoicism were independent and unique predictors of psychological distress, after controlling for sociodemographic and medical factors. Place of residence moderated the relationship between stoicism and distress, whereby the relationship was only significant for urban men. The relationship between self-reliance and distress was significant for all men regardless of place of residence. The current study takes an important step toward identifying potentially modifiable and context-specific factors that can impact the experience of psychological distress among men following RP.
Advancing cognitive behaviour therapy for older adults with comorbid insomnia and depression
- Authors: Sadler, Paul , McLaren, Suzanne , Klein, Britt , Jenkins, Megan
- Date: 2018
- Type: Text , Journal article , Review
- Relation: Cognitive Behaviour Therapy Vol. 47, no. 2 (2018), p. 139-154
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- Description: Insomnia and depression are two of the most common mental health problems that negatively impact older adults. The burden associated with these highly comorbid conditions requires an innovative approach to treatment. There have been significant advancements in the field of cognitive behaviour therapy for insomnia (CBT-I) over recent years. CBT-I has evolved from targeting homogenous insomnia samples to now showing promising results for comorbid insomnia. CBT-I is not only effective at treating comorbid insomnia, but can also have a positive impact on depression severity. Despite these important clinical developments, limited research has explored whether modifying CBT-I programmes to specifically target comorbid depression could improve outcomes for older populations. This paper reviews recent literature and provides therapeutic recommendations to advance CBT-I for older adults with comorbid insomnia and depression. © 2017 Swedish Association for Behaviour Therapy.
Cognitive behavior therapy for older adults with insomnia and depression : A randomized controlled trial in community mental health services
- Authors: Sadler, Paul , McLaren, Suzanne , Klein, Britt , Harvey, Jack , Jenkins, Megan
- Date: 2018
- Type: Text , Journal article
- Relation: Sleep Vol. 41, no. 8 (2018), p. 1-12
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- Description: Study Objectives: To investigate whether cognitive behavior therapy was effective for older adults with comorbid insomnia and depression in a community mental health setting, and explore whether an advanced form of cognitive behavior therapy for insomnia produced better outcomes compared to a standard form of cognitive behavior therapy for insomnia. Methods: An 8-week randomized controlled clinical trial was conducted within community mental health services, Victoria, Australia. Seventy-two older adults (56% female, M age 75 ± 7 years) with diagnosed comorbid insomnia and depression participated. Three conditions were tested using a group therapy format: cognitive behavior therapy for insomnia (CBT-I, standard), cognitive behavior therapy for insomnia plus positive mood strategies (CBT-I+, advanced), psychoeducation control group (PCG, control). The primary outcomes were insomnia severity (Insomnia Severity Index) and depression severity (Geriatric Depression Scale). Primary and secondary measures were collected at pre (week 0), post (week 8), and follow-up (week 20). Results: CBT-I and CBT-I+ both generated significantly greater reductions in insomnia and depression severity compared to PCG from pre to post (p < .001), which were maintained at follow-up. Although the differences between outcomes of the two treatment conditions were not statistically significant, the study was not sufficiently powered to detect either superiority of one treatment or equivalence of the two treatment conditions. Conclusion: CBT-I and CBT-I+ were both effective at reducing insomnia and depression severity for older adults. Mental health services that deliver treatment for comorbid insomnia with cognitive behavior therapy may improve recovery outcomes for older adults with depression. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR); URL: https://www.anzctr.org.au; Trial ID: ACTRN12615000067572; Date Registered: December 12, 2014.
Resiliency among older adults : Dispositional hope as a protective factor in the insomnia–depressive symptoms relation
- Authors: Trezise, Alexandra , McLaren, Suzanne , Gomez, Rapson , Bice, Bridget , Hodgetts, Jessica
- Date: 2018
- Type: Text , Journal article
- Relation: Aging and Mental Health Vol. 22, no. 8 (2018), p. 1088-1096
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- Reviewed:
- Description: Objectives: Depression is a significant mental health issue among older Australian adults. Research has indicated that insomnia is a key risk factor for the development of depressive symptoms in older adults, and that dispositional hope may be protective against the development of depressive symptoms in this population. This study examined whether dispositional hope and its dimensions, agency and pathways, moderated the relationship between insomnia symptoms and depressive symptoms among older Australian adults. Method: A community sample of 88 men (Mage = 71.11, SDage = 5.54) and 111 women (Mage = 70.25, SDage = 4.64), aged 65–94 years, completed the Insomnia Severity Index, Adult Dispositional Hope Scale, and Centre of Epidemiologic Studies Depression Scale. Results: After controlling for gender, age, relationship status, education level, method of participation, and perceived physical health, results supported the moderation models. The insomnia–depressive symptoms relation was significant for older adults with low and average (but not high) levels of dispositional hope, agency, and pathways. The Johnson–Neyman analyses indicated that the insomnia–depressive symptoms relation was significant for older adults who scored below 27.10 on dispositional hope, below 13.73 on agency, and below 13.49 and above 15.64 on pathways. Conclusion: The results of this study imply that interventions aimed at increasing dispositional hope, agency, and pathways among older adults who experience symptoms of insomnia may reduce their depressive symptoms. A cautionary note, however, is that very high scores on pathways among older adults who experience insomnia symptoms may be detrimental to their mental health.