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The factor structure of anxiety and depressive disorders in a sample of clinic-referred adolescents

- Gomez, Rapson, Vance, Alasdair, Gomez, Rashika

  • Authors: Gomez, Rapson , Vance, Alasdair , Gomez, Rashika
  • Date: 2014
  • Type: Text , Journal article
  • Relation: Journal of Abnormal Child Psychology Vol. 42, no. 2 (2014), p. 321-332
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  • Description: Abstract The current study used confirmatory factor analysis (CFA) to examine the factor structure of anxiety and depressive disorders in a sample of clinic-referred adolescents, aged between 12 and 18 years, for diagnoses based on parent (N = 655; male = 441) and adolescent (N = 626; male = 417) interviews. Three models were examined: a 1-factor model, with all anxiety and depressive disorders in a single factor; a DSM-based 2-factor model, with anxiety disorders in one factor, and depressive disorders in another factor; and an alternate 2-factor model, with fear related anxiety disorders in one factor, and other anxiety and depressive disorders in another factor. The findings indicated support for all three models. Also, ADHD and ODD/CD were associated with only the shared variances between the latent factors in the 2-factor models, and not their unique variance. The implications of the findings for taxonomy, comorbidity, and clinical practice are discussed. © 2013 Springer Science+Business Media New York.

A Scoping review of autism and the way it changes the presentation of suicidal thoughts and behavior compared to the general population

- Cleary, Michelle, West, Sancia, McLean, Loyola, Hunt, Glenn, Hungerford, Catherine, Kornhaber, Rachel

  • Authors: Cleary, Michelle , West, Sancia , McLean, Loyola , Hunt, Glenn , Hungerford, Catherine , Kornhaber, Rachel
  • Date: 2023
  • Type: Text , Journal article
  • Relation: Issues Mental Health Nursing Vol. 44, no. 4 (2023), p. 282-301
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  • Description: Autism spectrum conditions are a group of neurodevelopmental conditions that carries an array of co-occurring diagnoses, including a heightened risk of suicide attempts and suicide. This scoping review examined primary research focusing on autism and suicidality, to understand what is currently known on the topic, including how autism changes the presentation of suicidal thoughts and behavior and to assess the suicide awareness and prevention education programs currently available for autistic people, their families, and health professionals and support workers. A comprehensive search (November 2021) across Scopus, PubMed and CINAHL identified 39 articles from 38 studies. Three themes emerged, with five subthemes. 1. The prevalence of suicidality in autistic people 2. The presentation of suicidality in autistic people, including (a) risk of suicidality (b) gender, age, employment and education (c) co-occurring psychiatric conditions (d) autism traits and social communication (e) intellectual disability and 3. Autism-specific approaches to suicidal thoughts, behavior and prevention. Findings were mixed, including conflicting evidence on the risk of autism and suicidality, and limited evidence of resources related to autism-specific suicide awareness or information, and education or prevention programs.

An evolutionary perspective on the co-occurrence of social anxiety disorder and alcohol use disorder

- Bulley, Adam, Miloyan, Beyon, Brilot, Ben, Gullo, Matthew, Suddendorf, Thomas

  • Authors: Bulley, Adam , Miloyan, Beyon , Brilot, Ben , Gullo, Matthew , Suddendorf, Thomas
  • Date: 2016
  • Type: Text , Journal article
  • Relation: Journal of Affective Disorders Vol. 196, no. (2016), p. 62-70
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  • Description: Social Anxiety Disorder (SAD) commonly co-occurs with, and often precedes, Alcohol Use Disorder (AUD). In this paper, we address the relationship between SAD and AUD by considering how natural selection left socially anxious individuals vulnerable to alcohol use, and by addressing the underlying mechanisms. We review research suggesting that social anxiety has evolved for the regulation of behaviors involved in reducing the likelihood or consequences of threats to social status. The management of potential threats to social standing is important considering that these threats can result in reduced cooperation or ostracism - and therefore to reduced access to coalitional partners, resources or mates. Alcohol exerts effects upon evolutionarily conserved emotion circuits, and can down-regulate or block anxiety (or may be expected to do so). As such, the ingestion of alcohol can artificially signal the absence or successful management of social threats. In turn, alcohol use may be reinforced in socially anxious people because of this reduction in subjective malaise, and because it facilitates social behaviors - particularly in individuals for whom the persistent avoidance of social situations poses its own threat (i.e., difficulty finding mates). Although the frequent co-occurrence of SAD and AUD is associated with poorer treatment outcomes than either condition alone, a richer understanding of the biological and psychosocial drives underlying susceptibility to alcohol use among socially anxious individuals may improve the efficacy of therapeutic interventions aimed at preventing or treating this comorbidity. © 2016 Elsevier B.V. All rights reserved.

Oppositional defiant disorder dimensions : associations with traits of the multidimensional personality model among adults

- Gomez, Rapson, Stavropoulos, Vasileios

  • Authors: Gomez, Rapson , Stavropoulos, Vasileios
  • Date: 2019
  • Type: Text , Journal article
  • Relation: Psychiatric Quarterly Vol. 90, no. 4 (Dec 2019), p. 777-792
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  • Description: The occurrence of Oppositional Defiant Disorder (ODD) behaviours among adults has been supported by a proportion of scholars. The current work examines potential ODD dimensions and their associations with the primary personality traits of Tellegen's [57] multi-dimensional conceptualization during adulthood. Two independent, general community, adult groups [Group 1: N = 214; mean age (SD) = 35.74 (16.60); Group 2: N = 205; mean age (SD) = 29.00 (12.42)] completed the Current Symptom Scale involving the eight ODD criteria. Group 2 additionally addressed the Multidimensional Personality Questionnaire -Brief Form (MPQ-BF). A series of Confirmatory Factor Analyses (CFA) were implemented. The three-dimensional ODD conceptualization of Burke and colleagues [14] referring to "Negative Affect", "Oppositional Behavior", and "Antagonistic Behavior" was confirmed. Considering personality traits, valuable associations were revealed between Oppositional Behavior and Aggression, Antagonistic Behavior and Social Potency as well as Harm Avoidance, and finally, Negative Affect and Stress Reaction, as well as Aggression. The dimensionality of ODD behaviours in adulthood and its correspondence with particular personality traits is approached in the context of psychological practice.

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

- Klein, Britt, Nguyen, Huy, McLaren, Suzanne, Andrews, Brooke, Shandley, Kerrie

  • 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=

Depression across pregnancy and the postpartum, antidepressant use and the association with female sexual function

- Galbally, Megan, Watson, Stuart, Permezel, Michael, Lewis, Andrew

  • Authors: Galbally, Megan , Watson, Stuart , Permezel, Michael , Lewis, Andrew
  • Date: 2019
  • Type: Text , Journal article
  • Relation: Psychological Medcine Vol. 49, no. 9 (2019), p. 1490-1499
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  • Description: There is an established relationship between depression and sexual functioning in women. However, there is limited research examining the relationship between perinatal depression and sexual functioning. This study draws on the Mercy Pregnancy and Emotional Wellbeing Study and reports on 211 women recruited in early pregnancy and followed to 12 months postpartum. Women were assessed for depression using the Structured Clinical Interview for the DSM-IV, repeated measurement of depressive symptoms using the Edinburgh Postnatal Depression Scale and sexual functioning using the Female Sexual Functioning Inventory. Data were also collected on antidepressant use, mode of delivery, history of childhood trauma, breastfeeding and partner support. Women showed a decline in sexual functioning over pregnancy and the first 6 months postpartum, which recovered by 12 months. For women with depression, sexual functioning was lower throughout pregnancy and continued to be lower at 6 months postpartum than those without depression. Ongoing depressive symptoms at 12 months were also associated with lower sexual functioning. Sexual functioning was not predicted by mode of delivery, antidepressant use or childhood trauma. Breastfeeding predicted lower sexual functioning only at 6 months. Higher partner support predicted higher female sexual functioning. Pregnancy and the postpartum are a time of reduced sexual functioning for women however, women with depression are more likely to have lower levels of sexual functioning and this was not predicted by antidepressant use. In women with perinatal depression, consideration of the impact on sexual functioning should be an integral part of care.

Cognitive behavior therapy for older adults with insomnia and depression : A randomized controlled trial in community mental health services

- Sadler, Paul, McLaren, Suzanne, Klein, Britt, Harvey, Jack, Jenkins, Megan

  • 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.

Multiple comorbidities of 21 psychological disorders and relationships with psychosocial variables: A study of the online assessment and diagnostic system within a web-based population

- Al-Asadi, Ali, Klein, Britt, Meyer, Denny

  • Authors: Al-Asadi, Ali , Klein, Britt , Meyer, Denny
  • Date: 2015
  • Type: Text , Journal article
  • Relation: Journal of Medical Internet Research Vol. 17, no. 2 (2015), p. 355
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  • Description: Background: While research in the area of e-mental health has received considerable attention over the last decade, there are still many areas that have not been addressed. One such area is the comorbidity of psychological disorders in a Web-based sample using online assessment and diagnostic tools, and the relationships between comorbidities and psychosocial variables. Objective: We aimed to identify comorbidities of psychological disorders of an online sample using an online diagnostic tool. Based on diagnoses made by an automated online assessment and diagnostic system administered to a large group of online participants, multiple comorbidities (co-occurrences) of 21 psychological disorders for males and females were identified. We examined the relationships between dyadic comorbidities of anxiety and depressive disorders and the psychosocial variables sex, age, suicidal ideation, social support, and quality of life. Methods: An online complex algorithm based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision, was used to assign primary and secondary diagnoses of 21 psychological disorders to 12,665 online participants. The frequency of co-occurrences of psychological disorders for males and females were calculated for all disorders. A series of hierarchical loglinear analyses were performed to examine the relationships between the dyadic comorbidities of depression and various anxiety disorders and the variables suicidal ideation, social support, quality of life, sex, and age. Results: A 21-by-21 frequency of co-occurrences of psychological disorders matrix revealed the presence of multiple significant dyadic comorbidities for males and females. Also, for those with some of the dyadic depression and the anxiety disorders, the odds for having suicidal ideation, reporting inadequate social support, and poorer quality of life increased for those with two-disorder comorbidity than for those with only one of the same two disorders. Conclusions: Comorbidities of several psychological disorders using an online assessment tool within a Web-based population were similar to those found in face-to-face clinics using traditional assessment tools. Results provided support for the transdiagnostic approaches and confirmed the positive relationship between comorbidity and suicidal ideation, the negative relationship between comorbidity and social support, and the negative relationship comorbidity and quality of life. © 2015, Journal of Medical Internet Research. All rights reserved.

Patterns of comorbidity in community-dwelling older people hospitalised for fall-related injury: A cluster analysis

- Vu, Trang, Finch, Caroline, Day, Lesley

  • Authors: Vu, Trang , Finch, Caroline , Day, Lesley
  • Date: 2011
  • Type: Text , Journal article
  • Relation: BMC Geriatrics Vol. 11, no. 45 (2011), p. 1-10
  • Relation: http://purl.org/au-research/grants/nhmrc/565900
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  • Description: Background: Community-dwelling older people aged 65+ years sustain falls frequently; these can result in physical injuries necessitating medical attention including emergency department care and hospitalisation. Certain health conditions and impairments have been shown to contribute independently to the risk of falling or experiencing a fall injury, suggesting that individuals with these conditions or impairments should be the focus of falls prevention. Since older people commonly have multiple conditions/impairments, knowledge about which conditions/impairments coexist in at-risk individuals would be valuable in the implementation of a targeted prevention approach. The objective of this study was therefore to examine the prevalence and patterns of comorbidity in this population group. Methods: We analysed hospitalisation data from Victoria, Australia's second most populous state, to estimate the prevalence of comorbidity in patients hospitalised at least once between 2005-6 and 2007-8 for treatment of acute fall-related injuries. In patients with two or more comorbid conditions (multicomorbidity) we used an agglomerative hierarchical clustering method to cluster comorbidity variables and identify constellations of conditions. Results: More than one in four patients had at least one comorbid condition and among patients with comorbidity one in three had multicomorbidity (range 2-7). The prevalence of comorbidity varied by gender, age group, ethnicity and injury type; it was also associated with a significant increase in the average cumulative length of stay per patient. The cluster analysis identified five distinct, biologically plausible clusters of comorbidity: cardiopulmonary/metabolic, neurological, sensory, stroke and cancer. The cardiopulmonary/metabolic cluster was the largest cluster among the clusters identified. Conclusions: The consequences of comorbidity clustering in terms of falls and/or injury outcomes of hospitalised patients should be investigated by future studies. Our findings have particular relevance for falls prevention strategies, clinical practice and planning of follow-up services for these patients.

Effect of comorbidity on relative survival following hospitalisation for fall-related hip fracture in older people

- Hindmarsh, Diane, Loh, Ming, Finch, Caroline, Hayen, Andrew, Close, Jacqueline

Caring for clients with dual diagnosis in rural communities in Australia : The experience of mental health professionals

- Deans, Cecil, Soar, Rod

  • Authors: Deans, Cecil , Soar, Rod
  • Date: 2005
  • Type: Text , Journal article
  • Relation: Journal of Psychiatric and Mental Health Nursing Vol. 12, no. 3 (2005), p. 268-274
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  • Description: This paper identifies and describes the experiences of 13 rural mental health professionals who care for clients diagnosed with a mental illness and a coexisting alcohol and other drug disorder (dual diagnosis). Dual diagnosis is a common problem which is often poorly understood and managed by mental health professionals. The effect of excessive substance use on a person's mental well-being can present as a diagnostic challenge as each condition may mask symptoms of the other. The authors utilized a phenomenological approach to discover the experiences of a group of mental health professionals working in rural communities in Victoria, Australia. Caring for clients diagnosed with dual diagnosis was found to be a complex and stressful role that involved high levels of skill and knowledge. Despite the fact that health professionals in rural areas are expected to deliver the most appropriate care to individuals with a dual diagnosis, a number of these rural health professionals have limited preparation and experience in dealing with arising clinical diagnosis issues. Clinicians experience frustration, resentment and powerlessness in their attempt to understand their clients' drug misuse whilst simultaneously endeavouring to provide a quality mental health service. © 2005 Blackwell Publishing Ltd.
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  • Description: 2003001191

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

- Andrews, Brooke, Klein, Britt, McLaren, Suzanne, Watson, Shaun, Corboy, Denise

  • 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.

Major depression and generalised anxiety disorder: An analysis of the effects of remission status and comorbidity on mother‐infant emotional availability in the perinatal period

- Aran, Pavitra, Lewis, Andrew, Watson, Stuart, Galbally, Megan

  • Authors: Aran, Pavitra , Lewis, Andrew , Watson, Stuart , Galbally, Megan
  • Date: 2022
  • Type: Text , Journal article
  • Relation: Journal of Clinical Psychology Vol. 78, no. 4 (2022), p. 570-589
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  • Description: Background The effects of maternal depression on mother‐infant relationship quality likely vary according to depression heterogeneity. We investigated the effects of different presentations of major depression on mother‐infant emotional availability (EA). Methods Data were obtained from 115 mother‐infant dyads from a longitudinal pregnancy cohort. Disorders, symptoms, and antidepressant use were assessed in pregnancy and postpartum, and EA was observed 6‐month postpartum. Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) were assessed using the Structured Clinical Interview for the DSM‐5. A series of multivariate analyses of covariance analyses' examining the effects of disorder on EA were conducted. Results After controlling for maternal age, antidepressant use, and postpartum depressive symptoms, MDD accounted for 20% of the variance in EA. In the MDD/GAD group, 93% of interactions were rated as emotionally unavailable, nearly threefold the comparison group rate. Conclusions Findings demonstrate that different presentations of major depression are associated with observed differences in mother‐infant EA. HIGHLIGHTS Lifetime major depression predicted mother‐infant emotional availability, independent of antidepressant use or postpartum depressive symptoms The risk of emotional unavailability varied according to different presentations of major depression Comorbid generalized anxiety disorder was associated with the greatest risk of emotional unavailability

Exploring the relationship between testosterone and diabetes within the UK Biobank data

- Oatley, Giles

Big Five personality traits and alcohol, nicotine, cannabis, and gambling disorder comorbidity

- Dash, Genevieve, Slutske, Wendy, Martin, Nicholas, Statham, Dixie, Agrawal, Arpana, Lynskey, Michael

  • Authors: Dash, Genevieve , Slutske, Wendy , Martin, Nicholas , Statham, Dixie , Agrawal, Arpana , Lynskey, Michael
  • Date: 2019
  • Type: Text , Journal article
  • Relation: Psychology of Addictive Behaviors Vol. 33, no. 4 (2019), p. 420-429
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  • Description: The Diagnostic and Statistical Manual of Mental Disorders (DSM; 5th ed.) reassignment of gambling disorder as an addictive disorder alongside the substance-related addictive disorders encourages research into their shared etiologies. The aims of this study were to examine: (a) the associations of Big Five personality dimensions with alcohol, nicotine, cannabis, and gambling disorders, (b) the comorbidity between these disorders, (c) the extent to which common personality underpinnings explain comorbidity, (d) whether results differed for men and women, and (e) the magnitude of personality differences corresponding to the 4 disorders. Participants were 3,785 twins and siblings (1.365 men, 2,420 women; M-age = 32 years, range = 21-46 years) from the Australian Twin Registry who completed psychiatric interviews and Big Five personality inventories. The personality profile of high neuroticism, low agreeableness, and low conscientiousness was associated with all 4 addictive disorders. All but 1 of the pairwise associations between the disorders were significant. After accounting for Big Five traits, the associations were attenuated to varying degrees but remained significant. The results were generally similar for men and women. The results suggest that the Big Five traits of neuroticism, agreeableness, and conscientiousness are associated with the general propensity to develop an addictive disorder and may in part explain their co-occurrence; however, they may be more broadly associated with the propensity for any psychiatric disorder. The effect sizes of the personality associations suggest that the diagnosis of gambling disorder as operationalized by the DSM may be more severe than the other addictive disorders. Calibration of the diagnosis of gambling disorder to the other addictive disorders may be warranted.

Linked versus unlinked hospital discharge data on hip fractures for estimating incidence and comorbidity profiles

- Vu, Trang, Day, Lesley, Finch, Caroline

  • Authors: Vu, Trang , Day, Lesley , Finch, Caroline
  • Date: 2012
  • Type: Text , Journal article
  • Relation: BMC Medical Research Methodology Vol. 12, no. 113 (2012), p. 1-8
  • Relation: http://purl.org/au-research/grants/nhmrc/565900
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  • Description: Background: Studies comparing internally linked (person–identifying) and unlinked (episodes of care) hospital discharge data (HDD) on hip fractures have mainly focused on incidence overestimation by unlinked HDD, but little is known about the impact of overestimation on patient profiles such as comorbidity estimates. In view of the continuing use of unlinked HDD in hip fracture research and the desire to apply research results to hip fracture prevention, we concurrently assessed the accuracy of both incidence and comorbidity estimates derived from unlinked HDD compared to those estimated from internally linked HDD. Methods: We analysed unlinked and internally linked HDD between 01 July 2005 and 30 June 2008, inclusive, from Victoria, Australia to estimate the incidence of hospital admission for fall-related hip fracture in community-dwelling older people aged 65+ years and determine the prevalence of comorbidity in patients. Community-dwelling status was defined as living in private residence, supported residential facilities or special accommodation but not in nursing homes. We defined internally linked HDD as the reference standard and calculated measures of accuracy of fall-related hip fracture incidence by unlinked HDD using standard definitions. The extent to which comorbidity prevalence estimates by unlinked HDD differed from those by the reference standard was assessed in absolute terms. Results: The sensitivity and specificity of a standard approach for estimating fall-related hip fracture incidence using unlinked HDD (i.e. omitting records of in-hospital deaths, inter-hospital transfers and readmissions within 30 days of discharge) were 94.4% and 97.5%, respectively. The standard approach and its variants underestimated the prevalence of some comorbidities and altered their ranking. The use of more stringent selection criteria led to major improvements in all measures of accuracy as well as overall and specific comorbidity estimates. Conclusions: This study strongly supports the use of linked rather than unlinked HDD in injury research. In health systems where linked HDD are unavailable, current approaches for identifying incident hip fractures may be enhanced by incorporating additional evidence-based criteria.

Cognitive behaviour therapy for older adults experiencing insomnia and depression in a community mental health setting: Study protocol for a randomised controlled trial

- Sadler, Paul, McLaren, Suzanne, Klein, Britt, Jenkins, Megan, Harvey, Jack

  • Authors: Sadler, Paul , McLaren, Suzanne , Klein, Britt , Jenkins, Megan , Harvey, Jack
  • Date: 2015
  • Type: Text , Journal article
  • Relation: Trials Vol. 16, no. 1 (2015), p.1-12
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  • Description: Background: Cognitive behaviour therapy for insomnia (CBT-I) is a well-established treatment; however, the evidence is largely limited to homogenous samples. Although emerging research has indicated that CBT-I is also effective for comorbid insomnia, CBT-I has not been tested among a complex sample of older adults with comorbid insomnia and depression. Furthermore, no study has explored whether modifying CBT-I to target associated depressive symptoms could potentially enhance sleep and mood outcomes. Therefore, this study aims to report a protocol designed to test whether an advanced form of CBT for insomnia and depression (CBT-I-D) is more effective at reducing insomnia and depressive symptoms compared to a standard CBT-I and psychoeducation control group (PCG) for older adults in a community mental health setting. Methods/Design: We aim to recruit 150 older adults with comorbid insomnia who have presented to community mental health services for depression. Eligible participants will be randomly allocated via block/cluster randomisation to one of three group therapy conditions: CBT-I, CBT-I-D, or PCG. Participants who receive CBT-I will only practice strategies designed to improve their sleep, whereas participants who receive CBT-I-D will practice additional strategies designed to also improve their mood. This trial will implement a mixed-methods design involving quantitative outcome measures and qualitative focus groups. The primary outcome measures are insomnia and depression severity, and secondary outcomes are anxiety, hopelessness, beliefs about sleep, comorbid sleep conditions, and health. Outcomes will be assessed at pre-intervention (week 0), post-intervention (week 8), and 3-month follow-up (week 20). Discussion: This CBT study protocol has been designed to address comorbid insomnia and depression for older adults receiving community mental health services. The proposed trial will determine whether CBT-I is more effective for older adults with comorbid insomnia and depression compared to a PCG. It will also establish whether an advanced form of CBT-I-D generates greater reductions in insomnia and depression severity compared to standard CBT-I. The results from the proposed trial are anticipated to have important clinical implications for older adults, researchers, therapists, and community mental health services. Trial registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN: 12615000067572 , Date Registered 12 December 2014. © 2015 Sadler et al.

Comorbidity structure of psychological disorders in the online e-PASS data as predictors of psychosocial adjustment measures: psychological distress, adequate social support, self-confidence, quality of life, and suicidal ideation

- Al-Asadi, Ali, Klein, Britt, Meyer, Denny

  • Authors: Al-Asadi, Ali , Klein, Britt , Meyer, Denny
  • Date: 2014
  • Type: Text , Journal article
  • Relation: Journal of Medical Internet Research Vol. 16, no. 10 (2014), p. e248
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  • Description: BACKGROUND: A relative newcomer to the field of psychology, e-mental health has been gaining momentum and has been given considerable research attention. Although several aspects of e-mental health have been studied, 1 aspect has yet to receive attention: the structure of comorbidity of psychological disorders and their relationships with measures of psychosocial adjustment including suicidal ideation in online samples. OBJECTIVE: This exploratory study attempted to identify the structure of comorbidity of 21 psychological disorders assessed by an automated online electronic psychological assessment screening system (e-PASS). The resulting comorbidity factor scores were then used to assess the association between comorbidity factor scores and measures of psychosocial adjustments (ie, psychological distress, suicidal ideation, adequate social support, self-confidence in dealing with mental health issues, and quality of life). METHODS: A total of 13,414 participants were assessed using a complex online algorithm that resulted in primary and secondary Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) diagnoses for 21 psychological disorders on dimensional severity scales. The scores on these severity scales were used in a principal component analysis (PCA) and the resulting comorbidity factor scores were related to 4 measures of psychosocial adjustments. RESULTS: A PCA based on 17 of the 21 psychological disorders resulted in a 4-factor model of comorbidity: anxiety-depression consisting of all anxiety disorders, major depressive episode (MDE), and insomnia; substance abuse consisting of alcohol and drug abuse and dependency; body image-eating consisting of eating disorders, body dysmorphic disorder, and obsessive-compulsive disorders; depression-sleep problems consisting of MDE, insomnia, and hypersomnia. All comorbidity factor scores were significantly associated with psychosocial measures of adjustment (P<.001). They were positively related to psychological distress and suicidal ideation, but negatively related to adequate social support, self-confidence, and quality of life. CONCLUSIONS: This exploratory study identified 4 comorbidity factors in the e-PASS data and these factor scores significantly predicted 5 psychosocial adjustment measures. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG).

Efficacy of a digital mental health biopsychosocial transdiagnostic intervention with or without therapist assistance for adults with anxiety and depression : adaptive randomized controlled trial

- Andrews, Brooke, Klein, Britt, Nguyen, Huy, Corboy, Denise, McLaren, Suzanne, Watson, Shaun

  • 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.
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