Carolyn Coggan

Risk factors associated with the transition from acute to chronic occupational back pain

Study Design. A prospective cohort study was conducted on workers claiming earnings-related compensation for low back pain. Information obtained at the time of the initial claim was linked to compensation status (still claiming or not claiming) 3 months later. Objective. To identify individual, psychosocial, and workplace risk factors associated with the transition from acute to chronic occupational back pain. Summary of Background Data. Despite the magnitude of the economic and social costs associated with chronic occupational back pain, few prospective studies have investigated risk factors identifiable in the acute stage. Methods. At the time of the initial compensation claim, a self-administered questionnaire was used to gather information on a wide range of risk factors. Then 3 months later, chronicity was determined from claimants’ computerized records. Results. The findings showed that 3 months after the initial assessment, 204 of the recruited 854 claimants (23.9%) still were receiving compensation payments. A combined multiple regression model of individual, psychosocial, and workplace risk factors demonstrated that severe leg pain (odds ratio [OR], 1.9), obesity (OR, 1.7), all three Oswestry Disability Index categories above minimal disability (OR, 3.1–4), a General Health Questionnaire score of at least 6 (OR, 1.9), unavailability of light duties on return to work (OR, 1.7), and a job requirement of lifting for three fourths of the day or more all were significant, independent determinants of chronicity (P < 0.05). Conclusions. Simple self-report measures of individual, psychosocial, and workplace factors administered when earnings-related compensation for back pain is claimed initially can identify individuals with increased odds for development of chronic occupational disability.

Harstad injury prevention study: prevention of burns in young children by community based intervention

Objective—To describe the long term effectiveness of a community based program targeting prevention of burns in young children. Design—Quasiexperimental. Setting—The Norwegian city of Harstad (main intervention), six surrounding municipalities (intervention diffusion), and Trondheim (reference). Participants—Children under age 5 years in the three study populations. Methods—Outpatient and inpatient hospital data were coded according to the Nordic system, and collected as part of a national injury surveillance system. Burn data collection started in May 1985. The first 19.5 months of the study provided baseline data, while the last 10 years involved community based intervention, using a mix of passive and active interventions. Results—The mean burn injury rate decreased by 51.5% after the implementation of the intervention in Harstad (p<0.05) and by 40.1% in the six municipalities (not significant). Rates in the reference city, Trondheim, increased 18.1% (not significant). In Harstad and the six surrounding municipalities there was a considerable reduction in hospital admissions, operations, and bed days. Interventions with passive strategies were more effective, stove and tap water burns being eliminated in the last four years, while active strategies were less effective. Conclusions—A program targeting burns in children can be effective and sustainable. Local injury data provided the stimulus for community action.

Association between Bullying and Mental Health Status in New Zealand Adolescents

This study investigates the association between mental health status and chronic bullying. Findings are based on a cross-sectional survey of 3,265 randomly selected secondary school students. Students were classified as having experienced chronic bullying if they had experienced any of the following five or more times during the previous six months while at school: physical violence, verbal teasing, sexual harassment and racist comments. Analysis showed that bullied students had lower self-esteem, suffered more from depression, stress and hopelessness, and were more likely to think about and attempt self-harm and suicide than others. Our findings suggest that young people in New Zealand secondary schools are experiencing significant levels of mental distress. Addressing violence in the school setting is important, as positive mental health is a prerequisite for the social, academic and physical achievements of young people in a school environment.

Mental health services and sexual abuse: the need for staff training

ABSTRACT Identification of child abuse by mental health services is important for formulation of the causes of presenting problems and for development of comprehensive treatment plans. A small but growing number of studies suggest, however, that the majority of child sexual abuse cases are not identified by mental health services. A similarly small literature also suggests that abuse survivors are extremely reluctant to spontaneously tell anyone about the abuse, indicating that professionals have a responsibility to ask rather than wait for spontaneous disclosures. The purpose of this study, therefore, was to add to these two bodies of literature with a New Zealand sample. A postal questionnaire was completed by 191 women who had received counselling for childhood sexual abuse. The average amount of time taken to tell anyone about the abuse was 16 years. Only 22% of those who had been in contact with public mental health services had ever been asked about abuse by those services. It was concluded that New Zealand women are reluctant to disclose abuse and that mental health services are, as is the case elsewhere, failing to assist them with this process. The need for staff training is discussed, and an example described.

Suicide: Qualitative data from focus group interviews with youth

Suicide is a leading cause of morbidity and mortality among people aged 15-24 years of age. This paper illustrates the use of focus groups with young people to enhance knowledge of ways to address youth suicide. Analysis of the findings identified three themes perceived by participants as being warning signs of a suicidal friend (personality changes, risk-taking behaviour and unusual actions). An important finding, which has implications for the planning of further suicide prevention strategies, was that young people would either cope alone or turn to a friend if they were feeling suicidal. The fact that a lack of knowledge was identified as the major barrier to youth using existing services/resources suggests that health promotion awareness campaigns which provide information on where young people could access help need to be developed. The use of focus groups with young people has provided valuable insights into ways to address youth suicide. We urge other researchers to incorporate similar methodologies.

Evaluation of the Waitakere Community Injury Prevention Project

Objective—To evaluate the Waitakere Community Injury Prevention Project (WCIPP). Methods—Process and outcome evaluations were conducted over a three year period. Process activities included analysis of project documentation, participant observation, key informant interviews, and two post-implementation case studies. A quasiexperimental design was used for the outcome evaluation. Three primary sources of data were collected and analysed: injury statistics; a pre-post telephone survey (n=4000); and a pre-post organisation survey (n=144). Results—Process evaluation provided a comprehensive account of the operation and activities of the WCIPP. Findings stress the pivotal role of the coordinators and highlight the value of incorporating a multicultural approach. A positive impact on changes to Waitakere City Council safety policies and practices was also evident. Outcome evaluation findings demonstrated significant reductions in rates of Waitakere child injury hospitalisations (p<0.05), while comparison communities showed an increase in child hospitalisation rates. In addition, compared with pre-intervention and comparison data, significantly more Waitakere residents were aware of injury prevention safety messages (p=0.0001) and had acquired appropriate child safety items (p=0.0001). Conclusion—The community injury prevention model appears to be an effective strategy for injury prevention. The support provided by the council for the WCIPP has provided a benchmark for the role of local governments in injury prevention.

BLAMING CHILDREN FOR CHILD PEDESTRIAN INJURIES

Pedestrian injuries are a leading cause of childhood mortality. In this paper a case study of a child pedestrian death is presented in order to examine the apportionment of responsibility for child pedestrian injuries. The case presented illustrates how responsibility is located with the child, whilst structural contributors, in particular aspects of the transport system, are ignored. The strength and pervasiveness of the ideology of victim blaming in child pedestrian injuries is explained by the special position that the road transport system holds in relation to dominant economic interests. Victim blaming ideology is a strategy that serves to maintain these interests at the expense and suffering of children. Increased recognition of the political roots of the ideology of victim blaming in child pedestrian injuries, by the sectors of the community who suffer its consequences, will be an important step towards effective preventive action.

Problematising depression: young people, mental health and suicidal behaviours

The published literature provides strong evidence for connections between mental health issues, such as depression, and suicidal behaviours. However, in spite of this, no investigations to date have explored young peoples perceptions of the interconnections between depression, and suicidal behaviours. This article presents discussive analyses of discussions of the contributions of depression to their suicidal behaviours of young people in New Zealand. Two dominant discourses of depression emerged: a medicalised discourse, and a moral discourse. The medicalised discourse was accessible to the majority of participants, and constructed depression as a disease. This discourse prioritised the voices of health professionals and suggested that depression was difficult to resist. The moral discourse was an alternative to the medicalised discourse, and constructed young people who experienced depression and suicidal behaviours as failures. Both discourses were informed by a mechanistic cause-and-effect relationship between depression and suicidal behaviours: attempting suicide was seen as an inevitable outcome of experiencing depression, and suicidal behaviours were inevitably undertaken by young people who were depressed. Resistance to either of these dominant discourses was problematic, and was best articulated during discussions of the stigma associated with mental ill-health and depression.

Injury associated with methamphetamine use: A review of the literature

This paper reviews the literature exploring issues around methamphetamine and injury. There was a paucity of peer reviewed quantitative research and a lack of large scale epidemiological studies. Further sources described cases and others described injury risk as part of an overall review of methamphetamine misuse. Thus, a number of limitations and potential biases exist within the literature. The main areas where associations were noted or extrapolated with methamphetamine use and injury were around driving and violence. Other associations with injury related to methamphetamine manufacture. There was also circumstantial evidence for third party injury (that is injury to those not specifically involved in drug use or drug manufacture); however, the available data are inadequate to confirm these associations/risks.

TRAVELLERS: a school-based early intervention programme helping young people manage and process change, loss and transition. Pilot phase findings

Objective: This paper outlines the conceptual background and findings from the pilot phase of TRAVELLERS – an early intervention programme designed to enhance protective factors for young people experiencing change, loss and transition events and early signs of emotional distress. The pilot study aimed to determine whether TRAVELLERS was a feasible, acceptable and promising intervention for young people within secondary schools in Aotearoa/New Zealand. Method: The conceptual origins of the TRAVELLERS programme are described in terms of: adolescent mental health concerns; emerging mental health promotion theory and practice; and prevention and early intervention models. The key elements of the TRAVELLERS programme are described. The programme was piloted in two secondary schools, one rural and one urban with 34 participants (females n = 24, males n = 10). Evaluation methods included: review of programme materials; identification of potential selection tools appropriate to Year 9 students; analysis of selection questionnaire; and conduct of feedback from participants, facilitators and parents/caregivers. Results: The TRAVELLERS programme provides a means of identifying and selecting young people who may benefit from participating in an early intervention programme. The programme has achieved a statistically significant reduction in participants’ distress (p < 0.01). Young people were overwhelmingly enthusiastic about most aspects of TRAVELLERS. School personnel reported that TRAVELLERS was an appropriate and acceptable programme to the school. Conclusions: Targeted interventions provided within a supportive school environment can contribute to enhancing protective factors such as personal and interpersonal coping strategies, increased help-seeking behaviour, and young people feeling more positive about themselves and their lives. The pilot programme has been amended and prepared for a two year trial phase in 10 secondary schools during 2002–2003.