Catherine Chapman

Remission from post-traumatic stress disorder in the general population

BACKGROUNDnFew studies have focused on post-traumatic stress disorder (PTSD) remission in the population, none have modelled remission beyond age 54 years and none have explored in detail the correlates of remission from PTSD. This study examined trauma experience, symptom severity, co-morbidity, service use and time to PTSD remission in a large population sample.nnnMETHODnData came from respondents (n=8841) of the 2007 Australian National Survey of Mental Health and Wellbeing (NSMHWB). A modified version of the World Health Organizations World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to determine the presence and age of onset of DSM-IV PTSD and other mental and substance use disorders, type, age, and number of lifetime traumas, severity of re-experiencing, avoidance and hypervigilance symptoms and presence and timing of service use.nnnRESULTSnProjected lifetime remission rate was 92% and median time to remission was 14 years. Those who experienced childhood trauma, interpersonal violence, severe symptoms or a secondary anxiety or affective disorder were less likely to remit from PTSD and reported longer median times to remission compared to those with other trauma experiences, less severe symptoms or no co-morbidity.nnnCONCLUSIONSnAlthough most people in the population with PTSD eventually remit, a significant minority report symptoms decades after onset. Those who experience childhood trauma or interpersonal violence should be a high priority for intervention.

Discriminant validity and gender differences in DSM-5 posttraumatic stress disorder symptoms

BACKGROUNDnThe posttraumatic stress disorder (PTSD) literature is replete with investigations of factor structure, however, few empirical studies have examined discriminant validity and the moderating role of gender on factor structure and symptom expression. This study aimed to address these gaps.nnnMETHODSnAn online, population-based study of 3175 Australian adults was conducted. This study analyzed data from 642 participants who reported a traumatic event. Overall, 10.2% (13.4% females, 7.6% males) met diagnostic criteria for current PTSD.nnnRESULTSnConfirmatory factor analyses indicated that eight factor models provided excellent fit to the data. The DSM-5 model, anhedonia and hybrid models provided strong fit to the data, based on statistical fit indices and parsimony. The models factors were significantly associated with a number of external correlates. Factor structure was gender invariant for the three models, albeit significant latent mean-level differences were apparent in relation to the intrusion/re-experiencing and alterations in arousal and reactivity factors. Bonferroni-adjusted Wald chi-square tests indicated significant gender differences in four DSM-5 PTSD symptoms: females reported significantly higher rates of negative beliefs, diminished interest, restricted affect and sleep disturbance symptoms compared to men.nnnLIMITATIONSnResponse rate to the survey was low. However, the number of respondents who completed the survey was high and population weights were employed to account for self-selection biases and aid generalizability.nnnCONCLUSIONSnThe findings provide support for the DSM-5, anhedonia and hybrid models compared to alternative models based on DSM-5 symptoms. Discriminant validity analyses indicated similar patterns of significant associations with the transdiagnostic factors, potentially suggesting that all the PTSD factors are related to non-specific distress. Further research investigating how gender influences PTSD symptom expression is warranted, including possible gender differences in symptom item interpretation.

Onset and temporal sequencing of lifetime anxiety, mood and substance use disorders in the general population

Aims. To date, very few studies have examined the bi-directional associations between mood disorders (MDs), anxiety disorders (ADs) and substance use disorders (SUDs), simultaneously. The aims of the current study were to determine the rates and patterns of comorbidity of the common MDs, ADs and SUDs and describe the onset and temporal sequencing of these classes of disorder, by sex. Methods. Data came from the 2007 Australian National Survey of Mental Health and Wellbeing, a nationally representative household survey with 8841 (60% response rate) community residents aged 16-85. Results. Pre-existing mental disorders increase the risk of subsequent mental disorders in males and females regardless of the class of disorder. Pre-existing SUDs increase the risk of subsequent MDs and ADs differentially for males and females. Pre-existing MDs increase the risk of subsequent ADs differentially for males and females. Conclusions. Comorbidity remains a significant public health issue and current findings point to the potential need for sex-specific prevention and treatment responses.

Codesign of a mobile app to provide evidence-based information about crystal methamphetamine (ice) to the community. (Preprint)

Background Despite evidence of increasing harms and community concern related to the drug crystal methamphetamine (“ice”), there is a lack of easily accessible, evidence-based information for community members affected by its use, and to date, no evidence-based mobile apps have specifically focused on crystal methamphetamine. Objective This study aims to describe the co-design and beta testing of a mobile app to provide evidence-based, up-to-date information about crystal methamphetamine to the general community. Methods A mobile app about crystal methamphetamine was developed in 2017. The development process involved multiple stakeholders (n=12), including technology and drug and alcohol experts, researchers, app developers, a consumer expert with lived experience, and community members. Beta testing was conducted with Australian general community members (n=34), largely recruited by the Web through Facebook advertising. Participants were invited to use a beta version of the app and provide feedback about the content, visual appeal, usability, engagement, features, and functions. In addition, participants were asked about their perceptions of the app’s influence on awareness, understanding, and help-seeking behavior related to crystal methamphetamine, and about their knowledge about crystal methamphetamine before and after using the app. Results The vast majority of participants reported the app was likely to increase awareness and understanding and encourage help-seeking. The app received positive ratings overall and was well received. Specifically, participants responded positively to the high-quality information provided, usability, and visual appeal. Areas suggested for improvement included reducing the amount of text, increasing engagement, removing a profile picture, and improving navigation through the addition of a “back” button. Suggested improvements were incorporated prior to the app’s public release. App use was associated with an increase in perceived knowledge about crystal methamphetamine; however, this result was not statistically significant. Conclusions The Cracks in the Ice mobile app provides evidence-based information about the drug crystal methamphetamine for the general community. The app is regularly updated, available via the Web and offline, and was developed in collaboration with experts and end users. Initial results indicate that it is easy to use and acceptable to the target group.

Healthy, Wealthy and Wise: Protocol for the CSC (Climate School Combined) study to evaluate the long-term effectiveness of school-based depression, anxiety and alcohol misuse prevention into young adulthood (Preprint)

Background Mental health and substance use disorders are the leading causes of global disability in children and youth. Both tend to first onset or escalate in adolescence and young adulthood, calling for effective prevention during this time. The Climate Schools Combined (CSC) study was the first trial of a Web-based combined universal approach, delivered through school classes, to prevent both mental health and substance use problems in adolescence. There is also limited evidence for the cost-effectiveness of school-based prevention programs. Objective The aim of this protocol paper is to describe the CSC follow-up study, which aims to determine the long-term efficacy and cost-effectiveness of the CSC prevention program for depression, anxiety, and substance use (alcohol and cannabis use) up to 7 years post intervention. Methods A cluster randomized controlled trial (the CSC study) was conducted with 6386 participants aged approximately 13.5 years at baseline from 2014 to 2016. Participating schools were randomized to 1 of 4 conditions: (1) control (health education as usual), (2) Climate Substance Use (universal substance use prevention), (3) Climate Mental Health (universal mental health prevention), or (4) CSC (universal substance use and mental health prevention). It was hypothesized that the CSC program would be more effective than conditions (1) to (3) in reducing alcohol and cannabis use (and related harms), anxiety, and depression symptoms as well as increasing knowledge related to alcohol, cannabis, anxiety, and depression. This long-term study will invite follow-up participants to complete 3 additional Web-based assessments at approximately 5, 6, and 7 years post baseline using multiple sources of locator information already provided to the research team. The primary outcomes include alcohol and cannabis use (and related harms) and mental health symptoms. An economic evaluation of the program will also be conducted using both data linkage as well as self-report resource use and quality of life measures. Secondary outcomes include self-efficacy, social networks, peer substance use, emotion regulation, and perfectionism. Analyses will be conducted using multilevel mixed-effects models within an intention-to-treat framework. Results The CSC long-term follow-up study is funded from 2018 to 2022 by the Australian National Health and Medical Research Council (APP1143555). The first follow-up wave commences in August 2018, and the results are expected to be submitted for publication in 2022. Conclusions This is the first study to provide a long-term evaluation of combined universal substance use and mental health prevention up to 7 years post intervention. Evidence of sustained benefits into early adulthood would provide a scalable, easy-to-implement prevention strategy with the potential for widespread dissemination to reduce the considerable harms, burden of disease, injury, and social costs associated with youth substance use and mental disorders. International Registered Report Identifier (IRRID) PRR1-10.2196/11372

Substance Use Prevention Programs for Indigenous Adolescents in the United States of America, Canada, Australia and New Zealand: Protocol for a Systematic Review

Background Indigenous adolescents are at a higher risk of experiencing harms related to substance use compared with their non-Indigenous counterparts as a consequence of earlier onset and higher rates of substance use. Early onset of substance use has been identified as a risk factor for future substance use problems and other health, social, and family outcomes. Therefore, prevention of substance use among adolescents has been identified as a key area to improve health of Indigenous Peoples. Evidence exists for the effectiveness of prevention approaches for adolescents in mainstream populations and, most recently, for the use of computer- and Internet-delivered interventions to overcome barriers to implementation. However, there is currently no conclusive evidence about the effectiveness of these approaches for Indigenous adolescents. Objective The purpose of this review is to synthesize the international evidence regarding the effectiveness of substance use prevention programs for Indigenous adolescents in the United States, Canada, Australia, and New Zealand. Methods A total of 8 peer-reviewed databases and 20 gray literature databases will be searched, using search terms in line with the aims of this review and based on previous relevant reviews of substance use prevention. Studies will be included if they evaluate a substance use prevention program with Indigenous adolescents (aged 10 to 19 years) as the primary participant group and are published between January 1, 1990 and August 31, 2017. Results A narrative synthesis will be provided about the effectiveness of the programs, the type of program (whether culture-based, adapted, or unadapted), delivery of the program (computer- and Internet-delivered or traditional), and the setting in which the programs are delivered (community, school, family, clinical, or a combination). Conclusions The study will identify core elements of effective substance use prevention programs among Indigenous adolescents and appraise the methodological quality of the studies. This review will provide researchers, policy makers, and program developers with evidence about the potential use of prevention approaches for Indigenous adolescents.

Development and evaluation of ‘Pure Rush’: An online serious game for drug education: ‘Pure Rush’: An online serious game for drug education

INTRODUCTION AND AIMSnLearning is most effective when it is active, enjoyable and incorporates feedback. Past research demonstrates that serious games are prime candidates to utilise these principles, however the potential benefits of this approach for delivering drug education are yet to be examined in Australia, a country where drug education in schools is mandatory.nnnDESIGN AND METHODSnThe serious game Pure Rush was developed across three stages. First, formative consultation was conducted with 115 students (67% male, aged 15-17 years), followed by feasibility and acceptability testing of a prototype of the game (n = 25, 68% male). In the final stage, 281 students (62% female, aged 13-16 years) were randomly allocated to receive a lesson involving Pure Rush or an active control lesson. The lessons were compared in terms of learning outcomes, lesson engagement and future intentions to use illicit drugs.nnnRESULTSnStudents enjoyed playing Pure Rush, found the game age-appropriate and the information useful to them. Both the Pure Rush and the active control were associated with significant knowledge increase from pre to post-test. Among females, multi-level mixed-effects regression showed knowledge gain was greater in the Pure Rush condition compared to control (β = 2.36, 95% confidence interval 0.36-4.38). There was no evidence of between condition differences in lesson engagement or future intentions to use illicit drugs.nnnDISCUSSION AND CONCLUSIONSnPure Rush is an innovative online drug education game that is well received by students and feasible to implement in schools. [Stapinski LA, Reda B, Newton NC, Lawler S, Rodriguez D, Chapman C, Teesson M. Development and evaluation of Pure Rush: An online serious game for drug education. Drug Alcohol Rev 2017].

Pathways to prevention: protocol for the CAP (Climate and Preventure) study to evaluate the long-term effectiveness of school-based universal, selective and combined alcohol misuse prevention into early adulthood

BackgroundAlcohol use and associated harms are among the leading causes of burden of disease among young people, highlighting the need for effective prevention. The Climate and Preventure (CAP) study was the first trial of a combined universal and selective school-based approach to preventing alcohol misuse among adolescents. Initial results indicate that universal, selective and combined prevention were all effective in delaying the uptake of alcohol use and binge drinking for up to 3xa0years following the interventions. However, little is known about the sustainability of prevention effects across the transition to early adulthood, a period of increased exposure to alcohol and other drug use. This paper describes the protocol for the CAP long-term follow-up study which will determine the effectiveness of universal, selective and combined alcohol misuse prevention up to 7xa0years post intervention, and across the transition from adolescence into early adulthood.MethodsA cluster randomized controlled trial was conducted between 2012 and 2015 with 2190 students (mean age: 13.3xa0yrs) from 26 Australian high schools. Participants were randomized to receive one of four conditions; universal prevention for all students (Climate); selective prevention for high-risk students (Preventure); combined universal and selective prevention (Climate and Preventure; CAP); or health education as usual (Control). The positive effect of the interventions on alcohol use at 12-, 24- and 36-month post baseline have previously been reported. This study will follow up the CAP study cohort approximately 5- and 7-years post baseline. The primary outcome will be alcohol use and related harms. Secondary outcomes will be cannabis use, alcohol and other drug harms including violent behavior, and mental health symptomatology. Analyses will be conducted using multi-level, mixed effects models within an intention-to-treat framework.DiscussionThis study will provide the first ever evaluation of the long-term effectiveness of combining universal and selective approaches to alcohol prevention and will examine the durability of intervention effects into the longer-term, over a 7-year period from adolescence to early adulthood.Trial registrationThis trial was registered in the Australian New Zealand Clinical Trials Registry (ACTRN12612000026820) on January 6th 2012.

The CLIMATE schools combined study: a cluster randomised controlled trial of a universal Internet-based prevention program for youth substance misuse, depression and anxiety

BackgroundAnxiety, depressive and substance use disorders account for three quarters of the disability attributed to mental disorders and frequently co-occur. While programs for the prevention and reduction of symptoms associated with (i) substance use and (ii) mental health disorders exist, research is yet to determine if a combined approach is more effective. This paper describes the study protocol of a cluster randomised controlled trial to evaluate the effectiveness of the CLIMATE Schools Combined intervention, a universal approach to preventing substance use and mental health problems among adolescents.Methods/designParticipants will consist of approximately 8400 students aged 13 to 14-years-old from 84 secondary schools in New South Wales, Western Australia and Queensland, Australia. The schools will be cluster randomised to one of four groups; (i) CLIMATE Schools Combined intervention; (ii) CLIMATE Schools - Substance Use; (iii) CLIMATE Schools - Mental Health, or (iv) Control (Health and Physical Education as usual).The primary outcomes of the trial will be the uptake and harmful use of alcohol and other drugs, mental health symptomatology and anxiety, depression and substance use knowledge. Secondary outcomes include substance use related harms, self-efficacy to resist peer pressure, general disability, and truancy. The link between personality and substance use will also be examined.DiscussionCompared to students who receive the universal CLIMATE Schools - Substance Use, or CLIMATE Schools - Mental Health or the Control condition (who received usual Health and Physical Education), we expect students who receive the CLIMATE Schools Combined intervention to show greater delays to the initiation of substance use, reductions in substance use and mental health symptoms, and increased substance use and mental health knowledge.Trial registrationThis trial is registered with the Australian and New Zealand Clinical Trials registry, ACTRN12613000723785.