Helen Christensen

Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review

BackgroundAdolescents and young adults frequently experience mental disorders, yet tend not to seek help. This systematic review aims to summarise reported barriers and facilitators of help-seeking in young people using both qualitative research from surveys, focus groups, and interviews and quantitative data from published surveys. It extends previous reviews through its systematic research methodology and by the inclusion of published studies describing what young people themselves perceive are the barriers and facilitators to help-seeking for common mental health problems.MethodsTwenty two published studies of perceived barriers or facilitators in adolescents or young adults were identified through searches of PubMed, PsycInfo, and the Cochrane database. A thematic analysis was undertaken on the results reported in the qualitative literature and quantitative literature.ResultsFifteen qualitative and seven quantitative studies were identified. Young people perceived stigma and embarrassment, problems recognising symptoms (poor mental health literacy), and a preference for self-reliance as the most important barriers to help-seeking. Facilitators were comparatively under-researched. However, there was evidence that young people perceived positive past experiences, and social support and encouragement from others as aids to the help-seeking process.ConclusionsStrategies for improving help-seeking by adolescents and young adults should focus on improving mental health literacy, reducing stigma, and taking into account the desire of young people for self-reliance.

Adherence in internet interventions for anxiety and depression.

Background Open access websites which deliver cognitive and behavioral interventions for anxiety and depression are characterised by poor adherence. We need to understand more about adherence in order to maximize the impact of Internet-based interventions on the disease burden associated with common mental disorders. Objective The aims of this paper are to review briefly the adherence literature with respect to Internet interventions and to investigate the rates of dropout and compliance in randomized controlled trials of anxiety and depression Web studies. Methods A systematic review of randomized controlled trials using Internet interventions for anxiety and depression was conducted, and data was collected on dropout and adherence, predictors of adherence, and reasons for dropout. Results Relative to reported rates of dropout from open access sites, the present study found that the rates of attrition in randomized controlled trials were lower, ranging from approximately 1 - 50%. Predictors of adherence included disease severity, treatment length, and chronicity. Very few studies formally examined reasons for dropout, and most studies failed to use appropriate statistical techniques to analyze missing data. Conclusions Dropout rates from randomized controlled trials of Web interventions are low relative to dropout from open access websites. The development of theoretical models of adherence is as important in the area of Internet intervention research as it is in the behavioral health literature. Disease-based factors in anxiety and depression need further investigation.

A short form of the Positive and Negative Affect Schedule : evaluation of factorial validity and invariance across demographic variables in a community sample

Abstract The existence of two nearly-orthogonal dimensions of positive and negative affect was established for a ten-item short form of the Positive and Negative Affect Schedule using confirmatory factor analytic techniques in a large probability sample (n=2651) spanning ages 18 to 79. The factor structure and factor correlations were found to be unchanged with age. A multiple indicators, multiple causes model was used to investigate differences in item responses according to age, sex, education, marital status and financial hardship that could not be accounted for by differences in affect levels between groups. Only one item, excited from the Positive Affect scale, was found to elicit differential responses. While improvements to the Positive Affect scale might be desirable, the Short PANAS can be recommended for use when measures of positive and negative affect are required.

Smartphones for smarter delivery of mental health programs: A systematic review

Background The rapid growth in the use of mobile phone applications (apps) provides the opportunity to increase access to evidence-based mental health care. Objective Our goal was to systematically review the research evidence supporting the efficacy of mental health apps for mobile devices (such as smartphones and tablets) for all ages. Methods A comprehensive literature search (2008-2013) in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, PsycINFO, PsycTESTS, Compendex, and Inspec was conducted. We included trials that examined the effects of mental health apps (for depression, anxiety, substance use, sleep disturbances, suicidal behavior, self-harm, psychotic disorders, eating disorders, stress, and gambling) delivered on mobile devices with a pre- to posttest design or compared with a control group. The control group could consist of wait list, treatment-as-usual, or another recognized treatment. Results In total, 5464 abstracts were identified. Of those, 8 papers describing 5 apps targeting depression, anxiety, and substance abuse met the inclusion criteria. Four apps provided support from a mental health professional. Results showed significant reductions in depression, stress, and substance use. Within-group and between-group intention-to-treat effect sizes ranged from 0.29-2.28 and 0.01-0.48 at posttest and follow-up, respectively. Conclusions Mental health apps have the potential to be effective and may significantly improve treatment accessibility. However, the majority of apps that are currently available lack scientific evidence about their efficacy. The public needs to be educated on how to identify the few evidence-based mental health apps available in the public domain to date. Further rigorous research is required to develop and test evidence-based programs. Given the small number of studies and participants included in this review, the high risk of bias, and unknown efficacy of long-term follow-up, current findings should be interpreted with caution, pending replication. Two of the 5 evidence-based mental health apps are currently commercially available in app stores.

Using the BIS/BAS scales to measure behavioural inhibition and behavioural activation : Factor structure, validity and norms in a large community sample

Abstract The Behavioural Inhibition System and Behavioural Activation System (BIS/BAS) scales of Carver and White (1994) were used in an Australian community sample of 2725 individuals aged 18–79. Factor analysis of the BIS/BAS items supported the 4-factor structure found by Carver and White, as well as a 2-factor structure reflecting separate behavioural inhibition and behavioural activation systems. The BIS scale was related to neuroticism and negative affectivity, while the BAS scale was related to extraversion and positive affectivity. The BIS scale was less correlated with anxiety and depression symptoms than are neuroticism and negative affectivity scales, probably because it is designed to measure predisposition to anxiety rather than the experience of anxiety. BIS scores were higher in females, while the BAS subscales showed a more complex pattern, with reward responsiveness scores higher in females and drive scores higher in males. Both BIS and BAS scores were lower in older age groups, suggesting the possibility that the behavioural inhibition and behavioural activation systems become less responsive with age.

Quality of web based information on treatment of depression: cross sectional survey

Abstract Objectives: To evaluate quality of web based information on treatment of depression, to identify potential indicators of content quality, and to establish if accountability criteria are indicators of quality. Design: Cross sectional survey. Data sources: 21 frequently accessed websites about depression. Main outcome measures: (i) Site characteristics; (ii) quality of content—concordance with evidence based depression guidelines (guideline score), appropriateness of other relevant site information (issues score), and subjective rating of site quality (global score); and (iii) accountability—conformity with core accountability standards (Silberg score) and quality of evidence cited in support of conclusions (level of evidence score). Results: Although the sites contained useful information, their overall quality was poor: the mean guideline, issues, and global scores were only 4.7 (range 0-13) out of 43, 9.8 (6-14) out of 17, and 3 (0.5-7.5) out of 10 respectively. Sites typically did not cite scientific evidence in support of their conclusions. The guideline score correlated with the two other quality of content measures, but none of the content measures correlated with the Silberg accountability score. Content quality was superior for sites owned by organisations and sites with an editorial board. Conclusions: There is a need for better evidence based information about depression on the web, and a need to reconsider the role of accountability criteria as indicators of site quality and to develop simple valid indicators of quality. Ownership by an organisation and the involvement of a professional editorial board may be useful indicators. The study methodology may be useful for exploring these issues in other health related subjects.

Education, Activity, Health, Blood Pressure and Apolipoprotein E as Predictors of Cognitive Change in Old Age: A Review

Background: Cross-sectional studies have identified a number of health and lifestyle factors that correlate with cognitive function in old age. It is important to know whether these factors also predict change in cognitive function over time. Objective: To evaluate published findings on genetic, health and lifestyle predictors of cognitive change in late adulthood. Methods: Studies reporting data on education, health, blood pressure, activity and apolipoprotein E (APOE) as predictors of cognitive change were reviewed. A total of 34 studies were identified that reported data on these predictors. The average follow-up period of studies reviewed was 7.68 years. Results: Results showed that education, hypertension, objective indices of health and cardiovascular disease, and APOE were associated with cognitive change. Results regarding the effect of physical activity on cognitive change were inconclusive. Conclusion: Despite the lack of data on some predictors, the longitudinal trends are generally consistent with cross-sectional findings on predictors of cognitive performance in old age. More research is required to compare the influence of predictors on different types of cognitive abilities.

Attitudes towards people with a mental disorder: a survey of the Australian public and health professionals

Objective: The aim of this paper was to compare the Australian publics attitudes towards people who have been treated for a mental disorder with the attitudes of general practitioners, psychiatrists and clinical psychologists. Method: The study involved a household survey of 2031 members of the Australian public and a postal survey of 872 general practitioners, 1128 psychiatrists and 454 clinical psychologists. Survey participants were presented with a vignette describing a person with schizophrenia or one with depression. They were asked opinions about the persons long-term outcome in various areas of life after receiving treatment. Participants were also asked whether they thought the person described would be discriminated against by others. Results: Both the public and professionals rated outcomes as poorer and discrimination as more likely for the person with schizophrenia than for the one with depression. The professionals made more negative ratings than the public, although the clinical psychologists had similar attitudes to the public about depression. Conclusions: Compared to the public, health professionals rate long-term outcomes more negatively and discrimination as more likely. It is possible that these more negative attitudes are realistic, being based on greater knowledge of mental disorders. However, professional attitudes may be biased by greater contact with patients who have chronic or recurrent disorders. Either way, health professionals need to be aware of the effects that their negative attitudes might have on patients and the public.

Stigma in response to mental disorders: a comparison of Australia and Japan

BackgroundThere are few national or cross-cultural studies of the stigma associated with mental disorders. Australia and Japan have different systems of psychiatric health care, and distinct differences in cultural values, but enjoy similar standards of living. This study seeks to compare the nature and extent of stigma among the public in the two countries.MethodsA household survey of the public was conducted in each country using similar methodologies. The Australian study comprised a national survey of 3998 adults aged over 18 years. The Japanese survey involved 2000 adults aged 20 to 69 from 25 regional sites distributed across the country. Interviewees reported their personal attitudes (personal stigma, social distance) and perceptions of the attitudes of others (perceived stigma, perceived discrimination) in the community with respect to four case vignettes. These vignettes described a person with: depression; depression with suicidal ideation; early schizophrenia; and chronic schizophrenia.ResultsPersonal stigma and social distance were typically greater among the Japanese than the Australian public whereas the reverse was true with respect to the perception of the attitudes and discriminatory behaviour of others. In both countries, personal stigma was significantly greater than perceived stigma. The public in both countries showed evidence of greater social distance, greater personal stigma and greater perceived stigma for schizophrenia (particularly in its chronic form) than for depression. There was little evidence of a difference in stigma for depression with and without suicide for either country. However, social distance was greater for chronic compared to early schizophrenia for the Australian public.ConclusionStigmatising attitudes were common in both countries, but negative attitudes were greater among the Japanese than the Australian public. The results suggest that there is a need to implement national public awareness interventions tailored to the needs of each country. The current results provide a baseline for future tracking of national stigma levels in each country.

Apolipoprotein E allele ∈4, dementia, and cognitive decline in a population sample

From clinically based series it has been proposed that, in homozygotes for the apolipoprotein E epsilon 4 (apoE epsilon 4) allele, Alzheimers disease is almost inevitable by the age of 80. A population sample of persons aged 70 years and over was interviewed in 1990-91 to ascertain the presence of dementia or cognitive impairment. The sample was reinterviewed in 1994, when the apoE genotype was also determined. Prevalence data for the 638 persons who completed the second examination revealed a linear association between having an apoE epsilon 4 allele and both dementia and cognitive impairment (for heterozygotes, odds ratio for dementia 1.89, 95% confidence interval 1.04-3.44 and for homozygotes OR 3.58, 95% CI 1.08-11.82; both adjusted for age). However, even in subjects homozygous for epsilon 4 the estimated prevalence of dementia by age 90 was only about 50%. Persons with one or two epsilon 4 alleles were more likely to have a family history of dementia than those with none. This study confirms in a population sample that the epsilon 4 allele is a risk factor for dementia, but refutes the suggestion that homozygosity for the epsilon 4 allele is sufficient for the development of Alzheimers disease: persons with either one or two epsilon 4 alleles may reach late old age without cognitive impairment.