Jane Burns

Adolescent resilience : a concept analysis

There is need for greater clarity around the concept of resilience as it relates to the period of adolescence. Literature on resilience published between 1990 and 2000 and relevant to adolescents aged between 12- and 18-years of age was reviewed with the aim of examining the various uses of the term, and commenting on how specific ways of conceptualizing of resilience may help develop new research agendas in the field. By bringing together ideas on resilience from a variety of research and clinical perspectives, the purpose of the review is to explicate core elements of resilience in more precise ways, in the hope that greater conceptual clarity will lead to a range of tailored interventions that benefit young people.

Young men's attitudes and behaviour in relation to mental health and technology: Implications for the development of online mental health services

BackgroundThis mixed-methods study was designed to explore young Australian men’s attitudes and behaviour in relation to mental health and technology use to inform the development of online mental health services for young men.MethodsNational online survey of 486 males (aged 16 to 24) and 17 focus groups involving 118 males (aged 16 to 24).ResultsYoung men are heavy users of technology, particularly when it comes to entertainment and connecting with friends, but they are also using technology for finding information and support. The focus group data suggested that young men would be less likely to seek professional help for themselves, citing a preference for self-help and action-oriented strategies instead. Most survey participants reported that they have sought help for a problem online and were satisfied with the help they received. Focus group participants identified potential strategies for how technology could be used to overcome the barriers to help-seeking for young men.ConclusionsThe key challenge for online mental health services is to design interventions specifically for young men that are action-based, focus on shifting behaviour and stigma, and are not simply about increasing mental health knowledge. Furthermore, such interventions should be user-driven, informed by young men’s views and everyday technology practices, and leverage the influence of peers.

Preventive interventions for youth suicide: A risk factor-based approach

Objective: This review draws on current knowledge of risk for youth suicide to categorise strategies for intervention. Its goal is to identify areas of ‘research need’ and to provide an evidence base to identify ‘best buy’ preventive interventions for youth suicide. Method: The design, development, implementation and evaluation of prevention strategies ranging from clinical interventions to population-based universal approaches are considered within five risk factor domains: individual, family, community, school and peer. Results: There is a paucity of evidence on the effects of interventions targeting depression and suicidal behaviour. Nevertheless, there are effective indicated, selective and universal interventions for important risk factors for depression and suicidal behaviour. Little evidence has emerged to support the efficacy of some traditional approaches to suicide prevention, such as school based suicide education programs and telephone hotlines. Conclusions: Youth suicide prevention strategies in Australia have generally employed traditional approaches that focus on clinical interventions for self-harmers, restricting access to lethal means, providing services to high risk groups and enhancing general practitioner responses. Both program development and research evaluation of interventions for many important risk and protective factors for suicide have been neglected.

Building resilience in young people through meaningful participation

Abstract Building resilience in young people is an important goal if we are to strengthen capacity and promote skills that help to reduce mental health problems. One way to foster resilience in young people is through meaningful youth participation; that is, decision-making by young people that involves meaning, control, and connectedness. Whilst youth participation may occur in recognition of young people’s rights to be involved in all decisions that affect them, meaningful participation can itself enhance a young person’s sense of connectedness, belonging and valued participation, and thereby impact on mental health and well being. Based on its extensive experience working collaboratively with young people, the Inspire Foundation, in partnership with young people, has developed a flexible and diverse approach to youth participation. This paper outlines the theoretical and conceptual underpinnings of the model, and discusses the operationalisation of program goals, atmosphere and activities that seek to build resilience through meaningful youth participation.

Mental Health of Young People in the United States: What Role Can the Internet Play in Reducing Stigma and Promoting Help Seeking?

One third of young Americans experience mental health difficulties, often without seeking help. More than 90% use the Internet. Reach Out (www.reachout.com.au), an Australian Internet-based service, is discussed in relation to the role it could play in reducing stigma and increasing help seeking in young Americans aged 16-25 years.

Providing online support for young people with mental health difficulties : challenges and opportunities explored

Despite its growing popularity there is a paucity of information exploring the potential of the Internet to build a trusted community that helps reduce stigma, facilitates help‐seeking and aids in the prevention or helps in the management of mental health difficulties for young people. Unsupervised online forums or chat rooms hold potential dangers for young people including the possibility of attracting adults who may take advantage of vulnerable adolescents. Contagion with members organizing suicide pacts, or describing suicidal or self‐harming intentions and methods and young people ruminating about feeling depressed are also potential risks. This paper describes the development and conceptual underpinnings of the Reach Out! Online Community Forum, a moderated bulletin board, developed in consultation with, and facilitated by young people aged 16–25. The Forum, although facilitated by young people, is supported and monitored by trained moderators. Anecdotal evidence collected via unsolicited feedback from young people using the Forum suggests that it is a positive, unique and helpful online experience although little is known about the impact on stigma reduction and help seeking in the offline world. Given the proliferation of unsupervised forums and chat rooms there is a need for further research to determine the effectiveness or potential dangers of online forums in mental health prevention and early intervention work.

Acute exacerbation of chronic obstructive pulmonary disease: Influence of social factors in determining length of hospital stay and readmission rates

BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the leading reason for hospitalization in Canada and a significant financial burden on hospital resources. Identifying factors that influence the time a patient spends in the hospital and readmission rates will allow for better use of scarce hospital resources. OBJECTIVES To determine the factors that influence length of stay (LOS) in the hospital and readmission for patients with AECOPD in an inner-city hospital. METHODS Using the Providence Health Records, a retrospective review of patients admitted to St Pauls Hospital (Vancouver, British Columbia) during the winter of 2006 to 2007 (six months) with a diagnosis of AECOPD, was conducted. Exacerbations were classified according to Anthonisen criteria to determine the severity of exacerbation on admission. Severity of COPD was scored using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. For comparative analysis, severity of disease (GOLD criteria), age, sex and smoking history were matched. RESULTS Of 109 admissions reviewed, 66 were single admissions (61%) and 43 were readmissions (39%). The number of readmissions ranged from two to nine (mean of 3.3 readmissions). More than 85% of admissions had the severity of COPD equal to or greater than GOLD stage 3. The significant indicators for readmission were GOLD status (P<0.001), number of related comorbidities (OR 1.47, 95% CI 1.10 to 1.97; P<0.009) and marital status (single) (OR 4.18, 95% CI 1.03 to 17.02; P<0.046). The requirement for social work involvement during hospital admission was associated with a prolonged LOS (P<0.05). CONCLUSIONS The results of the present study show that disease severity (GOLD status) and number of comorbidities are associated with readmission rates of patients with AECOPD. Interestingly, social factors such as marital status and the need for social work intervention are also linked to readmission rates and LOS, respectively, in patients with AECOPD.

Positive relationships between public awareness activity and recognition of the impacts of depression in Australia

OBJECTIVE This report records the level of exposure to depression-related information across the Australian community and explores associations with recognition of depression and relevant sociodemographic factors. METHOD A cross-sectional telephone survey was conducted with a representative community sample. Participants consisted of 3200 respondents (400 respondents across each Australian State/Territory). RESULTS Sixty-five point four per cent (n=2089/3193) of respondents indicated that they or someone close to them had experienced depression, of whom 18.7% (n=391/2089) reported a personal experience of this illness. Various measures of recent exposure to depression-related information were high with 69.0% (n=2207/3200) reporting that they had seen, read or heard something in the media in the last 12 months. Recognition of beyondblue: the national depression initiative was also surprisingly high (61.9%, 1982/3200). Those with greater understanding that depression is common and debilitating were more likely to recall recent media stories, spontaneously recall relevant organizations such as beyondblue, to have had direct or family experiences, to be younger and to have achieved higher levels of education. Depression, however, is rarely mentioned (1.3%, 47/3720) as a major general health as distinct from a mental health problem. CONCLUSION The active promotion of depression-related material to the community appears to have contributed to recognition of the commonality and impacts of this illness. Although depression is commonly recognized as a mental health problem, it is not yet considered a major general health problem. Further, like many public health campaigns, those initially reached appear more likely to be female, younger, better educated and residing in metropolitan areas.

Clinical management of deliberate self-harm in young people: the need for evidence-based approaches to reduce repetition

OBJECTIVE To examine the evidence for the effectiveness of clinical interventions designed to reduce the repetition of deliberate self-harm (DSH) in adolescents and young adults. METHODS Electronic databases were searched for papers describing randomised and clinical control trials (RCTs) and quasi-experimental studies of interventions targeting adolescents and young adults presenting to clinical services following DSH or suicidal ideation. RESULTS Three RCTs, four clinical control trials and three quasi-experimental studies were identified. Group therapy, trialled in a RCT, was the only specific programme which led to a significant reduction in rates of repetition of self-harm. Attendance at follow-up did not improve significantly regardless of the intervention, while one clinically controlled trial of intensive intervention resulted in poorer attendance at follow-up. One quasi-experimental study of family therapy resulted in a significant reduction in suicidal ideation. CONCLUSIONS The evidence base for treatments designed to reduce the repetition of self-harm in adolescents and young adults is very limited. Expensive interventions such as intensive aftercare offer no clear benefit over routine aftercare. Given that deliberate self-harm among young people is a common clinical problem further good quality treatment studies are warranted. Careful consideration should be given to process evaluation to determine which individual components of any given intervention are effective.

Enhancing early engagement with mental health services by young people

International studies have shown that the prevalence of mental illness, and the fundamental contribution it make to the overall disease burden, is greatest in children and young people. Despite this high burden, adolescents and young adults are the least likely population group to seek help or to access professional care for mental health problems. This issue is particularly problematic given that untreated, or poorly treated, mental disorders are associated with both short- and long-term functional impairment, including poorer education and employment opportunities, potential comorbidity, including drug and alcohol problems, and a greater risk for antisocial behavior, including violence and aggression. This cycle of poor mental health creates a significant burden for the young person, their family and friends, and society as a whole. Australia is enviably positioned to substantially enhance the well-being of young people, to improve their engagement with mental health services, and – ultimately – to improve mental health. High prevalence but potentially debilitating disorders, such as depression and anxiety, are targeted by the specialized youth mental health service, headspace: the National Youth Mental Health Foundation and a series of Early Psychosis Prevention and Intervention Centres, will provide early intervention specialist services for low prevalence, complex illnesses. Online services, such as ReachOut.com by Inspire Foundation, Youthbeyondblue, Kids Helpline, and Lifeline Australia, and evidence-based online interventions, such as MoodGYM, are also freely available, yet a major challenge still exists in ensuring that young people receive effective evidence-based care at the right time. This article describes Australian innovation in shaping a comprehensive youth mental health system, which is informed by an evidence-based approach, dedicated advocacy and, critically, the inclusion of young people in service design, development, and ongoing evaluation to ensure that services can be continuously improved.