Jill Beattie

A randomised controlled trial of the Flinders Program™ of chronic condition management in Vietnam veterans with co-morbid alcohol misuse, and psychiatric and medical conditions:

Objective: To evaluate the efficacy of the Flinders Program™ of chronic condition management on alcohol use, psychosocial well-being and quality of life in Vietnam veterans with alcohol misuse. Method: This 9-month wait-list, randomised controlled trial used the Alcohol Use Disorders Identification Test (AUDIT) score ≥ 8 as the entry criterion. Intervention veterans received the Flinders Program plus usual care and controls received usual care. The primary outcome measure was AUDIT score at baseline, 3, 6 and 9 months. Secondary measures included quality of life, alcohol dependence (DSM-IV), anxiety and depression. All measures were repeated at variable trial end dates between 9 and 18 months in the intervention group. Results: Randomisation resulted in 46 intervention and 31 control participants. Intent-to-treat analyses showed AUDIT scores improved significantly from baseline to 9-month follow-up (p = 0.039) in the intervention group compared to control group. The control group had 1.46 times the risk of alcohol dependence than the intervention group at 9 months (p = 0.027). There were no significant differences between groups for secondary measures. Within-group analyses showed that both groups significantly improved in AUDIT (p < 0.001), anxiety and depression (p < 0.01), anger (p < 0.001), and post-traumatic stress (p < 0.01). Improvements in AUDIT (p < 0.001) and alcohol dependence were maintained in the intervention group to 18 months. Conclusions: Use of the Flinders Program in addition to usual care resulted in reduced alcohol use, reduced alcohol dependence, and global clinical improvement in Vietnam veterans with risky alcohol behaviours and chronic mental health problems. The findings demonstrate that the Flinders Program provides a structured framework for delivering self-management support, case management and coordinated care for people with chronic conditions. This clinical approach has the potential to bridge the gap between physical and mental illness service delivery for people with long-term conditions in Australia.

Mindfulness and perinatal mental health: A systematic review.

BACKGROUND Perinatal stress is associated with adverse maternal and infant outcomes. Mindfulness training may offer a safe and acceptable strategy to support perinatal mental health. AIM To critically appraise and synthesise the best available evidence regarding the effectiveness of mindfulness training during pregnancy to support perinatal mental health. METHODS The search for relevant studies was conducted in six electronic databases and in the grey literature. Eligible studies were assessed for methodological quality according to standardised critical appraisal instruments. Data were extracted and recorded on a pre-designed form and then entered into Review Manager. FINDINGS Nine studies were included in the data synthesis. It was not appropriate to combine the study results because of the variation in methodologies and the interventions tested. Statistically significant improvements were found in small studies of women undertaking mindfulness awareness training in one study for stress (mean difference (MD) -5.28, 95% confidence intervals (CI) -10.4 to -0.42, n=22), two for depression (for example MD -5.48, 95% CI -8.96 to -2.0, n=46) and four for anxiety (for example, MD -6.50, 95% CI -10.95 to -2.05, n=32). However the findings of this review are limited by significant methodological issues within the current research studies. CONCLUSION There is insufficient evidence from high quality research on which to base recommendations about the effectiveness of mindfulness to promote perinatal mental health. The limited positive findings support the design and conduct of adequately powered, longitudinal randomised controlled trials, with active controls.

The acceptability and outcomes of a peer- and health-professional-led Stanford self-management program for Vietnam veterans with alcohol misuse and their partners.

OBJECTIVE The purpose of this study was to determine the acceptability of peer- and health-professional-led self-management education using the Stanford Program with Australian veterans and their partners. METHODS The 6-week program taught problem-solving and decision-making skills to activate healthful behaviors, including action-planning and goal-setting. The evaluation included a participant and facilitator postprogram questionnaire; group interview; and alcohol, posttraumatic stress disorder, anxiety, depression, anger, relationship, and quality-of-life measures as part of a randomized controlled study. RESULTS Participants included 25 male veterans with comorbid alcohol dependency, psychiatric and medical conditions, and 18 female partners (n = 43), 61.5% of who reported a chronic condition. The primary outcome was a self-reported improvement in self-management of their conditions in 69% of participants, with another 22.2% reporting that their confidence to self-manage had improved. There was an improvement in all measures at 9 months. CONCLUSIONS The program resulted in improvements in lifestyle and confidence in self-management for Vietnam veterans, a cohort difficult to engage in healthy behaviors. Most participants were also accompanied by their partners. The program is a valuable resource for providing self-management education to veterans with alcohol dependency and various chronic conditions and needs to be considered in the suite of rehabilitation programs available to Defense Force personnel, veterans, and their partners.

Effects of mindfulness on maternal stress, depressive symptoms and awareness of present moment experience: A pilot randomised trial

OBJECTIVE To determine the feasibility and acceptability and measure the effects of a mindfulness intervention compared to a pregnancy support program on stress, depressive symptoms and awareness of present moment experience. DESIGN A pilot randomised trial using mixed methods. PARTICIPANTS AND SETTING Forty-eight women attending a maternity service were randomly allocated to a mindfulness-based or pregnancy support program. MEASURES Perceived Stress Scale, Edinburgh Postnatal Depression Scale, Mindfulness Attention Awareness Scale, and Birth Outcomes. Womens perceptions of the impact of the programs were examined via summative evaluation, interviews, diaries and facilitator field notes. FINDINGS Nine women in the mindfulness program and 11 in the pregnancy support program completed post-program measures. There were no statistically significant differences between groups. Of practical significance, was an improvement in measures for both groups with a greater improvement in awareness of present moment experience for the intervention group. The intervention group reported learning how to manage stressors, fear, anxiety, and to regulate their attention to be more present. The control group reported learning how to calm down when stressed which increased their confidence. Intervention group themes were: releasing stress, becoming aware, accepting, having options and choices, connecting and being compassionate. Control group themes were:managing stress, increasing confidence, connecting, focussing, being accepted, preparing. KEY CONCLUSION The feasibility and acceptability of the intervention was confirmed. Programs decreased womens self-reported stress in different ways. Women in the mindfulness program accepted themselves and their experiences as they arose and passed in the present moment, while those in the control group gained acceptance primarily from external sources such as peers. IMPLICATIONS FOR PRACTICE Mindfulness programs can foster an internalised locus of self-acceptance which may result in woman becoming less dependent on others for their wellbeing. Adequately powered RCTs, with an active control, long-term follow up and economic evaluation are recommended.