Joanne Allen

Australian schizophrenia research bank: a database of comprehensive clinical, endophenotypic and genetic data for aetiological studies of schizophrenia

Objective: This article describes the establishment of the Australian Schizophrenia Research Bank (ASRB), which operates to collect, store and distribute linked clinical, cognitive, neuroimaging and genetic data from a large sample of people with schizophrenia and healthy controls. Method: Recruitment sources for the schizophrenia sample include a multi-media national advertising campaign, inpatient and community treatment services and non-government support agencies. Healthy controls have been recruited primarily through multi-media advertisements. All participants undergo an extensive diagnostic and family history assessment, neuropsychological evaluation, and blood sample donation for genetic studies. Selected individuals also complete structural MRI scans. Results: Preliminary analyses of 493 schizophrenia cases and 293 healthy controls are reported. Mean age was 39.54 years (SD = 11.1) for the schizophrenia participants and 37.38 years (SD = 13.12) for healthy controls. Compared to the controls, features of the schizophrenia sample included a higher proportion of males (cases 65.9%; controls 46.8%), fewer living in married or de facto relationships (cases 16.1%; controls 53.6%) and fewer years of education (cases 13.05, SD = 2.84; controls 15.14, SD = 3.13), as well as lower current IQ (cases 102.68, SD = 15.51; controls 118.28, SD = 10.18). These and other sample characteristics are compared to those reported in another large Australian sample (i.e. the Low Prevalence Disorders Study), revealing some differences that reflect the different sampling methods of these two studies. Conclusion: The ASRB is a valuable and accessible schizophrenia research facility for use by approved scientific investigators. As recruitment continues, the approach to sampling for both cases and controls will need to be modified to ensure that the ASRB samples are as broadly representative as possible of all cases of schizophrenia and healthy controls.

Neurobiological basis of parenting disturbance

Objective: It has been proposed that early attachment relationships shape the structure and reactivity of social brain structures that underlie later social capacities. We provide a review of the literature surrounding the development of neurological regulatory systems during infancy and outline recent research suggesting these systems go on to underlie adaptive parental responses. Method: We review evidence in the peer-reviewed psychiatric literature including (i) observational human literature on the neurobiological and social sequelae of early parenting experiences, (ii) experimental animal literature on the effects of early maternal care on neurological development, (iii) experimental animal literature on the neurobiological underpinnings of parenting behaviours, (iv) observational and fMRI evidence on the neurobiological correlates of parenting behaviours, (v) functional and volumetric imaging studies on adults affected by borderline personality disorder. Results: The development of infant regulatory systems is influenced by early parenting experiences. These frontolimbic regulatory systems are also heavily implicated in normal parental responses to infant cues. These frontolimbic disturbances are also observed in studies of borderline personality disorder; a disorder associated with poor emotional regulation, early trauma and disturbed parenting. Conclusions: While the current literature is limited to animal models of abnormal care giving, existing disorders associated with deficits in regulatory capacity and abnormal frontolimbic functioning may yet provide a human model of the neurobiology of parenting disturbance.

Construct validity of the Assessment of Quality of Life - 6D (AQoL-6D) in community samples

BackgroundThe Assessment of Quality of Life - 6D scale (AQoL-6D) is a self-report instrument designed to provide a sensitive multidimensional evaluation of health related quality of life. The current paper assesses the construct, concurrent and convergent validity of the AQoL-6D in a combined longitudinal population sample drawn from across urban, regional and remote areas of Australia.MethodsThe AQoL-6D was administered within the Hunter Community Study and the Australian Rural Mental Health Study over time (mean years lag = 3.90, SD = 1.30). Observations with sufficient data were used to confirm the construct validity of the AQoL-6D domains and higher-order structure using confirmatory factor analyses (CFA, N = 7915). The stability of this structure across cohorts and over time was assessed using multi-group CFA. Additionally, the concurrent validity (against the SF-36) and convergent validity of AQoL-6D domains and factors were assessed.ResultsThe construct validity of the AQoL-6D domains was considered satisfactory. Two higher-order factors, representing the physical and psychological components of quality of life were identified (CFA model fit: RMSEA = .07, SRMR = .03; TLI = .96, CFI = .98). These factors displayed group and temporal invariance, as well as concurrent and convergent validity against a range of measures. Recommendations for the derivation of summary scores are provided, together with a provisional set of norms.ConclusionsThe AQoL-6D is a useful tool for assessing quality of life impairment in epidemiological cohort studies, both cross-sectionally and over time. It displays appropriate levels of construct, concurrent and convergent validity. Conceptualisation of higher-order factors as representing the physical and psychological aspects of quality of life impairment may increase the sensitivity and appeal of the AQoL-6D, particularly for studies examining predictors of and changes in social and psychological outcomes.

Social support and age influence distress outcomes differentially across urban, regional and remote Australia: an exploratory study.

BackgroundThe variation of determinants of mental health with remoteness has rarely been directly examined. The current research aims to examine whether the association of psychosocial factors with psychological distress outcomes varies with increasing remoteness.MethodsParticipants were persons aged 55 and over from two community cohorts sampling from across rural and urban New South Wales (N = 4219; mean age = 69.00 years; 46.1% male). Measures of social support from these studies were calibrated to facilitate comparison across the sample. Remoteness was assessed using a continuous measure, the Accessibility/Remoteness Index of Australia. The association between demographic characteristics, social support, remoteness, and their interactions with remoteness in the prediction of high psychological distress (cut-off > 21 on the Kessler 10) were examined using logistic regression.ResultsNot being in a married or defacto relationship (OR 0.69; 99% CI 0.51-0.94), lower education (OR 0.52; 99% CI 0.38-0.71) and decreased social support (OR 0.36; 99% CI 0.31-0.42) significantly predicted psychological distress. There was a significant interaction of age and remoteness (OR 0.84; 99% CI 0.67-1.00), indicating that as remoteness increases, older persons are less likely to be highly distressed, as well as a significant interaction of social support and remoteness (OR 1.22; 99% CI 1.04-1.44), indicating that as remoteness decreases, persons with low levels of social support are more likely to be highly distressed.ConclusionsRemoteness may moderate the influence of social support and age on psychological distress outcomes.

Quality of life impact of cardiovascular and affective conditions among older residents from urban and rural communities

BackgroundThe demographic, health and contextual factors associated with quality of life impairment are investigated in older persons from New South Wales, Australia. We examine the impact of cardiovascular and affective conditions on impairment and the potential moderating influence of comorbidity and remoteness.MethodsData from persons aged 55 and over were drawn from two community cohorts sampling from across urban to very remote areas. Hierarchical linear regressions were used to assess: 1) the impact of cardiovascular and affective conditions on physical and psychological quality of life impairment; and 2) any influence of remoteness on these effects (N = 4364). Remoteness was geocoded to participants at the postal code level. Secondary data sources were used to examine the social capital and health service accessibility correlates of remoteness.ResultsPhysical impairment was consistently associated with increased age, male gender, lower education, being unmarried, retirement, stroke, heart attack/angina, depression/anxiety, diabetes, hypertension, current obesity and low social support. Psychological impairment was consistently associated with lower age, being unmarried, stroke, heart attack/angina, depression/anxiety and low social support. Remoteness tended to be associated with lower psychological impairment, largely reflecting overall urban versus rural differences. The impacts of cardiovascular and affective conditions on quality of life were not influenced by remoteness. Social capital increased and health service accessibility decreased with remoteness, though no differences between outer-regional and remote/very remote areas were observed. Trends suggested that social capital was associated with lower psychological impairment and that the influence of cardiovascular conditions and social capital on psychological impairment was greater for persons with a history of affective conditions. The beneficial impact of social capital in reducing psychological impairment was more marked for those experiencing financial difficulty.ConclusionsCardiovascular and affective conditions are key determinants of physical and psychological impairment. Persons affected by physical-psychological comorbidity experience greater psychological impairment. Social capital is associated with community remoteness and may ameliorate the psychological impairment associated with affective disorders and financial difficulties. The use of classifications of remoteness that are sensitive to social and health service accessibility determinants of health may better inform future investigations into the impact of context on quality of life outcomes.

Integrating and extending cohort studies: lessons from the eXtending Treatments, Education and Networks in Depression (xTEND) study

BackgroundEpidemiologic studies often struggle to adequately represent populations and outcomes of interest. Differences in methodology, data analysis and research questions often mean that reviews and synthesis of the existing literature have significant limitations. The current paper details our experiences in combining individual participant data from two existing cohort studies to address questions about the influence of social factors on health outcomes within a representative sample of urban to remote areas of Australia. The eXtending Treatments, Education and Networks in Depression study involved pooling individual participant data from the Australian Rural Mental Health Study (T0 N = 2639) and the Hunter Community Study (T0 N = 3253) as well as conducting a common three-year follow-up phase (T1 N = 3513). Pooling these data extended the capacity of these studies by: enabling research questions of common interest to be addressed; facilitating the harmonization of baseline measures; permitting investigation of a range of psychosocial, physical and contextual factors over time; and contributing to the development and implementation of targeted interventions for persons experiencing depression and alcohol issues.DiscussionThe current paper describes the rationale, challenges encountered, and solutions devised by a project aiming to maximise the benefits derived from existing cohort studies. We also highlight opportunities for such individual participant data analyses to assess common assumptions in research synthesis, such as measurement invariance, and opportunities for extending ongoing cohorts by conducting a common follow-up phase.SummaryPooling individual participant data can be a worthwhile venture, particularly where adequate representation is beyond the scope of existing research, where the effects of interest are small though important, where events are of relatively low frequency or rarely observed, and where issues are of immediate regional or national interest. Benefits such as these can enhance the utility of existing projects and strengthen requests for further research funding.

Brief neuropsychological profiles in psychosis: a pilot study using the Audio Recorded Cognitive Screen (ARCS)

UNLABELLED Loughland CM, Allen J, Gianacas L, Schofield PW, Lewin TJ, Hunter M, Carr VJ. Brief neuropsychological profiles in psychosis: a pilot study using the Audio Recorded Cognitive Screen (ARCS). OBJECTIVE This pilot study examines the utility of a novel, standardised brief neuropsychological assessment tool (the ARCS, Audio Recorded Cognitive Screen) in a different clinical setting to that in which it was initially developed. We hypothesised that the ARCS would be feasible to administer to individuals with a psychotic illness and that it would detect cognitive deficits similar to those identified by an established instrument (the RBANS, Repeatable Battery for the Assessment of Neuropsychological Status). METHODS Twenty-five people with psychosis (mean age = 43.72, SD = 9.78) and 25 age- and gender-matched controls were recruited from the Newcastle community (NSW, Australia). The ARCS and RBANS were completed about 1 week apart in a counterbalanced order. RESULTS The ARCS was well received, performed satisfactorily and both the ARCS and RBANS were sensitive to deficits typically associated with psychosis (e.g. memory and attention). After controlling for memory deficits, the largest disparity between the psychosis and control groups was on the ARCS fluency domain [p < 0.001, partial Eta-squared (η p 2) = 0.21]. CONCLUSION The ARCS uses audio administration (approximately 34 min) to reduce clinician time (to 3-5 min for scoring) and appears to be a useful brief assessment tool for examining the cognitive deficits associated with psychosis. However, the potential clinical utility of the ARCS needs to be investigated further in larger samples drawn from a wider variety of specialist and non-specialist settings.

Longitudinal Trajectories of Quality of Life and Depression by Housing Tenure Status

Objectives A large body of research has demonstrated the positive effects of home ownership on well-being and health outcomes. However, most previous studies have been cross-sectional. The present study aimed to understand the long-term impact of housing tenure on the psychological wellbeing of older people in New Zealand. Method Data were collected between 2010 and 2014. The 2010 sample (aged from 50-85 years) comprised 2,843 participants (55.4% female). Latent growth curve modeling was used to investigate trajectories of change for home owners and tenants in quality of life and depression symptoms. Analyses also examined the additional impact of demographic and socio-economic variables. Results Over time, quality of life increased, while depression symptoms decreased, for home owners. For tenants, lower levels of quality of life and higher levels of depression symptoms remained stable. Economic living standard, urban versus rural residence, length of residence, ethnicity, age, and household composition emerged as significant covariates. Discussion The psychological benefits of home ownership highlight the importance of secure and sustainable housing. Policies should be designed to ensure access to safe housing solutions for all older people.

Factors associated with personal hopefulness in older rural and urban residents of New South Wales

Background: As research focuses on the concept of resilience, evidence suggests that greater levels of personal hope may have a mitigating effect on the mental health impact of adversity. In view of the adversity affecting rural communities, a better understanding of factors influencing personal hope may help identify foci for mental health promotion and mental illness prevention research and interventions. Aim: To explore the relationship between demographic, socioeconomic and mental health factors and personal hopefulness, including the influence of locality and remoteness. Method: Using data from two community-based longitudinal cohorts from New South Wales – one urban and one rural – we analysed cross-sectional relationships between a range of factors and personal hopefulness using logistic regression techniques, as part of a common follow-up. Personal hopefulness was measured using a 12-item scale and scores were categorised as low (<2.5), medium (2.5–3.4) and high (≥3.5). Results: Of 2774 participants (53% female, mean age 69.1 years [SD 7.3, range 58–91 years], 36% living outside metropolitan areas) 32% had low, 51% had medium and 17% had high personal hopefulness scores. Several factors displayed univariate associations with personal hopefulness. In the multivariate model, five factors were independently associated with lower personal hopefulness: being older, having lower perceived prosperity, less frequent socialisation, experiencing high psychological distress or psychological impairment. Hopefulness was not associated with geographical location. Conclusion: The impact of current psychological distress and aspects of adversity on personal hopefulness over time should be further investigated in longitudinal research. Personal hopefulness did not differ across geographical location.

The sensitivity of the MOS SF-12 and PROMIS® global summary scores to adverse health events in an older cohort

PurposeTo compare the predictive validity of two self-reported outcome measures, the Patient-Reported Outcome Measurement Information System (PROMIS) Global Health measure and the 12-item Health Survey (SF-12).MethodsData were obtained from 1286 persons (55% female) aged 61–77 responding to a longitudinal survey. Inter-correlations of the SF-12 and PROMIS physical and mental summary scores were examined. ROC and AUC analyses were conducted to compare mental health score sensitivity to high levels of depression symptoms. Multiple regression was used to assess physical health score sensitivity to adverse health events over 12-month follow-up.ResultsAll scores displayed negatively skewed distributions. The respective SF-12 and PROMIS physical (r = .78) and mental (r = .62) health scores displayed strong associations. Mental health scores provided useful discrimination of persons reporting high depression symptoms (AUCSF12 = 0.90; AUCPROMIS = 0.84), although the SF-12 provided better case discrimination. Decreases in physical health over time were associated with recurrent falls (BSF12 = − 1.62; BPROMIS = − 1.14) and hospitalisations (BSF12 = − 1.69; BPROMIS = − 1.11).ConclusionsThe SF-12 and PROMIS brief measures of physical and mental health assess related but distinct health constructs. However, they display comparable sensitivity to adverse health outcomes. Results from studies utilising the SF-12 and PROMIS global health measures should be compared with sensitivity to differences in the content and scoring of these measures.