Kate L. Francis

Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis

Objective: The aim of this paper was to systematically review and meta-analyse the prevalence of co-morbid psychiatric disorders (DSM-IV Axis I disorders) among treatment-seeking problem gamblers. Methods: A systematic search was conducted for peer-reviewed studies that provided prevalence estimates of Axis I psychiatric disorders in individuals seeking psychological or pharmacological treatment for problem gambling (including pathological gambling). Meta-analytic techniques were performed to estimate the weighted mean effect size and heterogeneity across studies. Results: Results from 36 studies identified high rates of co-morbid current (74.8%, 95% CI 36.5–93.9) and lifetime (75.5%, 95% CI 46.5–91.8) Axis I disorders. There were high rates of current mood disorders (23.1%, 95% CI 14.9–34.0), alcohol use disorders (21.2%, 95% CI 15.6–28.1), anxiety disorders (17.6%, 95% CI 10.8–27.3) and substance (non-alcohol) use disorders (7.0%, 95% CI 1.7–24.9). Specifically, the highest mean prevalence of current psychiatric disorders was for nicotine dependence (56.4%, 95% CI 35.7–75.2) and major depressive disorder (29.9%, 95% CI 20.5–41.3), with smaller estimates for alcohol abuse (18.2%, 95% CI 13.4–24.2), alcohol dependence (15.2%, 95% CI 10.2–22.0), social phobia (14.9%, 95% CI 2.0–59.8), generalised anxiety disorder (14.4%, 95% CI 3.9–40.8), panic disorder (13.7%, 95% CI 6.7–26.0), post-traumatic stress disorder (12.3%, 95% CI 3.4–35.7), cannabis use disorder (11.5%, 95% CI 4.8–25.0), attention-deficit hyperactivity disorder (9.3%, 95% CI 4.1–19.6), adjustment disorder (9.2%, 95% CI 4.8–17.2), bipolar disorder (8.8%, 95% CI 4.4–17.1) and obsessive-compulsive disorder (8.2%, 95% CI 3.4–18.6). There were no consistent patterns according to gambling problem severity, type of treatment facility and study jurisdiction. Although these estimates were robust to the inclusion of studies with non-representative sampling biases, they should be interpreted with caution as they were highly variable across studies. Conclusions: The findings highlight the need for gambling treatment services to undertake routine screening and assessment of psychiatric co-morbidity and provide treatment approaches that adequately manage these co-morbid disorders. Further research is required to explore the reasons for the variability observed in the prevalence estimates.

The Prevalence of Comorbid Personality Disorders in Treatment-Seeking Problem Gamblers: A Systematic Review and Meta-Analysis.

The aim of this study was to systematically review and meta-analyze the prevalence of comorbid personality disorders among treatment-seeking problem gamblers. Almost one half (47.9%) of problem gamblers displayed comorbid personality disorders. They were most likely to display Cluster B disorders (17.6%), with smaller proportions reporting Cluster C disorders (12.6%) and Cluster A disorders (6.1%). The most prevalent personality disorders were narcissistic (16.6%), antisocial (14.0%), avoidant (13.4%), obsessive-compulsive (13.4%), and borderline (13.1%) personality disorders. Sensitivity analyses suggested that these prevalence estimates were robust to the inclusion of clinical trials and self-selected samples. Although there was significant variability in reported rates, subgroup analyses revealed no significant differences in estimates of antisocial personality disorder according to problem gambling severity, measure of comorbidity employed, and study jurisdiction. The findings highlight the need for gambling treatment services to conduct routine screening and assessment of co-occurring personality disorders and to provide treatment approaches that adequately address these comorbid conditions.

Solarium use in Australia, recent trends and context

Objectives: To describe the prevalence of solarium use among representative samples of Australian adolescents (12–17 years) and adults (18–69 years).

National estimates of Australian gambling prevalence: findings from a dual-frame omnibus survey

Abstract Background, aims and design The increase in mobile telephone‐only households may be a source of bias for traditional landline gambling prevalence surveys. Aims were to: (1) identify Australian gambling participation and problem gambling prevalence using a dual‐frame (50% landline and 50% mobile telephone) computer‐assisted telephone interviewing methodology; (2) explore the predictors of sample frame and telephone status; and (3) explore the degree to which sample frame and telephone status moderate the relationships between respondent characteristics and problem gambling. Setting and participants A total of 2000 adult respondents residing in Australia were interviewed from March to April 2013. Measurements Participation in multiple gambling activities and Problem Gambling Severity Index (PGSI). Findings Estimates were: gambling participation [63.9%, 95% confidence interval (CI) = 61.4–66.3], problem gambling (0.4%, 95% CI = 0.2–0.8), moderate‐risk gambling (1.9%, 95% CI = 1.3–2.6) and low‐risk gambling (3.0%, 95% CI = 2.2–4.0). Relative to the landline frame, the mobile frame was more likely to gamble on horse/greyhound races [odds ratio (OR) = 1.4], casino table games (OR = 5.0), sporting events (OR = 2.2), private games (OR = 1.9) and the internet (OR = 6.5); less likely to gamble on lotteries (OR = 0.6); and more likely to gamble on five or more activities (OR = 2.4), display problem gambling (OR = 6.4) and endorse PGSI items (OR = 2.4‐6.1). Only casino table gambling (OR = 2.9) and internet gambling (OR = 3.5) independently predicted mobile frame membership. Telephone status (landline frame versus mobile dual users and mobile‐only users) displayed similar findings. Finally, sample frame and/or telephone status moderated the relationship between gender, relationship status, health and problem gambling (OR = 2.9–7.6). Conclusion Given expected future increases in the mobile telephone‐only population, best practice in population gambling research should use dual frame sampling methodologies (at least 50% landline and 50% mobile telephone) for telephone interviewing.

Adolescence and the next generation

Adolescent growth and social development shape the early development of offspring from preconception through to the post-partum period through distinct processes in males and females. At a time of great change in the forces shaping adolescence, including the timing of parenthood, investments in today’s adolescents, the largest cohort in human history, will yield great dividends for future generations.

The Experience of Teasing in Elective Cosmetic Surgery Patients

The role of teasing as a motivator for patients undertaking elective cosmetic surgery was investigated. Pre-operative data were collected, using a range of standardized tests in addition to open ended questions about their experience of teasing, from 449 patients aged 18 to 70 undergoing elective cosmetic surgery in Australia. Just under half of the sample indicated that they had been teased or bullied about their appearance. Teased patients showed significantly higher levels of anxiety, depression and dysmorphic concern; lower levels of physical attractiveness and appearance satisfaction; and lower levels of satisfaction with discrete aspects of their appearance than nonteased patients. Teasing also contributed to longer periods of considering surgery as an answer to body dissatisfaction concerns, even when controlling for age. Prevention education initiatives on appearance-related teasing should be targeted at school students. This, along with earlier detection of the psychological impacts of weight and appearance-related teasing, fewer people, if offered strategies for coping through counseling, may contemplate surgery as a response to this teasing.

Combining social norms and social marketing to address underage drinking: development and process evaluation of a whole-of-community intervention

Youth alcohol consumption has been steadily declining in Australia, as in other countries; fewer young people are drinking and the age of initiation is increasing. However, young people, their parents and others in their communities continue to believe that adolescent (excessive) drinking is the norm. This perception, and the concurrent misperception that the majority of parents are happy to provide their underage children with alcohol, creates a perceived culture of acceptance of youth alcohol consumption. Young people believe that it is accepted, and even expected, that they will drink; and parents perceive that not providing their adolescent children with alcohol will lead to social exclusion. There is evidence that shifting social norms can have an immediate and lasting effect adolescents’ (and adults’) alcohol related attitudes and behaviors. This paper reports on a novel, community based social marketing intervention designed to correct misperceptions of alcohol related social norms in an Australian community. The project utilized a social marketing approach, informed by the full complement of Andreasen’s social marketing benchmarking criteria, and concurrently targeted adolescents, parents of adolescents and the broader community. Using extensive formative research and multiple evaluation techniques, the study demonstrates that shifts in community social norms are possible and suggests that this approach could be used more widely to support the positive trends in youth alcohol consumption and parental supply.

Psychological characteristics and outcomes of elective cosmetic surgery patients: the influence of cosmetic surgery history

The early cosmetic surgery literature suggested that individuals re-presenting for aesthetic surgical procedures (referred to as “insatiable patients”) display poorer psychological functioning and satisfaction with surgical outcomes than those who request one procedure. The aim of the study was to compare 284 patients with and without a history of cosmetic procedures on demographic characteristics, appearance concerns, expectations of surgery, psychosocial dysfunction, and postoperative dissatisfaction. There were few differences between the groups, suggesting that the group of patients with a history of aesthetic surgeries did not represent the population that has been described as “surgery insatiable.” Post hoc analyses of subgroups of patients with a history of surgeries also revealed few differences except for lower self-esteem and postoperative satisfaction. Further research is required to fully explore the applicability of the “insatiable patient” label in the context of increasing societal acceptance of cosmetic surgery.

Is removing blood donation barriers a donation facilitator?: Australian African migrants’ view

Purpose – The aim of this study was to assess whether the removal of blood donation “barriers” facilitates blood donation intentions, using a sample of African migrants, and to identify the implications for social marketing. African migrants are currently under-represented as blood donors in Australia. Some members of the African community have unique donation needs that can only be served by this community. Design/methodology/approach – Interviews were conducted with 425 people from the African community in Victoria and South Australia. Factor analysis was performed on the barriers and the removal of barriers. Item groupings for both constructs differed, suggesting that barriers and their removal are not necessarily opposite constructs. Findings – The cultural society factor was negatively associated with blood donation intention (i.e. a barrier), whereas engagement and overcoming fear were positively associated with blood donation intention (i.e. facilitators). Cultural issues and lack of understanding ...

An audit of the dietary intake of Australian children with type 1 diabetes

To understand what children with type 1 diabetes in a representative tertiary hospital clinic are eating compared to their peers and explore dietary intake impact on HbA1c outcome. An open cross-sectional dietary audit of children and adolescents with diabetes aged 2–17 years attending the Royal Children’s Hospital, Melbourne was conducted using an age-appropriate validated Food Frequency Questionnaire. Total energy, macronutrient intake and diet quality were calculated and compared to dietary advice provided and national intake data. Body weight, and dietary intake influences on glycaemic control were investigated. Overall, 785 patients were recruited, from which 429 dietary surveys were completed. Dietary intakes were overall nutritionally adequate with macronutrient distribution (% total energy intake) being lower carbohydrate (48.6%), higher total sugars (22.4%), fat (32.9%), saturated fat (14.9%) and protein intake (19.1%) than recommendations, but similar to their peers. Energy intakes were excessive compared to their peers in the 4–13 year olds. Rates of overweight (30%) were significantly higher than national data (18%). Overall, 43% achieved optimal glycaemic control (HbA1c < 7.5%; <58 mmol/mol). HbA1c prediction via linear regression indicated that the following factors were associated with lower HbA1c values: being male, on pump regimen, lower rates of insulin per kg, shorter duration of disease. This audit has identified areas requiring targeted education/support to improve health outcomes including dietary adherence, rates of overweight/obesity, appropriate energy intakes and optimal glycaemic targets. Furthermore, it provides baseline data to evaluate efficacy of future interventions.