Leigh Roeger

Gender differences in the relationship between depression and suicidal ideation in young adolescents

Objective: This study examined the risk relationship between depressive symptomatology and suicidal ideation for young adolescent males and females. Method: A large cohort of students in their first year of high school completed the Center for Epidemiological Studies Depression Scale (CES-D) and the Adolescent Suicide Questionnaire. The risk relationship between depressive symptomatology and suicidal ideation was modelled using non-parametric kernel-smoothing techniques. Results: Suicidal ideation was more frequently reported by females compared with males which was partly explained by females having higher mean depression scores. At moderate levels of depression females also had a significantly higher risk of suicidal ideation compared with males and this increased risk contributed to the overall higher levels of female ideation. Conclusions: The risk relationship between depressive symptomatology and suicidal ideation is different for young adolescent males and females. The results indicate that moderate levels of depressive symptomatology can be associated with suicidal ideation (especially among young females) and that for these young people a suicide risk assessment is required.

Does school bullying affect adult health? Population survey of health-related quality of life and past victimization

Objective: The purpose of the present study was to determine the proportion of adult South Australians who report having experienced school bullying and to examine the relationship between past victimization and adult health-related quality of life. Method: A representative sample (n=2833) of metropolitan and country South Australian adults were asked in a face-to-face interview whether they had experienced bullying when they were at school. Health-related quality of life was measured using the Medical Outcomes Study Short Form 36-item health survey questions (SF-36). Regression analyses (linear and logistic) were performed, taking into account survey weights. Results: Nearly one-fifth of adults reported having experienced bullying when they were at school. Older persons and those born overseas were less likely to report having been bullied. Those reporting that they had been bullied experienced significantly poorer mental and physical health compared to those who had not been bullied. Conclusions: Adults commonly reported experiencing bullying while at school and these reports were associated with lower health-related quality of life in adulthood. School bullying needs further investigation as a preventable cause of mental health problems across the lifespan.

Perceived academic performance as an indicator of risk of attempted suicide in young adolescents.

ABSTRACT This study investigated perceived academic performance and self-reported suicidal behavior in adolescents (n = 2,596), mean age 13 years, from 27 South Australian high schools. Groups perceiving their academic performance as failing, below average, average and above average were significantly different on measures of self-esteem, locus of control, depressive symptoms, suicidal thoughts, plans, threats, deliberate self-injury, and suicide attempts. Multivariate logistic regression analyses revealed that failing academic performance (compared to above average) is associated with a five-fold increased likelihood of a suicide attempt, controlling for self-esteem, locus of control and depressive symptoms. Teachers should note that a student presenting with low self-esteem, depressed mood and perceptions of failure may be at increased risk for suicidal thoughts and behaviors, and need referral for clinical assessment.

Correlates of firesetting in a community sample of young adolescents.

Objective: To investigate relationships between firesetting, antisocial behaviour, individual, family and parenting factors in a large community sample of adolescents. Method: A cross-sectional study of students (n = 2596) aged 13 years on average, from 27 schools in South Australia with a questionnaire on firesetting, antisocial behaviour (adapted 21-item Self Report Delinquency Scale), risk-taking, drug use, suicidality, physical and sexual abuse, depressive symptomatology, hopelessness, anxiety, locus of control, self-esteem, family functioning (McMaster Family Assessment Device) and parenting style (Influential Relationships Questionnaire). Data analysis included χ2, ANOVA and logistic regression. Results: Large significant differences are found between firesetters and non-firesetters on all measures. Among adolescents with serious levels of antisocial behaviour (7++ acts included in diagnostic guidelines for DSM-IV conduct disorder), firesetters differ from nonfiresetters in reporting more extreme antisocial behaviour (10++ acts), extreme drug use, suicidal behaviour, and perceived failure at school. Gender differences are apparent. A study limitation is the single item assessment of firesetting. Conclusions: Self-report firesetting is strongly associated with extreme antisocial behaviour in young community adolescents, in support of existing evidence from incarcerated delinquent and psychiatric populations. Early detection of community firesetters demands further assessment and intervention. Clinicians should consider its coexistence with serious drug use and high risk-taking (especially in girls), and suicidality, sexual and physical abuse (in boys).

Depression in young adolescents: Investigations using 2 and 3 factor versions of the Parental Bonding Instrument

Associations between parenting style and depressive symptomatology in a community sample of young adolescents (N = 2596) were investigated using self-report measures including the Parental Bonding Instrument and the Center for Epidemiologic Studies Depression Scale. Specifically, the 25-item 2-factor and 3-factor models by Parker et al. (1979), Kendlers (1996) 16-item 3-factor model, and Parkers (1983) quadrant model for the Parental Bonding Instrument were compared. Data analysis included analysis of variance and logistic regression. Reanalysis of Parkers original scale indicates that overprotection is composed of separate factors: intrusiveness (at the individual level) and restrictiveness (in the social context). All models reveal significant independent contributions from paternal care, maternal care, and maternal overprotection (2-factor) or intrusiveness (3-factor) to moderate and serious depressive symptomatology, controlling for sex and family living arrangement. Additive rather than multiplicative interactions between care and overprotection were found. Regardless of the level of parental care and affection, clinicians should note that maternal intrusiveness is strongly associated with adverse psychosocial health in young adolescents.

What the family brings: gathering evidence for strengths-based work

Families attending child and adolescent mental health (CAMH) services are often assumed to have problems in key areas such as communication, belonging/acceptance and problem-solving. Family therapy is often directed towards addressing these difficulties. With increasing emphasis in family therapy and human services fields over the last decade on identifying and building from strengths, a different starting point has been advocated. This paper describes a large survey of the self-reported pre-therapy functioning of children and families using a public CAMH service (n = 416). Before commencing family therapy parents identified family strengths across a range of key areas, despite the burden of caring for children with moderate to severe mental health problems. This evidence supports theoretical and clinical work that advocates a strengths perspective, and highlights how resilience framed in family (and social) rather than individual terms enables a greater appreciation of how strengths may be harnessed in therapeutic work.

Equity of access in the spatial distribution of GPs within an Australian metropolitan city

Equitable access to primary health care is a key objective for health policy makers. In Australia, poor access to primary care providers has been well documented for many rural areas, yet the distribution of general practitioners (GPs) in metropolitan regions remains relatively unknown. Traditional methods of determining geographic access to GPs are limited as they rely on simple population to provider ratios within artificial administrative borders and, among other things, fail to take into account patients that utilise close-by facilities outside of these borders. This study utilised specialised geographic information systems to examine the equity of access to GPs in an Australia capital city (Adelaide). Results showed that by Australian standards, residents of metropolitan Adelaide have low GP ratios. However, an inequitable spatial distribution of GPs within metropolitan Adelaide was found, with ~16% of residents considered to be living in areas of GP workforce shortage. Residents in the outer suburbs and those with lower social economic status appeared to be the most disadvantaged. It is recommended that future studies employ specialised GIS techniques as they provide a more accurate measurement of variations in spatial accessibility to primary care within metropolitan cities.

Is a history of school bullying victimization associated with adult suicidal ideation?: a South Australian population-based observational study

The objective of this research was to determine whether a history of school bullying victimization is associated with suicidal ideation in adult life. A random and representative sample of 2907 South Australian adults was surveyed in Autumn, 2008. Respondents were asked “When you were at school, did you experience traumatic bullying by peers that was particularly severe, for example, being frequently targeted or routinely harassed in any way by ‘bullies’?” Depression was determined by the mood module of the PRIME-MD which includes a suicidal ideation question; “In the last 2 weeks, have you had thoughts that you would be better off dead or hurting yourself in some way?” The overall prevalence of suicidal ideation in postschool age respondents was 3.4% (95% confidence interval: 2.8%–4.2%) in 2008. Bullying by peers was recalled by 18.7% (17.2%–20.3%). Respondents with a history of being bullied were approximately 3 times (odds ratio: 3.2) more likely to report suicidal ideation compared with those who did not. The association between being bullied and suicidal ideation remained after controlling for both depression and sociodemographic variables (odds ratio: 2.1). The results from the present research suggest that there is a strong association between a history of childhood bullying victimization and current suicidal ideation that persists across all ages. Bullying prevention programs in schools could hold the potential for longer lasting benefits in this important area of public health.

The relationship between self-reported health status and the increasing likelihood of South Australians seeking Internet health information

Objective: To determine the proportion of South Australians seeking health information on the Internet and the relationship between searches for health information and self‐reported health status.

Recruitment for a clinical trial of chronic disease self-management for older adults with multimorbidity: a successful approach within general practice

BackgroundA robust research base is required in General Practice. The research output for General Practice is much less than those of other clinical disciplines. A major impediment to more research in this sector is difficulty with recruitment. Much of the research in this area focuses on barriers to effective recruitment and many projects have great difficulty with this process. This paper seeks to describe a systematic approach to recruitment for a randomized controlled trial that allowed the study team to recruit a substantial number of subjects from General Practice over a brief time period.MethodsA systematic approach to recruitment in this setting based on prior literature and the experience of the investigator team was incorporated into the design and implementation of the study. Five strategies were used to facilitate this process. These included designing the study to minimize the impact of the research on the day-to-day operations of the clinics, engagement of general practitioners in the research, making the research attractive to subjects, minimizing attrition and ensuring recruitment was a major focus of the management of the study.Outcomes of the recruitment process were measured as the proportion of practices that agreed to participate, the proportion of potentially eligible subjects who consented to take part in the trial and the attrition rate of subjects. Qualitative interviews with a subset of successfully recruited participants were done to determine why they chose to participate in the study; data were analyzed using thematic analysis.ResultsFive out of the six general practices contacted agreed to take part in the study. Thirty-eight per cent of the 1663 subjects who received a letter of invitation contacted the university study personnel regarding their interest in the project. Recruitment of the required number of eligible participants (n = 256) was accomplished in seven months. Thematic analysis of interviews with 30 participants regarding key factors in their study participation identified a personalised letter of endorsement from their general practitioner, expectation of personal benefit and altruism as important factors in their decision to participate.ConclusionRecruitment can be successfully achieved in General Practice through design of the research project to facilitate recruitment, minimize the impact on general practice operations and ensure special care in enrolling and maintaining subjects in the project.