Meg Smith

Effects of adjunctive peer support on perceptions of illness control and understanding in an online psychoeducation program for bipolar disorder: A randomised controlled trial

OBJECTIVES To examine the comparative effectiveness of an online psychoeducation program for people diagnosed with bipolar disorder within the previous 12 months, completed alone or with adjunctive peer support, on symptoms and perceived control over the illness. METHOD Participants were randomly allocated to an eight-week online psychoeducation program (n=139), a psychoeducation program plus online peer support (n=134) or an attentional control condition (n=134). RESULTS Increased perceptions of control, decreased perceptions of stigmatisation and significant improvements in levels of anxiety and depression, from pre- to post-intervention were found across all groups. There were no significant differences between groups on outcome measures, although a small clinical difference was found between the supported and unsupported conditions in depression symptoms and in functional impairment at the six-month follow-up. Adherence to the treatment program was significantly higher in the supported intervention than in the unsupported program. Gender and age were also significant predictors of adherence, with females and those over the age of 30 showing greater adherence. LIMITATIONS Mood state at study entry was measured by self-report rather than by clinical interview. CONCLUSIONS The pattern of outcomes suggests a primary influence of non-specific or common therapeutic factors across all three intervention groups. A personally tailored intervention may be more suitable for individuals recently diagnosed with bipolar disorder, and longer term coaching may increase program adherence and long-term improvement in symptoms and functioning.

Suicide: An Australian psychological society discussion paper

This paper presents a review of literature, research, and practice relating to suicide and intentional self-injury. It incorporates both an international perspective and a particular focus on Australia. The paper reviews the epidemiological knowledge base, noting its complexity and the ways in which risk factors may vary with the population or subpopulation being studied. While much of the recent focus on suicide has been shaped by the increase in youth suicide, suicide remains a significant problem across all adult age groups. Hence, this paper discusses suicide across the life span, but also identifies youth suicide and Indigenous suicide as two areas of particular concern. In relation to Indigenous suicide, it is important to move from a national focus to examine regional suicide patterns and conditions of risk within particular communities. The paper considers core principles of clinical assessment and intervention, acknowledging the powerful emotions and sensitive, complex judgments involved in this work. Mental health service provision is briefly reviewed and issues of concern identified, ranging from gaps in services to the need for more research and training in referral processes. Conceptualisations of suicide prevention and postvention are outlined, noting considerable debate about preferred approaches and a clear need for careful evaluation.

A prospective study of the impact of smoking on outcomes in bipolar and schizoaffective disorder

BACKGROUND Tobacco smoking is more prevalent among people with mental illnesses, including bipolar disorder, than in the general community. Most data are cross-sectional, and there are no prospective trials examining the relationship of smoking to outcome in bipolar disorder. The impact of tobacco smoking on mental health outcomes was investigated in a 24-month, naturalistic, longitudinal study of 240 people with bipolar disorder or schizoaffective disorder. METHOD Participants were interviewed and data recorded by trained study clinicians at 9 interviews during the study period. RESULTS Comparisons were made between participants who smoked daily (n = 122) and the remaining study participants (n = 117). During the 24-month study period, the daily smokers had poorer scores on the Clinical Global Impressions-Depression (P = .034) and Clinical Global Impressions-Overall Bipolar (P = .026) scales and had lengthier stays in hospital (P = .012), compared with nonsmokers. LIMITATIONS Smoking status was determined by self-report. Nicotine dependence was not measured. CONCLUSION These findings suggest that smoking is associated with poorer mental health outcomes in bipolar and schizoaffective disorder.

Schema-focused cognitive therapy for bipolar disorder: reducing vulnerability to relapse through attitudinal change

Objective: Acceptance of, and adaptability to illness, are major determinants of adherence to treatment and functional recovery. This paper addresses the major psychosocial factors associated with bipolar disorder and the role of psychological interventions in symptom management and adaptability to the illness experience. A new model is presented highlighting the role of developmental experiences and temperament in determining reactions to bipolar disorder. The authors propose that by addressing reactions to the illness experiences and effects on self-concept through schema-focused cognitive therapy, functional recovery is more likely to occur among those patients functioning below expectation. Method: A systematic review of the current literature including an Index Medicus/MEDLINE search was conducted, focusing on risk factors, cognitive vulnerabilities and triggers associated with bipolar disorder. Psychological treatments available for the treatment of bipolar disorder are reviewed and details of a novel schema-focused cognitive model for this condition are presented. Traditional models of adaptation to chronic illness are outlined and incorporated into the proposed model. Schema-focused cognitive therapy is proposed as an approach to help patients reduce cognitive vulnerability to relapse in addition to adopting effective mood management strategies. Results and Conclusions: There is a need for psychological treatments which reduce the risks associated with poor functionality in patients with bipolar disorder. Schema-focused cognitive therapy specifically targets the temperament, developmental experiences and cognitive vulnerabilities that determine adjustment to illness. This proposed treatment, combined with pharmacotherapy, may offer new psychotherapeutic options for the future.

Next generation of self-management education: Web-based bipolar disorder program.

Objective: Education and self-management training assist patients with bipolar disorder to take control of their condition and to reduce disability, but the timeliness and availability of the education are important. A free Web-based bipolar education program has been recently developed to provide accessible evidence-based information for patients, carers and health professionals. The present paper describes the nine-module program, reports usage data and user profiles, and overviews the aims and methodology of a randomized controlled trial to measure its impact. Methods: Customized Web reports were developed to measure usage of the Web-based program, and to profile its users on a month-by-month basis. Data on the percentage of completers of each module were also collected. A randomized controlled trial evaluating the program in people with newly diagnosed bipolar disorder was also commenced. Results: More than 8000 visitors used the online program in its first 6 months. Users were predominantly female, of a broad cross-section of ages, 43.5% with bipolar disorder, and with the remainder describing themselves as health professionals, carers/family/friends of a person with bipolar disorder or members of the general public. The majority (76%) completed the sessions they commenced. Conclusions: The Web-based education program is attracting a steady stream of users and is exhibiting good completion rates. This preliminary support for the programs utility requires validation from our randomized controlled trial before definite conclusions can be drawn.

Mechanisms underpinning effective peer support: a qualitative analysis of interactions between expert peers and patients newly-diagnosed with bipolar disorder

BackgroundThe increasing burden on mental health services has led to the growing use of peer support in psychological interventions. Four theoretical mechanisms have been proposed to underpin effective peer support: advice grounded in experiential knowledge, social support, social comparison and the helper therapy principle. However, there has been a lack of studies examining whether these mechanisms are also evident in clinical populations in which interpersonal dysfunction is common, such as bipolar disorder.MethodThis qualitative study, conducted alongside a randomized controlled trial, examined whether the four mechanisms proposed to underpin effective peer support were expressed in the email exchange between 44 individuals newly-diagnosed with bipolar disorder and their Informed Supporters (n = 4), over the course of a supported online psychoeducation program for bipolar disorder. A total of 104 text segments were extracted and coded. The data were complemented by face-to-face interviews with three of the four Informed Supporters who participated in the study.ResultsQualitative analyses of the email interchange and interview transcripts revealed rich examples of all four mechanisms. The data illustrated how the involvement of Informed Supporters resulted in numerous benefits for the newly-diagnosed individuals, including the provision of practical strategies for illness management as well as emotional support throughout the intervention. The Informed Supporters encouraged the development of positive relationships with mental health services, and acted as role models for treatment adherence. The Informed Supporters themselves reported gaining a number of benefits from helping, including a greater sense of connectedness with the mental health system, as well as a broader knowledge of illness management strategies.ConclusionsExamples of the mechanisms underpinning effective peer support were found in the sample of emails from individuals with newly-diagnosed bipolar disorder and their Informed Supporters. Experiential knowledge, social support, social comparison and helper therapy were apparent, even within a clinical population for whom relationship difficulties are common. Trial registration number ACTRN12608000411347.

A prospective study of the impact of subthreshold mixed states on the 24-month clinical outcomes of bipolar I disorder or schizoaffective disorder.

OBJECTIVES The clinical significance of subthreshold mixed states is unclear. This study investigated the clinical outcomes in participants with bipolar I disorder or schizoaffective disorder, using the Cassidy and Benazzi criteria for manic and depressive mixed states, respectively. METHODS Participants (N=239) in a prospective observational study of treatment and outcomes in bipolar I or schizoaffective disorder, bipolar type, were grouped based on study entry clinical presentation as having pure depression (n=63) if they satisfied DSM-IV-TR criteria for a Major Depressive Episode (MDE), depressive mixed state if they also had at least three concurrent hypomanic symptoms (n=33), or not depressed (n=143) if they did not satisfy the criteria for MDE. Participants were similarly grouped as having pure mania (n=3) if they satisfied DSM-IV criteria for a Manic Episode, manic mixed state if they also had at least two concurrent depressive symptoms (n=33), or not manic (n=203). Clinical data were collected by interview every 3 months over a 24-month period. RESULTS Measures of quality of life, mental and physical health over the 24-month period were significantly worse for participants who were classified as having mixed states at study entry on most outcome measures compared to participants who were not in an illness episode at study entry. A depressive mixed state was predictive of greater manic symptomatology over the 24 months compared to participants with pure depression. CONCLUSION In participants with a current episode of mood disorder, the presence of subthreshold symptoms of opposite polarity was associated with poorer clinical outcomes over a 24-month period.

Post-Fordism and Workplace Change: Towards a Critical Research Agenda:

Despite the well-developed academic critique, in particular that directed against the work of John Mathews, post-Fordism is still an influential account of workplace change. This is interesting and serious. Interesting, because it raises the question of how a discredited doctrine remains influential in the teeth of intense academic criticism. Serious, because post-Fordism propagates an image of workplace change that could confuse the deliberations of those vitally affected by the latter. This article identifies three incompatible positions on the nature of post-Fordist work organization within the work of Mathews. We argue that post-Fordism. in particu lar the work of Mathews, fails to distinguish favourable from unfavourable (for workers) forms of work organization, misreads developments in management strategy, and neglects the gender dimension of workplace change. Accordingly we counterpose a critical research agenda to that suggested by Mathews. We attempt, hesitantly, to take the debate towards a sociology of knowledge of post-Fordism, by pointing to some of the political interests post-Fordism serves.

The impact of age at onset of bipolar I disorder on functioning and clinical presentation

Objectives: Recent studies have proposed the existence of three distinct subgroups of bipolar 1 disorder based on age at onset (AAO). The present study aims to investigate potential clinical and functional differences between these subgroups in an Australian sample. Methods: Participants (n = 239) were enrolled in the Bipolar Comprehensive Outcomes Study (BCOS), a 2-year longitudinal, observational, cross-sectional study. Assessment measures included the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAMD21), Clinical Global Impressions Scale (CGI-BP), SF-36, SLICE/Life Scale, and the EuroQol (EQ-5D). Participants were also asked about their age at the first major affective episode. Results: Three AAO groups were compared: early (AAO < 20, mean = 15.5 ± 2.72; 44.4% of the participants); intermediate (AAO 20–39, mean = 26.1 ± 4.8; 48.14% of the participants) and late (AAO > 40, mean = 50.6 ± 9.04; 7.4% of the participants). Higher rates of depression, suicidal ideation and binge drinking were reported by the early AAO group. This group also reported poorer quality of life in a number of areas. The early AAO group had a predominant depressive initial polarity and the intermediate group had a manic predominance. Conclusion: Early AAO is associated with an adverse outcome.

Gender pay equity, wage fixation and industrial relations reform in Australia: One step forward and two steps backwards?

Purpose – The purpose of this paper is to discuss the impact on the new federal wage fixing system on gender pay equity in Australia.Design/methodology/approach – The article is divided into four parts. The first section briefly examines the policy approach to the issue of gender pay equity in other Anglophone counties and the history of pay (in)equity under the Australian tribunal based industrial relations system. The second section overviews the recent developments at the State level in Australia focused on gender pay equity. The third section discusses recent cases in State wage fixing systems in Australia designed to remedy the gender based undervaluation of childrens services employees. The fourth and final section discusses the implications of the new “national” workplace relations laws in the context of gender pay equity in Australia.Findings – The capacity of State tribunals to continue to apply gender free wage determinations is under threat because of the federal governments 2006 “reforms” to...