Nick Kowalenko

Evaluation of universal, indicated, and combined cognitive-behavioral approaches to the prevention of depression among adolescents

A cluster, stratified randomized design was used to evaluate the impact of universal, indicated, and combined universal plus indicated cognitive- behavioral approaches to the prevention of depression among 13- to 15-year-olds initially reporting elevated symptoms of depression. None of the intervention approaches differed significantly from a no-intervention condition or from each other on changes in depressive symptoms, anxiety, externalizing problems, coping skills, and social adjustment. All high-symptom students, irrespective of condition, showed a significant decline in depressive symptoms and improvement in emotional well-being over time although they still demonstrated elevated levels of psychopathology compared with the general population of peers at 12-month follow-up. There were also no significant intervention effects for the universal intervention in comparison with no intervention for the total sample of students in those conditions.

Postnatal Depression, Anxiety and Unsettled Infant Behaviour

Objective: This study compares maternal mood, marital satisfaction and infant temperament in 128 mothers admitted to the residential care unit of a parentcraft hospitaland 58 mothers in a demographically matched group. Method: Mothers were recruited from the residential care unit of a parentcraft hospital (Tresillian Family Care Centres) and a comparison group from a private obstetric practice in the same demographic area. Both groups completed self-report questionnaires on depression, anxiety and marital adjustment, while mothers in the residential care group also received a structured diagnostic interview for depression (CIDI). Results: Sixty-two per cent of mothers in the residential care group met diagnostic criteria for a major depressive episode occurring since childbirth and a further 13% met DSM-IV research criteria for minor depression. The residential care group also scored significantly higher on both state and trait anxiety and rated their infants as significantly more temperamentally difficult than did the comparison group. Conclusions: This study replicates a previous Australian finding of a high incidence of maternal mood disorders in mothers admitted to parentcraft hospitals. Acknowledgement of the close association between maternal mood state and unsettled infant behaviour facilitates an integrated multidisciplinary approach offering appropriate management for both mothers and infants. Residential care units may be ideally suited to provide such early intervention strategies in a non-stigmatizing environment, but provision of adequate staff support, mental health consultation, education and skills in managing mental health problems in these settings is important.

Adolescents' reactions to universal and indicated prevention programs for depression : perceived stigma and consumer satisfaction

There is a common view that one of the major considerations in selecting between universal and indicated interventions is the marked stigma produced by the latter. However, to date there has been no empirical examination of this assumption. The current study examined reported stigma and program satisfaction following two school-based interventions aimed at preventing depression in 532 middle adolescents. The interventions were conducted either across entire classes by classroom teachers (universal delivery) or in small high risk groups by mental health professionals (indicated delivery). The indicated delivery was associated with significantly greater levels of perceived stigma, but effect sizes were small and neither program was associated with marked stigma in absolute terms. Perceived stigma was more strongly associated with aspects of the individual including being male and showing greater externalizing symptomatology. In contrast, the indicated program was evaluated more positively by both participants and program leaders and effect sizes for these measures of satisfaction were moderate to large. The results point to the need for further empirical evaluation of both perceived stigma and program satisfaction in providing balanced considerations of the value of indicated and universal programs.

Drug-induced extrapyramidal reactions

Abstract: A child with psychotic symptoms and attention‐deficit hyperactivity disorder who developed extrapyramidal symptoms while on a combination of risperidone, methylphenidate, sertraline, tropisetron and ketorolac is described herein. The extrapyramidal symptoms resolved with the administration of benztropine, an anticholinergic drug. Successful treatment of his psychosis was achieved by decreasing the dose of risperidone, followed by slow upward titration.

Family matters: infants toddlers and preschoolers of parents affected by mental illness

One in five young people in Australia, including infants, toddlers and preschoolers, lives in a family with a parent with a mental illness.1 Families affected by mental illness are more likely than other families to experience poverty and social isolation,2 and are more likely to have children taken into care.3 A combination of factors influences the child’s risk of psychopathology. These include psychosocial adversity, the child’s developmental status and age, genetics, family relationships, the severity and chronicity of parental psychiatric disorder, comorbidity, and the involvement of other carers in the child’s life. Not all children whose parents have mental health problems will experience difficulties themselves.4 Parental diagnosis itself does not confer risk, and many parents with severe depression, schizophrenia and other disorders are adequate caregivers.5 Rather, it is the severity and chronicity of psychopathology and the variation in parental personality, genetic characteristics, coping style and social circumstances that confer risk. Children’s characteristics, such as temperament and sex, can also influence the parent–child relationship and parenting behaviour.6 This article outlines the impact of three key mental health disorders on parenting and young offspring, and describes implications for practice.

Supporting depressed mothers at home: their views on an innovative relationship-based intervention.

This study explored the responses of a group of 111 mothers who experienced distress and/or depression in the early months after childbirth and who received an innovative home visiting service until their child’s first birthday. The current study reports a thematic content analysis of the qualitative questionnaire responses returned by the mothers after completing the intervention. The mothers valued the home visiting program for its capacity to increase their parenting confidence and to enhance their bond to their infants. They attributed this to the reassurance provided by the program and the skills and qualities of the home visitors. Their responses complement the benefits identified in quantitative analysis of the program and demonstrate its impact from participants’ viewpoint.

Rural workforce development and staff support: remodelling service provision for early intervention in child and adolescent mental health

Objective: Through professional workforce development, focused clinical placements and local consultation this innovative project aimed to develop and evaluate a best practice staff-support model by strengthening a rural—urban partnership. To sustain the impact of the program, the project incorporated multilevel interventions (developing strategic partnerships and providing support to all levels of staff from management to front-line) and included multiple components (engaging media partnerships to boost community awareness, management briefings, staff education and training, consultative support and clinical placements) to reorient services, and the broader community, towards early intervention. Methods: Structured key informant interviews were conducted with rural mental health staff to evaluate outcomes of the clinical placements and consultation sessions. Evaluations of the education and training courses were also conducted. Results: At project commencement, 43% of the rural child and adolescent mental health staff reported good skills in the identification and treatment of depression and anxiety. Following the project, 86% of staff reported good to very good skills in these areas. Rural professionals reported greater work satisfaction and an increase in their skills and confidence. They also reported that their involvement had further enhanced their work practices in child and adolescent mental health. Conclusions: This collaborative project is an example of a best practice model for staff-support. It has developed workforce capacity to provide a range of early intervention initiatives and provided the consultative skills to initiate their implementation. Above all, the approach taken by the project is feasible. It is a replicable model that supports the orientation of rural mental health services towards early intervention.

The three year old social and emotional well-being check is good news.

Australian & New Zealand Journal of Psychiatry, 46(10) Minister for Mental Health and Ageing, Minister Assisting the Prime Minister on Mental Health Reform Mark Butler MP announced that the Healthy Kids Check (previously for four year olds) would be carried out at three years of age and include a social and emotional well-being component (Butler, 2011). It also assesses physical and oral health, growth, vision, hearing and development and is to be conducted in primary care by general practitioners, practice nurses and aboriginal health workers. One of the aims of this initiative is to provide opportunities for early intervention. Media outlets reported that its bad news (Hall, 2012; Dunlevy, 2012) and an alternative view was expressed (Goodfellow, 2012). In principle, checking social and emotional wellbeing in pre-schoolers is supported by the Royal Australian and New Zealand College of Psychiatrists (RANZCP, 2012), but there is a risk there will be some devil in the detail. Our New Zealand colleagues have some experience with this approach as the B4 school check (Health Department New Zealand, 2011) includes the use of a screening tool for social and emotional problems, the Strengths and Difficulties Questionnaire (Goodman et al., 2000).

A systems approach to enhance global efforts to implement family-focused mental health interventions

ABSTRACT This paper acknowledges progress over the last 20 years in addressing intergenerational risks to the mental health of children whose parents experience mental illness (COPMI-Children of Parents with a Mental Illness and FaPMI-Families Where a Parent Has a Mental Illness) and emphasises ongoing challenges to implement evidence informed family focused interventions. Challenges include variability in practice at individual, regional, and cross-national service system levels and the gap between implementation science and practice. This article begins to address this gap with descriptions of key systems approaches and implementation strategies from around the world to illustrate variability and common themes. A multifaceted, integrated systems approach is proposed as a way forward. Learnings and experience from initiatives, expertise and evidence targeting other vulnerable groups and successful change implementation will enhance existing (COPMI/FaPMI) efforts to facilitate systems change and improve the lives and futures of these children and families around the world.

Mental health professionals' family-focused practice with families with dependent children: A survey study

BackgroundMany people with a mental illness are parents caring for dependent children. These children are at greater risk of developing their own mental health concerns compared to other children. Mental health services are opportune places for healthcare professionals to identify clients’ parenting status and address the needs of their children. There is a knowledge gap regarding Thai mental health professionals’ family-focused knowledge and practices when working with parents with mental illness and their children and families.MethodsThis cross –sectional survey study examined the attitudes, knowledge and practices of a sample (n = 349) of the Thai mental health professional workforce (nurses, social workers, psychologists, psychiatrists) using a translated version of the Family-Focused Mental Health Practice Questionnaire (FFMHPQ).ResultsThe majority of clinicians reported no training in family (76.8%) or child-focused practice (79.7%). Compared to other professional groups, psychiatric nurses reported lower scores on almost all aspects of family-focused practice except supporting clients in their parenting role within the context of their mental illness. Social workers scored highest overall including having more workplace support for family-focused practice as well as a higher awareness of family-focused policy and procedures than psychiatrists; social workers also scored higher than psychologists on providing support to families and parents. All mental health care professional groups reported a need for training and inter-professional practice when working with families.ConclusionsThe findings indicate an important opportunity for the prevention of intergenerational mental illness in whose parents have mental illness by strengthening the professional development of nurses and other health professionals in child and family-focused knowledge and practice.