The Kimberley assessment of depression of older Indigenous Australians: prevalence of depressive disorders, risk factors and validation of the KICA-dep scale

Older Aboriginal and Torres Strait Islander People's Experiences With Hearing Loss and Audiological Services: A Scoping Review

INTRODUCTION

In Australia, older Aboriginal and Torres Strait Islander people have the highest prevalence of hearing loss, for which dedicated audiological services are available. However, there is limited research on the experiences older Aboriginal and Torres Strait Islander people have with hearing loss and audiological services. Therefore, this study aimed to consolidate existing literature with a scoping review, specifically on the above to identify gaps and guide future research.

METHOD

Ten databases, including electronic journal databases and government databases, were systematically searched. Additional studies were sought from article reference lists, review articles, conference abstracts and Google Scholar. We identified 540 records and 22 of them met our inclusion criteria. Our inclusion criteria constituted research of any design on the experiences of older Aboriginal and Torres Strait Islander people (aged 45+ years) with hearing loss and audiological services.

RESULTS

Seventeen studies reported on experiences with hearing loss, four studies reported on experiences with audiological services and one study reported on both experiences. Prevalence of hearing loss was estimated to be 20%-34% in older Aboriginal and Torres Strait Islander people; a discrepancy between self-reported and objective hearing difficulties was also identified. Audiological services currently available to older Aboriginal and Torres Strait Islander people were also underutilised.

CONCLUSIONS

Future research on older Aboriginal and Torres Strait Islander people is required to uncover: (1) the reasons for underreported hearing loss; (2) types of hearing loss experienced; (3) barriers to accessing audiological services; and (4) best hearing-loss management and rehabilitation practices.

The prevalence of falls and associated factors in older adults of the Torres Strait

OBJECTIVE

To assess the prevalence of falls and examine associations between falls and potential risk factors in older adults of the Torres Strait Region of Australia.

METHODS

Two hundred and fifty people aged ≥45 years residing in the Torres Strait, who identified as Torres Strait Islander, Aboriginal or both, were asked whether they had sustained any falls in the past year. Associations between self-reported falls and predictor variables were examined using logistic regression.

RESULTS

21% of participants reported at least one fall; 9% reported ≥2 falls. Participants who reported any falls in the past year were more than twice as likely to have urinary incontinence and poor mobility (p < .01) compared to participants who did not report any falls.

CONCLUSIONS

Around one in five respondents reported one or more falls in the past year, demonstrating that falls are a significant issue for older adults of the Torres Strait. Fall prevention strategies that are effective in other populations are likely to be beneficial to the region but need to be informed by local consultation and implemented in partnership with the people of the Torres Strait.

Co-Occurring Mental Health and Substance Use Research Among Aboriginal and Torres Strait Islander People: A Systematic Review

Objective: This systematic review describes studies focussed on co-occurring mental health and substance use (MH/SU) conditions among Aboriginal and Torres Strait Islander people, including the: characteristics; co-occurring conditions examined; cultural methodological quality; traditional scientific methodological quality of studies; and study outcomes. Methods: A systematic review examined the literature on co-occurring MH/SU conditions among Aboriginal and Torres Strait Islander people. Four databases were searched, with data from relevant studies extracted for narrative synthesis. Results: Twelve articles (11 studies) were included. Nine studies used cross-sectional designs; one was a qualitative study and one a mixed methods study with a nested randomized controlled trial. Cultural methodological quality was low across the studies, with a maximum of 7 out of 14 criteria met. Thirty-three combinations of co-occurring conditions were examined. Conclusion: Most research to date has been cross-sectional with limited research exploring the effectiveness of treatments for co-occurring MH/SU conditions. Further Indigenous-led research is needed to find culturally safe, responsive and effective solutions in reducing the burden associated with MH/SU conditions and improving wellbeing.

How First Nations peoples living in the Torres Strait and Northern Peninsula Area describe and discuss social and emotional well-being

OBJECTIVE

This study was the first phase of a broader project designed to develop a new tool to screen social and emotional well-being (SEWB). Its objective was to identify words used by First Nations people living in the Torres Strait (Zenadth Kes) and Northern Peninsula Area (NPA) to describe and discuss SEWB. We pay our respects to Elders past and present. We acknowledge the First Nations peoples who took part in this project as holders of their cultural knowledge now and forevermore.

SETTING

This study took place in community and primary health care settings located on islands of the Torres Strait and NPA of Australia.

PARTICIPANTS

Twelve yarns with 35 community members and health professionals were led by Torres Strait Islander members of the project team between August and December 2022.

DESIGN

This study employed a descriptive qualitative design. Yarning, an Australian First Nations relational method, was used to share stories about SEWB. All but one yarn was audio recorded and subsequently professionally transcribed. Inductive thematic analysis was used to analyse the yarns.

RESULTS

Worry, sad and stress were the words most often used by participants to describe feelings of low SEWB. Signs of low SEWB included behaviour change, particularly significantly reduced community engagement.

CONCLUSIONS

Worry is not a word that is used in Australian mainstream tools that screen for psychological distress. Findings of this study indicate that a question that asks about worries should be included when screening for low SEWB in Australian First Nations peoples living in the Torres Strait and NPA.

Community-based dementia risk management and prevention program for Aboriginal Australians (DAMPAA): a randomised controlled trial study protocol

INTRODUCTION

Aboriginal and Torres Strait Islander peoples are the First Peoples of Australia. Up to 45% of dementia in these populations is due to potentially modifiable risk factors. The Dementia Prevention and Risk Management Program for Aboriginal Australians (DAMPAA) is an Aboriginal Health Practitioner led programme that aims to reduce cognitive decline and functional impairment in older Aboriginal people.

METHODS

Design: DAMPAA is a multisite, randomised controlled trial aiming to deliver and evaluate a culturally appropriate risk factor management programme.

POPULATION

Community-dwelling Aboriginal people aged 45-90 years.

INTERVENTION

Participants will be randomly assigned to either usual care (control) or to a group programme comprising exercise and health education yarning sessions and pharmacist-delivered medication reviews delivered over a 12-month period.

PRIMARY OUTCOME

Cognitive function (Kimberley Indigenous Cognitive Assessment (KICA)-Cog score), daily function (KICA-Activities of Daily Living (ADL) score) and quality of life (Good Spirit, Good Life and EQ-5D-5L scores).

SECONDARY OUTCOMES

Process evaluation interviews, cardiovascular risk factors, falls and death. Process evaluation will be conducted with qualitative methods. Quantitative outcomes will be analysed with generalised linear mixed models.

ETHICS AND DISSEMINATION

The study was approved by the Western Australian Aboriginal Health Ethics Committee and the University of Western Australia Human Research Ethics Committee. Study results will be published in peer-reviewed journals and presented at scientific meetings. We will also develop and disseminate a comprehensive DAMPAA toolkit for health services. The study's findings will guide future prevention strategies and outline a comprehensive process evaluation that may be useful in other Aboriginal health research to contextualise findings.

Sensitivity and specificity of Aboriginal-developed items to supplement the adapted PHQ-9 screening measure for depression: results from the Getting it Right study

OBJECTIVE

To determine the psychometric properties of an Aboriginal and Torres Strait Islander-developed depressive symptom screening scale.

DESIGN

Prospective diagnostic accuracy study.

SETTING

Ten primary health care services or residential alcohol and other drug rehabilitation services in Australia that predominantly serve Aboriginal and Torres Strait Islander peoples.

PARTICIPANTS

500 adults (18 years or older) who identified as Aboriginal and/or Torres Strait Islander and were able to communicate sufficiently to respond to questionnaire and interview questions. Recruitment occurred between 25 March 2015 and 2 November 2016.

MAIN OUTCOME MEASURE

Criterion validity of seven Aboriginal and Torres Strait Islander-developed items, using the adapted Patient Health Questionnaire 9 (aPHQ-9) and depression module of the Mini International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standards.

RESULTS

The seven-item scale had good internal consistency (α = 0.83) and correlated highly with the aPHQ-9 (ρ = 0.76). All items were significantly associated with diagnosis of a current major depressive episode. Discriminant function and decision tree analysis identified three items forming a summed scale that classified 85% of participants correctly. These three items showed equivalent sensitivity and specificity to the aPHQ-9 when compared with the MINI-identified diagnosis of a current major depressive episode.

CONCLUSION

Three items developed by and for Aboriginal and Torres Strait Islander people may provide effective, efficient and culturally appropriate screening for depression in Aboriginal and Torres Strait Islander health care contexts.

Counting the Ways That Aboriginal and Torres Strait Islander Older People Participate in Their Communities and Culture

OBJECTIVES

This study aimed to determine the proportion of older Aboriginal and Torres Strait Islander peoples participating in cultural events and activities and determine the demographic and sociocultural characteristics associated with participation.

METHODS

The Australian Bureau of Statistics National Aboriginal and Torres Strait Islander Social Survey (2014-2015) was used to measure the prevalence of participation in cultural events and activities. Multivariate logistic regression models were used to measure associations. Sociocultural factors were selected by matching survey items to the 12 sociocultural factors described in the Good Spirit Good Life Framework, a culturally validated quality-of-life tool for older people.

RESULTS

The majority (62.0%) of survey respondents 45 years and older participated in cultural events (e.g., ceremonies, funerals/sorry business, NAIDOC week activities, sports carnivals, festivals/carnivals) or were involved in organizations. Many (58.5%) also participated in activities (e.g., fishing, hunting, gathering wild plants/berries, arts/crafts, music/dance/theater, writing/telling of stories). In regression models including demographic and cultural variables, participation in cultural events was highest among people living remotely (odds ratio [OR] = 2.71), reporting recognition of homelands (OR = 2.39), identifying with a cultural group (OR = 3.56), and those reporting having a say in their communities (OR = 1.57), with similar odds seen for participation in activities. Participation was inversely proportional to increasing age, with a greater proportion of females participating in events and males in activities.

DISCUSSION

The social lives of older Aboriginal and Torres Strait Islander people were characterized by widespread participation in cultural events and activities. These findings provide important insights into services as they support older people to live a good life.

A Delphi study and development of a social and emotional wellbeing screening tool for Australian First Nations Peoples living in the Torres Strait and Northern Peninsula Area of Australia

Tools screening depression and anxiety developed using the Western biomedical paradigm are still used with First Nations Peoples globally, despite calls for cross-cultural adaption. Recent work by this research team found that tools used to screen for depression and anxiety were inappropriate for use with Australian First Nations Peoples living in the Torres Strait and Northern Peninsula Area of Australia. The objective of this Delphi study, the second phase of a broader four-phase project, was to gain consensus from an expert mental health and/or social and emotional wellbeing (SEWB) panel to inform the development of an appropriate screening tool. This Delphi study took place between March and May 2023. Three sequential rounds of anonymous online surveys delivered using QualtricsTM were planned, although only two were needed to reach 75% consensus. The first round sought consensus on whether a new screening tool needed to be developed or whether existing tools could be used. The second round achieved consensus. Twenty-eight experts (47% response rate) participated across the two Delphi rounds. In the second round, 83% of these experts agreed or strongly agreed that a new screening tool, using the holistic First Nations concept of social and emotional wellbeing, be developed. Ninety-four percent of them agreed that it should take a Yarning approach. These findings enabled the development of a new SEWB screening tool that adopted a Yarning (narrative) approach designed for use in primary care and geriatric settings in the region. The new tool has four different Yarning areas: Community engagement and behaviour; Stress worries; Risk; and Feeling strong. Guidelines for tool use are integrated as well as Summary and Recommendation sections. At a macro-level this project responds to the need for new screening tools that are underpinned by First Nations worldviews.

Prevalence of functional limitations in older remote-living Aboriginal Australians

INTRODUCTION

To better tailor prevention and care strategies, there is a need to identify modifiable factors associated with functional impairment in older Aboriginal people, and related service needs.

OBJECTIVE

To investigate the prevalence and associated factors for functional impairment in older Aboriginal people, and related service needs.

DESIGN

Cross-sectional survey of 289 Aboriginal people aged ≥45 years living in the remote Kimberley region of Western Australia. Factors associated with functional impairment were explored with logistic regression.

FINDINGS

41.2% (95% CI 35.6%-47.0%) of participants required assistance with at least one I/ADL, and 26.0% (95% CI 21.2%-31.3%) required assistance with two or more I/ADLs. A core activity limitation (required assistance with showering, dressing or cooking) was reported by 15.9% (95% CI 12.1%-20.6%). In multivariable logistic regression analyses, older age, diabetes, difficulty walking, head injury, higher depression score and worse cognition were associated with needing help with two or more I/ADLs, while older age, history of stroke, higher depression score and worse cognition were associated with the presence of a core activity limitation. The proportion of participants receiving support with I/ADLs ranged from 71.2% to 97.6%. Support was generally provided by family and friends rather than service providers.

DISCUSSION

The key modifiable factors associated with functional impairment in older Aboriginal people living in remote regions are diabetes, depression and cognitive impairment. Services required are transport and socio-cultural activities, and ensuring support for family providing the majority of care.

CONCLUSIONS

This study highlights the need for holistic prevention strategies and care for older Aboriginal people with functional limitations and their families.

Depressive symptoms in the entire spectrum of cognitive ageing in Greece: evidence from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD)

OBJECTIVES

To study (i) the prevalence of mild and moderate-to-severe depressive symptoms in the entire spectrum of cognitive ageing in Greece and (ii) the relationship between these symptoms and demographic and clinical data.

METHODS

The study was based on the randomly selected cohort of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD). Depressive symptoms were assessed with the 15-item version of the Geriatric Depression Scale. Participants also received a comprehensive neuropsychological assessment, while the clinical diagnoses of dementia and mild cognitive impairment were established according to international diagnostic criteria. Statistical analyses relied on comparison tests and a logistic (proportional odds) ordinal regression model.

RESULTS

Depressive symptoms were detected in 19.5% of the 1936 study participants, while 11.3% of both people with MCI and dementia had moderate-to-severe depressive symptoms. The regression model revealed that older adults with more severe depressive symptoms were more likely female, cognitively impaired, less educated, were treated with psychotropic medication and lived in Attica versus Thessaly.

CONCLUSIONS

Since depressive symptoms were detected in almost one in five older adults, healthcare professionals in Greece should safeguard the timely detection and effective treatment of such symptoms and the post-diagnostic care of older adults with depression.

Developing an appropriate depression and anxiety screening tool for use with Australian First Nations peoples living in the Torres Strait and Northern Peninsula Area of Australia: Protocol for a Delphi study

Tools that screen for depression and anxiety developed using the Western biomedical paradigm are still used with First Nations peoples globally, despite calls for cross-cultural adaption. Recent work by the research team found that tools used to screen for depression and anxiety were not appropriate for use with Australian First Nations peoples living in the Torres Strait and Northern Peninsula Area (NPA). of Australia. Consequently, the objective of this Delphi study is to gain consensus from an expert mental health panel to inform the development of an appropriate depression and anxiety screening tool(s). A Delphi study with Australian expert panellists will be used to reach consensus about whether an existing screening tool should be used or whether adaption or new tool development should take place. Three sequential rounds of anonymous online surveys will be used to reach consensus. The first round will seek consensus about the tool(s). Subsequent rounds will seek consensus on the development of the tool(s) identified in round one. Panellists will be identified using a combination of authorship of related publications, established national clinical or research profile in First Nations mental health, and/or by peer referral. Consensus will be reached when 75% of the panel agree. When agreement is not reached suggestions will be taken to the next round. If agreement is not achieved by the third round, the Steering Committee will make any outstanding decisions. Dissemination of the findings through continuing community engagement, conference presentations and publications will be led by Torres Strait Islander members of the research team.

The methods of improving cultural sensitivity of depression scales for use among global indigenous populations: a systematic scoping review

Cultural adaptation of psychometric measures has become a process aimed at increasing acceptance, reliability, and validity among specific Indigenous populations. We present a systematic scoping review to: (1) identify the depression scales that have been culturally adapted for use among Indigenous populations worldwide, (2) globally report on the methods used in the cultural adaptation of those scales, and (3) describe the main features of those cultural adaptation methods. We included articles published from inception to April 2021, including 3 levels of search terms: Psychometrics, Indigenous, and Depression. The search was carried out in the Ovid Medline, PubMed, Embase, Global Health, PsycINFO, and CINAHL databases, following PRISMA guidelines. We identified 34 reports on processes of cultural adaptation that met the criteria. The scales were adapted for use among Indigenous populations from Africa, Australia, Asia, North America, and Latin America. The most common scales that underwent adaptation were the Patient Health Questionnaire (PHQ-9), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Edinburgh Postnatal Depression Scale (EPDS). Methods of adaptation involved a revision of the measures' cultural appropriateness, standard/transcultural translation, revision of the administration process, and inclusion of visual supports. Culturally safe administration of scales was reported in some studies. To come to a consensus on most appropriate methods of improving cultural safety of psychometric measurement, most studies utilized qualitative methods or mixed methods to understand the specific community's needs. Revision of linguistic equivalence and cultural relevance of content, culturally safe administration procedures, qualitative methods, and participatory research were key features of developing safe culturally adapted measures for depressive symptoms among Indigenous populations. While for comparability, uniform scales would be ideal as mental health evaluations, an understanding of the cultural impact of measurements and local depression expressions would benefit the process of developing culturally sensitive psychometric scales. PROSPERO registration ID: CRD42023391439.

Safe and valid? A systematic review of the psychometric properties of culturally adapted depression scales for use among Indigenous populations

Background

Implementing culturally sensitive psychometric measures of depression may be an effective strategy to improve acceptance, response rate, and reliability of psychological assessment among Indigenous populations. However, the psychometric properties of depression scales after cultural adaptation remain unclear.

Methods

We screened the Ovid Medline, PubMed, Embase, Global Health, PsycInfo, and CINAHL databases through three levels of search terms: Depression, Psychometrics, and Indigenous, following the PRISMA guidelines. We assessed metrics for reliability (including Cronbach's alpha), validity (including fit indices), and clinical utility (including predictive value).

Results

Across 31 studies included the review, 13 different depression scales were adapted through language or content modification. Sample populations included Indigenous from the Americas, Asia, Africa, and Oceania. Most cultural adaptations had strong psychometric properties; however, few and inconsistent properties were reported. Where available, alphas, inter-rater and test-retest reliability, construct validity, and incremental validity often indicated increased cultural sensitivity of adapted scales. There were mixed results for clinical utility, criterion validity, cross-cultural validity, sensitivity, specificity, area under the receiver operating characteristic curve, predictive value, and likelihood ratio.

Conclusions

Modifications to increase cultural relevance have the potential to improve fit and acceptance of a scale by the Indigenous population, however, these changes may decrease specificity and negative predictive value. There is an urgent need for suitable tools that are useful and reliable for identifying Indigenous individuals for clinical treatment of depression. This awaits future work for optimal specificity and validated cut-off points that take into account the high prevalence of depression in these populations.

Approaches to the development of new screening tools that assess distress in Indigenous peoples: A systematic mixed studies review

This mixed studies review assessed the extent of the literature related to approaches used to develop new tools that screen for distress in Indigenous adults globally. It answered the research question: What qualitative and quantitative approaches are used to develop new screening tools that assess distress in Indigenous peoples globally? CINAHL, Embase, Emcare, Medline, PsychInfo and Scopus databases were systematically searched to identify relevant articles published between January 2000 and February 2023. Articles describing the development of a new screening tool for Indigenous peoples, globally, published in English since 2000 and constituted a full publication of primary research, met the inclusion criteria. Studies underwent quality appraisal using the Mixed-Methods Appraisal Tool. A sequential exploratory design guided data analysis. Synthesis occurred using a two-phase sequential method. Nineteen articles constituted the data set. Articles described the use of qualitative, quantitative, or mixed methods in approximately equal numbers. Overall, qualitative methods were used in early stages of tool development, with mixed and quantitative methods used to pilot and validate them. However, most studies did not follow the theoretical guidelines for tool development, and while validation studies took place in over half of the data set, none adequately assessed construct validity. Sixty percent of the articles were located using citation searches, which suggests database searches were ineffective. Valid tools that screen for distress in Indigenous populations support equitable access to health care. This review found that most screening tools were developed in Australia. However, additional evidence of their validity is needed in addition to a valid diagnostic tool that supports the determination of criterion validity. These needs present important future research opportunities.

Erratum: Potentially preventable dementia in a First Nations population in the Torres Strait and Northern Peninsula Area of North Queensland, Australia: a cross sectional analysis using population attributable fractions

[This corrects the article DOI: 10.1016/j.lanwpc.2023.100855.][This corrects the article DOI: 10.1016/j.lanwpc.2022.100532.].

Screening depression and anxiety in Indigenous peoples: A global scoping review

Indigenous peoples' worldviews are intricately interconnected and interrelated with their communities and the environments in which they live. Their worldviews also manifest in a holistic view of health and well-being, which contrasts with those of the dominant western biomedical model. However, screening depression and/or anxiety in Indigenous peoples often occurs using standard western tools. Understandably, the cultural appropriateness of these tools has been questioned. The purpose of this scoping review was to map the literature that used any type of tool to screen depression or anxiety in Indigenous adults globally. A systematic scoping review method was used to search databases including, but not limited to, CINAHL, PubMed, Scopus and Google. Database-specific search terms associated with Indigenous peoples, depression and anxiety, and screening tools were used to identify literature. In addition, citation searches of related systematic reviews and relevant websites were conducted. The data set was limited to English language publications since database inception. Fifty-four publications met the review's inclusion criteria. Most studies were completed in community settings using standard western depression and anxiety screening tools. Thirty-three different tools were identified, with the Patient Health Questionnaire-9 being the most frequently used. The review's findings are concerning given repeated calls for culturally appropriate screening tools to be used with Indigenous peoples. Although there has been some work to cross-culturally adapt depression screening tools for specific Indigenous populations, clearly more clinicians and researchers need to be aware of, and use, culturally appropriate approaches to screening.

Dementia Risk Models in an Australian First Nations Population: Cross-Sectional Associations and Preparation for Follow-Up

Background

Reducing the burden of dementia in First Nations populations may be addressed through developing population specific methods to quantify future risk of dementia.

Objective

To adapt existing dementia risk models to cross-sectional dementia prevalence data from a First Nations population in the Torres Strait region of Australia in preparation for follow-up of participants. To explore the diagnostic utility of these dementia risk models at detecting dementia.

Methods

A literature review to identify existing externally validated dementia risk models. Adapting these models to cross-sectional data and assessing their diagnostic utility through area under the receiver operating characteristic curve (AUROC) analyses and calibration using Hosmer-Lemeshow Chi².

Results

Seven risk models could be adapted to the study data. The Aging, Cognition and Dementia (AgeCoDe) study, the Framingham Heart Study (FHS), and the Brief Dementia Screening Indicator (BDSI) had moderate diagnostic utility in identifying dementia (i.e., AUROC >0.70) before and after points for older age were removed.

Conclusion

Seven existing dementia risk models could be adapted to this First Nations population, and three had some cross-sectional diagnostic utility. These models were designed to predict dementia incidence, so their applicability to identify prevalent cases would be limited. The risk scores derived in this study may have prognostic utility as participants are followed up over time. In the interim, this study highlights considerations when transporting and developing dementia risk models for First Nations populations.

Depression, childhood trauma, and physical activity in older Indigenous Australians

OBJECTIVES

Indigenous Australians experience higher levels of psychological distress compared to the general population. Physical activity is a culturally acceptable approach, associated with reduction of depressive symptoms. The protective properties of physical activity for depressive symptoms are yet to be evaluated in older Indigenous Australians.

DESIGN

A two-phase study design comprised of a qualitative thematic analysis following a quantitative regression and moderation analysis.

PARTICIPANTS

Firstly, a total of 336 Indigenous Australians aged 60 years and over from five NSW areas participated in assessments on mental health, physical activity participation, and childhood trauma. Secondly, a focus group of seven Indigenous Australians was conducted to evaluate barriers and facilitators to physical activity.

MEASUREMENTS

Regression and moderation analyses examined links between depression, childhood trauma, and physical activity. Thematic analysis was conducted exploring facilitators and barriers to physical activity following the focus group.

RESULTS

Childhood trauma severity and intensity of physical activity predicted depressive symptoms. Physical activity did not affect the strength of the relationship between childhood trauma and depression. Family support and low impact activities facilitated commitment to physical activity. In contrast, poor mental health, trauma, and illness acted as barriers.

CONCLUSION

Physical activity is an appropriate approach for reducing depressive symptoms and integral in maintaining health and quality of life. While situational factors, health problems and trauma impact physical activity, accessing low-impact group activities with social support was identified to help navigate these barriers.

Culturally Appropriate Assessment of Depression and Anxiety in Older Torres Strait Islanders: Limitations and Recommendations

OBJECTIVES

The aim of the study was to assess the prevalence of anxiety and depression in older Aboriginal and Torres Strait Islander adults.

METHODS

A modified version of the PHQ-9 (KICA-dep) and the Geriatric Anxiety Inventory (GAI) were administered as part of a wider dementia prevalence study conducted in the Torres Strait. Results were compared to diagnoses obtained on Geriatric review to evaluate their applicability in the region.

RESULTS

A total of 236 participants completed the KICA-dep and 184 completed the GAI short form. Of these, 10.6% were identified with depression and 15.8% with anxiety. Some participants found questions about suicide ideation and self-harm offensive and others had difficulty understanding concepts on the GAI. The KICA-dep performed poorly in comparison to diagnosis on geriatric clinical review, so results are unlikely to reflect the true prevalence of depression in the region.

CONCLUSIONS

Further research is required to explore the underlying dimensions of depression and anxiety and terminology used to express mood symptoms in the Torres Strait.

CLINICAL IMPLICATIONS

• Current mental health screening tools are not applicable for the Torres Strait• More work is required to determine how symptoms of depression and anxiety are expressed within Torres Strait communities.

Prevalence of depressive symptoms and their associated factors among older adults in Yirgalem town, Southern Ethiopia: A community-based cross-sectional study

Background

Depression is a serious mental health issue and the largest contributor to disability worldwide. Elderly people with depression are significantly more likely to experience negative outcomes such as poor physical health, strained social relationships, and decreased quality of life. Studies on geriatric depression are limited in developing nations like Ethiopia.

Objectives

The purpose of this study was to determine the prevalence of depressive symptoms and associated factors among older adults in Yirgalem, Southern Ethiopia, in 2022.

Methods

A community-based cross-sectional study was conducted on a sample of 628 older adults in Yirgalem town from May 15 to June 15, 2022. The study subjects were selected using a multi-stage systematic sampling technique. Data were collected using the 15-item Geriatric depression scale through face-to-face interviews. The collected data were edited, cleaned, coded, and entered into Epi data version 4.6 software and analyzed using STATA version 14. Bivariable and multivariate logistic regression analysis was computed to identify factors associated with depression, and statistical significance was declared at a 95% confidence interval with a P-value less than 0.05.

Results

A total of 620 older adults were included in the study, with a response rate of 97.8%. The prevalence of depressive symptoms among older adults was 51.77% (95% CI: 47.83-55.69). Being a woman (AOR = 2.3, 95% CI: 1.56-3141); being of more advanced age: 70-79 years old (AOR = 1.92, 95% CI: 1.20-3.07), 80-89 years old (AOR = 2.15, 95% CI: 1.27-3.65), 90 and older (AOR = 3.77, 95% CI: 1.95-7.79); living alone (AOR = 1.99, 95% CI = 1.17-3.41); having a chronic illness (AOR = 3.24, 95% CI: 1.06-4.46); having anxiety (AOR = 3.40; 95% CI: 2.25-5.14); and having poor social support (AOR = 3.56, 95% CI: 2.09-6.04) were statistically associated with depressive symptoms at a P-value of less than 0.05.

Conclusion

This study found that depression affects more than half of the elderly residents in the study area. More advanced age, being a woman, living alone, having a chronic illness, having anxiety, and having poor social support were all strongly linked to depression. There is a need to integrate counseling and psychiatric services into the community healthcare system.

How Australian First Nations peoples living in the Torres Strait and Northern Peninsula Area of Australia describe and discuss social and emotional well-being: a qualitative study protocol

INTRODUCTION

Colonisation has, and continues to, negatively impact the mental well-being of Australia's First Nations peoples. However, the true magnitude of the impact is not known, partially because clinicians have low levels of confidence in using many existing screening tools with First Nations clients. In addition, many authors have critiqued the use of tools designed for Western populations with First Nations peoples, because their worldview of health and well-being is different. Therefore, the aim of the overarching study is to develop an appropriate mental well-being screening tool(s) for older adults (aged 45 and over) living in the Torres Strait that can be used across primary health and geriatric settings. This protocol describes the first phase designed to achieve the overarching aim-yarning about social and emotional well-being (inclusive of mental well-being) in First Nations peoples living in the Torres Strait and Northern Peninsula Area of Australia.

METHOD AND ANALYSIS

The study will be guided by decolonising and participatory action research methodologies. Yarning is an Australian First Nations relational method that relies on storytelling as a way of sharing knowledge. Yarning circles will be conducted with community members and health and aged care workers living on six different island communities of the Torres Strait. Participants will be recruited using purposive sampling. Thematic analysis of the data will be led by Torres Strait Islander members of the research team.

ETHICS AND DISSEMINATION

The Far North Queensland, Human Research Ethics Committee (HREC) (HREC/2021/QCH/73 638-1518) and James Cook University HREC (H8606) have approved this study. Dissemination of study findings will be led by Torres Strait members of the research team through conferences and peer-reviewed publications.

Potentially preventable dementia in a First Nations population in the Torres Strait and Northern Peninsula Area of North Queensland, Australia: A cross sectional analysis using population attributable fractions

Background

Dementia is highly prevalent among Australia's First Nations peoples, including Torres Strait Islander and Aboriginal peoples in Far North Queensland (FNQ). It is likely that historically recent exposure to modifiable risk factors underlies these rates, and a large proportion of dementia may be potentially preventable.

Methods

Data from two adult community health checks (2015-2018) were analyzed to determine the prevalence of 11 modifiable dementia risk factors among the First Nations residents of the Torres Strait and Northern Peninsula Area of FNQ. Population attributable fractions (PAF%) for dementia were calculated using age-standardized prevalence estimates derived from these health checks and relative risks obtained from previous meta-analyses in other populations. PAF% estimates were weighted for communality to account for overlap of risk factors.

Findings

Half (52·1%) of the dementia burden in this population may be attributed to 11 potentially modifiable risk factors. Hypertension (9·4%), diabetes mellitus (9·0%), obesity (8·0%), and smoking (5·3%) were the highest contributing risk factors. The contribution of depression (2·0%) and alcohol (0·3%) was lower than other global and national estimates. While the adjusted PAF% for social isolation was low based on the adult community health check data (1·6%), it was higher (4·2%) when official census data were analyzed.

Interpretation

These results suggest that a substantial proportion of dementia in FNQ First Nations peoples could potentially be prevented. Government investment in preventative health now is essential to reduce the future burden of dementia.

Funding

National Health and Medical Research Council (NHMRC, GNT1107140, GNT1191144, GNT1106175, GNT0631947).

Approaches to the development of new mental well-being screening tools for Indigenous peoples: a systematic mixed studies review protocol

INTRODUCTION

Indigenous peoples' world views are intricately interrelated and interconnected with those of their communities and the environments where they live. Consequently, Indigenous peoples have a holistic view of their health, which contrasts with the dominant Western biomedical paradigm. However, the mental well-being of Indigenous peoples is predominately screened using tools developed using the Western paradigm that may not be culturally appropriate. The objective of this systematic mixed studies review (SMSR) is to assess the extent of the literature related to approaches used to develop new tools to screen the mental well-being of Indigenous adults.

METHODS AND ANALYSIS

This SMSR will be conducted in accordance with the method proposed by Pluye et al. It will include studies that describe the development of any type of tool or approach to screen for mental well-being in Indigenous adults, globally. Searches will be limited to the English language and literature published since January 2000. Databases to be searched include: CINAHL, Medline, PsycINFO, PubMed and Scopus. Only published studies will be included in the SMSR. Data that answers the research questions will be extracted from the literature and recorded on the associated data charting form. A sequential synthesis method will be used to analyse data from qualitative, quantitative and mixed-method studies. Data will be presented graphically, diagrammatically or in tabular form depending on what approach best conveys its meaning.

ETHICS AND DISSEMINATION

The SMSR will describe the approach to developing new tools for screening the mental well-being of Indigenous peoples across the globe. It will support researchers, clinicians and practitioners to consider both their approach to new tool development or, if they are using a previously developed tool, how reliable and valid it is for the population that they intend to use it with. Peer-reviewed publications will be used to disseminate SMSR findings.

"It's what makes us unique": Indigenous Australian perspectives on genetics research to improve comorbid mental and chronic disease outcomes

BACKGROUND

The role of personalized treatment approaches, including those based on genetic testing, are increasingly enabling informed decision-making to improve health outcomes. Research involving Indigenous Australians has been lagging behind, although this population experiences a higher prevalence of chronic disease and mental health disorders.

METHODS

Using community-based participatory research principles, this study purposefully interviewed participants with a diagnosed common mental disorder and a comorbid chronic disease condition. This was an inductive thematic analysis on semi-structured interviews with consenting participants (n = 48). Common themes and analytical domains were identified that provided a semantic understanding shared by participants.

RESULTS

Five emerging themes were identified, primarily focusing on: (1) The perceptions and understanding of genetics research; (2) culturally appropriate conduct of genetics research; (3) the role of indigenous-led genetics research; (4) future prospects of genetics research; and (5) the importance of genetics research for patients with mental and physical health comorbidities.

CONCLUSION

Indigenous Australians are under-represented in pharmacogenomics research despite well-documented epidemiological research demonstrating that Indigenous people globally experience greater risk of developing certain chronic diseases and more severe disease progression. Positive outcomes from this study highlight the importance of not only involving Indigenous participants, but providing leadership and governance opportunities for future genetics research.

Factors associated with the increased risk of dementia found in the Torres Strait

OBJECTIVE

To identify the specific risk factors for dementia in the Torres Strait.

METHODS

This research was conducted as part of a cross-sectional dementia prevalence study conducted in the Torres Strait. Participants underwent a comprehensive health assessment, where data on risk factors were collected, and a Geriatrician assessment, which was used to establish dementia diagnoses.

RESULTS

A total of 276 Torres Strait residents aged between 45 and 93 participated in the study. Cerebrovascular disease, chronic kidney disease and older age were the most significant risk factors in this population. Once adjusted for age, cerebrovascular disease, chronic kidney disease, diabetes, low education and problems with mobility and incontinence were significantly associated with dementia.

CONCLUSIONS

Reducing dementia risk in the Torres Strait requires multifactorial interventions to address potentially modifiable risk factors with a particular focus on addressing the development of chronic midlife diseases.

Prevalence and determinants of depression among old age: a systematic review and meta-analysis

BACKGROUND

Depression is a leading cause of disability worldwide and is a major contributor to the overall global burden of disease. It is also one of the most common geriatric psychiatric disorders and a major risk factor for disability and mortality in elderly patients. Even though depression is a common mental health problem in the elderly population, it is undiagnosed in half of the cases. Several studies showed different and inconsistent prevalence rates in the world. Hence, this study aimed to fill the above gap by producing an average prevalence of depression and associated factors in old age.

OBJECTIVE

This study aims to conduct a systematic review and meta-analysis to provide a precise estimate of the prevalence of depression and its determinants among old age.

METHOD

A comprehensive search of PubMed, Scopus, Web of sciences, Google Scholar, and Psych-info from database inception to January 2020. Moreover, the reference list of selected articles was looked at manually to have further eligible articles. The random-effects model was employed during the analysis. Stata-11 was used to determine the average prevalence of depression among old age. A sub-group analysis and sensitivity analysis were also run. A graphical inspection of the funnel plots and Egger's publication bias plot test were checked for the occurrence of publication bias.

RESULT

A search of the electronic and manual system resulted in 1263 articles. Nevertheless, after the huge screening, 42 relevant studies were identified, including, for this meta-analysis, n = 57,486 elderly populations. The average expected prevalence of depression among old age was 31.74% (95% CI 27.90, 35.59). In the sub-group analysis, the pooled prevalence was higher among developing countries; 40.78% than developed countries; 17.05%), studies utilized Geriatrics Depression Scale-30(GDS-30); 40.60% than studies that used GMS; 18.85%, study instrument, and studies having a lower sample size (40.12%) than studies with the higher sample; 20.19%.

CONCLUSION

A high prevalence rate of depression among the old population in the world was unraveled. This study can be considered as an early warning and advised health professionals, health policymakers, and other pertinent stakeholders to take effective control measures and periodic care for the elderly population.

The risk of common mental disorders in Indigenous Australians experiencing traumatic life events

Background

Experiencing traumatic life events is associated with an increased risk of common mental disorders (CMDs), but studies investigating this association within Indigenous populations are limited.

Aims

The aim of this study was to investigate associations between trauma and CMDs after controlling for other exposures.

Method

Trauma exposures and CMD diagnoses were determined in a broadly representative sample of 544 Indigenous Australians, using a diagnostic clinical interview. Associations were determined by multivariate logistic regression.

Results

Trauma exposure independently predicted CMDs. After adjustment for potential confounders, trauma exposure was associated with a 4.01-fold increased risk of a diagnosis of a CMD in the past 12 months. The increased risks were 4.38-, 2.65- and 2.78-fold of having an anxiety disorder, mood disorder or a substance use disorder, respectively. Trauma exposure and comorbid post-traumatic stress disorder was associated with a 4.53-fold increased risk of a diagnosis of a mood disorder, 2.47-fold increased risk of a diagnosis of a substance use disorder, and 3.58-fold increased risk of any diagnosis of a CMD, in the past 12 months. Experiencing both sexual and physical violence was associated with a 4.98-fold increased risk of a diagnosis of an anxiety disorder in the past 12 months.

Conclusions

Indigenous Australians experience significantly increased exposure to potentially harmful trauma compared with non-Indigenous Australians. Preventing and healing trauma exposure is paramount to reduce the high burden of CMDs in this population.

A community-led design for an Indigenous Model of Mental Health Care for Indigenous people with depressive disorders

OBJECTIVE

To generate outcomes for the development of a culturally appropriate mental health treatment model for Indigenous Australians with depression.

METHODS

Three focus group sessions and two semi-structured interviews were undertaken over six months across regional and rural locations in South West Queensland. Data were transcribed verbatim and coded using manual thematic analyses. Transcripts were thematically analysed and substantiated. Findings were presented back to participants for authenticity and verification.

RESULTS

Three focus group discussions (n=24), and two interviews with Elders (n=2) were conducted, from which six themes were generated. The most common themes from the focus groups included Indigenous autonomy, wellbeing and identity. The three most common themes from the Elder interviews included culture retention and connection to Country, cultural spiritual beliefs embedded in the mental health system, and autonomy over funding decisions.

CONCLUSIONS

A treatment model for depression must include concepts of Indigenous autonomy, identity and wellbeing. Further, treatment approaches need to incorporate Indigenous social and emotional wellbeing concepts alongside clinical treatment approaches. Implications for public health: Any systematic approach to address the social and cultural wellbeing of Indigenous peoples must have a community-led design and delivery.

Prevalence and sites of pain in remote-living older Aboriginal Australians, and associations with depressive symptoms and disability

BACKGROUND

Pain is a growing public health problem associated with significant health and functional implications. Limited data exist for Aboriginal Australians.

AIMS

To describe the prevalence, severity and sites of pain, analgesic use and associated factors, including depression and disability, in remote-living Aboriginal Australians.

METHODS

Cross-sectional study of 263 Aboriginal Australians aged ≥45 years from six remote Indigenous communities and the town of Derby in the Kimberley region of Western Australia between 2011 and 2013. Pain was assessed using a culturally adapted pain scale. Factors associated with pain were investigated with binary logistic regression.

RESULTS

One hundred and seventy (64.6%) participants reported having pain and 53 (20.2%) reported persistent pain. Of those reporting pain, 61 (35.9%) rated it as moderate and 70 (41.2%) as severe. The most common sites of pain were back and knee, and 38 (22.4%) participants with pain indicated three or more sites of pain. Only 70 (41.2%) participants with pain were on some type of analgesic medication. After adjustment, poor vision (odds ratio (OR) = 2.21; 95% confidence interval (CI) 1.22-4.00), hypertension (OR = 1.89; 95% CI 1.03-3.45) and heart problems (OR = 2.05; 95% CI 1.01-4.14) were associated with pain. Higher depression scores were associated with more persistent pain, but pain was not significantly associated with clinically relevant depressive symptoms, or requiring assistance with two or more personal and/or instrumental activities of daily living.

CONCLUSION

High levels of pain were reported, although the prevalence of persistent pain was comparable to the general population. Identifying risk factors, improving pain recognition and assessment and evaluating culturally tailored management approaches should be a priority.

The outcomes of a person-centered, non-pharmacological intervention in reducing agitation in residents with dementia in Australian rural nursing homes

BACKGROUND

There is limited best- practice evidence to address behavioral and psychiatric symptoms for those with dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, 'Harmony in the Bush', based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia.

METHODS

A quasi-experimental (nonrandomized, pre-post) intervention study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focused on the theory of the Progressively Lowered Stress Threshold principles and delivery of person-centered care plan with integrated music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff's caregiving stress, using Caregivers Stress Inventory. This study adheres to the CONSORT guidelines.

RESULTS

Mean age of residents with dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was similar reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency.

CONCLUSIONS

The Harmony in the Bush model is effective in reducing agitation among dementia residents with significant reduction in staff stress levels in nursing homes in rural Australia.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458.

The Social Gradient in Mental Health and Well-Being for Indigenous Older Adults Living in Rural Areas: A Cross-Sectional Comparison With Rural Non-indigenous Population in Chile

Objectives: To compare differences in depression, loneliness and personal well-being in a sample made up of indigenous (Aymara and Mapuche) and non-indigenous older people resident in original rural territories. Methods: A cross-sectional study involving 800 older adults living in a rural context in Chile, of whom 201 were Aymara, 368 Mapuche and 231 non-indigenous. Validated instruments were included for depression, loneliness and personal well-being (outcome variables). Ordinary least squares regression analyses were performed. Results: Membership of an indigenous group was significantly associated with lower scores for depression and loneliness and higher scores for personal well-being. The interactions of severe deprivation and housing deprivation with indigenous group membership were significantly associated with lower loneliness scores and higher personal well-being scores for Aymara and Mapuche participants. Discussion: Native rural settings and territories may offer a degree of protection to indigenous peoples. Cultural continuity enhanced by rural areas would produce a culturally constructed resilience against deprivation.

Developing the Canadian Indigenous Cognitive Assessment for Use With Indigenous Older Anishinaabe Adults in Ontario, Canada

Background and Objectives

Dementia is a growing public health issue for aging Indigenous populations. Current cognitive assessments present varying degrees of cultural, educational, and language bias, impairing their application in Indigenous communities. Our goal is to provide Anishinaabe communities in Canada with a brief cognitive test that can be administered within the community setting by community health workers or professionals. The purpose of this study was to adapt the Kimberly Indigenous Cognitive Assessment (KICA) for use as a brief cognitive test with Anishinaabe populations in Canada.

Research Design and Methods

We used a community-based participatory research approach coupled with two-eyed seeing to provide an equitable space for Indigenous knowledge. Adaptation of the KICA was accomplished over 22 months using an iterative cycle of monthly consultations between an 11-member expert Anishinaabe language group (EALG) and the investigators, with ad hoc consultations with an Indigenous Elder, a community advisory council, and the KICA authors. Face validity was established with two pilot studies using cognitive interviewing with Indigenous older adults (n = 15) and a focus group consultation with local health professionals (n = 7).

Results

Each question of the KICA was scrutinized by the EALG for cultural appropriateness, language and translation, and cultural safety. Every domain required adaptation to reflect cultural values, specificity of language, tone, and a culturally safe approach. Orientation, verbal comprehension and fluency, praxis, and naming domains required the most adaptations. The first pilot for face validity resulted in additional changes; the second confirmed satisfactory adaptation of all changes.

Discussion and Implications

The research resulted in the new Canadian Indigenous Cognitive Assessment. The findings reveal important cultural and linguistic considerations for cross-cultural cognitive assessment in Indigenous contexts. This new culturally appropriate and safe brief cognitive test may improve case finding accuracy and lead to earlier diagnosis and improved dementia care for Indigenous peoples.

Multi-ethnic validation of 15-item Geriatric Depression Scale in Chile

Background

There has been scant research published regarding the assessment of depression in ethnic groups, and few studies have addressed the validation of scales for standardized assessment of depressive symptoms among indigenous minorities.

Objective

The aim of this study was to analyze the psychometric properties of the 15-item Geriatric Depression Scale (GDS-15) for a multi-ethnic sample of older Chilean adults.

Methods

Cross-sectional study with a sample of 800 older people, 71% of whom were self-declared indigenous (Aymara/Mapuche).

Results

The non-indigenous group had a higher total GDS-15 score and lower quality of life and wellbeing scores than the indigenous groups (p < 0.001). The GDS-15 had a KR-20 coefficient of 0.90 for the non-indigenous group, 0.80 for Aymara, and 0.85 for Mapuche. The homogeneity index was 0.38 for non-indigenous, 0.24 for Aymara, and 0.29 for Mapuche.

Discussion

The GDS-15 showed satisfactory psychometric characteristics for the samples studied. However, the better results observed for the non-indigenous group suggest that some characteristics and content of the rating scale are not fully appropriate for the indigenous older population.

Conclusions

There is a need to develop the transcultural validation of scales such as GDS-15, which are applied in a standardized manner in geriatric evaluations as part of primary healthcare.

Let's CHAT (community health approaches to) dementia in Aboriginal and Torres Strait Islander communities: protocol for a stepped wedge cluster randomised controlled trial

BACKGROUND

Documented rates of dementia and cognitive impairment not dementia (CIND) in older Aboriginal and Torres Strait Islander Peoples is 3-5 times higher than the rest of the population, and current evidence suggests this condition is under-diagnosed and under-managed in a clinical primary care setting. This study aims to implement and evaluate a culturally responsive best practice model of care to optimise the detection and management of people with cognitive impairment and/or dementia, and to improve the quality of life of carers and older Aboriginal and Torres Islander Peoples with cognitive impairment.

METHODS/DESIGN

The prospective study will use a stepped-wedge cluster randomised controlled trial design working with 12 Aboriginal Community Controlled Health Services (ACCHSs) across four states of Australia. Utilising a co-design approach, health system adaptations will be implemented including (i) development of a best practice guide for cognitive impairment and dementia in Aboriginal and Torres Strait Islander communities (ii) education programs for health professionals supported by local champions and (iii) development of decision support systems for local medical software. In addition, the study will utilise a knowledge translation framework, the Integrated Promoting Action on Research Implementation in Health Services (iPARIHS) Framework, to promote long-term sustainable practice change. Process evaluation will also be undertaken to measure the quality, fidelity and contextual influences on the outcomes of the implementation. The primary outcome measures will be rates of documentation of dementia and CIND, and evidence of improved management of dementia and CIND among older Indigenous peoples attending Aboriginal and Torres Strait Islander primary care services through health system changes. The secondary outcomes will be improvements to the quality of life of older Indigenous peoples with dementia and CIND, as well as that of their carers and families.

DISCUSSION

The Let's CHAT Dementia project will co-design, implement and evaluate a culturally responsive best practice model of care embedded within current Indigenous primary health care. The best practice model of care has the potential to optimise the timely detection (especially in the early stages) and improve the ongoing management of people with dementia or cognitive impairment.

TRIAL REGISTRATION

ACTRN12618001485224. Date of registration: 04 of September 2019.

Process evaluation of the Getting it Right study and acceptability and feasibility of screening for depression with the aPHQ-9

BACKGROUND

The Getting it Right study determined the validity, sensitivity, specificity and acceptability of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) people. In this process evaluation we aimed to explore staff perceptions about whether Getting it Right was conducted per protocol, and if the aPHQ-9 was considered an acceptable and feasible screening tool for depression in primary healthcare. This process evaluation will provide information for clinicians and policy makers about the experiences of staff and patients with Getting it Right and what they thought about using the aPHQ-9.

METHODS

Process evaluation using grounded theory approaches. Semi-structured interviews with primary healthcare staff from services participating in Getting it Right were triangulated with feedback (free-text and elicited) from participants collected during the validation study and field notes. Data were thematically analysed according to the Getting it Right study protocol to identify the acceptability and feasibility of the aPHQ-9.

RESULTS

Primary healthcare staff (n = 36) and community members (n = 4) from nine of the ten participating Getting it Right services and Indigenous participants (n = 500) from the ten services that took part. Most staff reported that the research was conducted according to the study protocol. Staff from two services reported sometimes recruiting opportunistically (rather than recruiting consecutive patients attending the service as outlined in the main study protocol), when they spoke to patients who they knew from previous interactions, because they perceived their previous relationship may increase the likelihood of patients participating. All Getting it Right participants responded to at least six of the seven feedback questions and 20% provided free-text feedback. Most staff said they would use the aPHQ-9 and most participants said that the questions were easy to understand (87%), the response categories made sense (89%) and that they felt comfortable answering the questions (91%).

CONCLUSION

Getting it Right was predominantly conducted according to the study protocol. The aPHQ-9, the first culturally adapted, nationally validated, freely available depression screening tool for use by Indigenous people, appears to be acceptable and feasible to use.

TRIAL REGISTRATION

Australian New Zealand Clinical Trial Registry ANZCTR12614000705684 , 03/07/2014.

Potentially suboptimal prescribing of medicines for older Aboriginal Australians in remote areas

OBJECTIVES

To investigate the prevalence of polypharmacy, under-prescribing and potentially inappropriate medicine use among Aboriginal Australians living in remote Western Australia.

DESIGN

Cross-sectional study.

SETTING

Six remote communities and the town of Derby in the Kimberley, Western Australia.

PARTICIPANTS

Aboriginal people aged 45 years or more with complete medication histories.

MAIN OUTCOME MEASURES

Proportions of patients with medicine histories indicating polypharmacy, potential under-prescribing of indicated medicines, or potentially inappropriate prescribing (including potential prescribing cascades or drug interactions).

RESULTS

Complete medicine histories were available for 273 participants. The mean number of prescribed medicines was 5.1 (SD, 3.6). At least one form of suboptimal prescribing was identified for 166 participants (61%), including polypharmacy for 145 (53%), potential under-prescribing of at least one indicated medicine for 33 (12%), and potentially inappropriate prescribing for 54 participants (20%). Potential prescribing cascades or drug interactions were identified for 12 participants (4%).

CONCLUSIONS

Potentially suboptimal prescribing affected more than half the participating older Aboriginal Australians from the Kimberley. If generalisable to other remote Indigenous Australians, the prevalence of polypharmacy, potentially inappropriate prescribing, and under-prescribing of indicated medicines is problematic, and suggests that older Indigenous people in remote areas are at risk of medicine-related harm.

The Getting it Right Collaborative Group, Hackett ML, Teixeira‐Pinto A, Farnbach S, Glozier N, Skinner T, Askew DA, Gee G, Cass A, Brown A. Getting it Right: validating a culturally specific screening tool for depression (aPHQ-9) in Aboriginal and Torres Strait Islander Australians

OBJECTIVES

To determine the validity, sensitivity, specificity and acceptability of the culturally adapted nine-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander people.

DESIGN

Prospective observational validation study, 25 March 2015 - 2 November 2016.

SETTING, PARTICIPANTS

500 adults (18 years or older) who identified as Aboriginal or Torres Strait Islander people and attended one of ten primary health care services or service events in urban, rural and remote Australia that predominantly serve Indigenous Australians, and were able to communicate sufficiently to respond to questionnaire and interview questions.

MAIN OUTCOME MEASURES

Criterion validity of the aPHQ-9, with the depression module of the Mini-International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standard.

RESULTS

108 of 500 participants (22%; 95% CI, 18-25%) had a current episode of major depression according to the MINI criterion. The sensitivity of the aPHQ-9 algorithm for diagnosing a current major depressive episode was 54% (95% CI, 40-68%), its specificity was 91% (95% CI, 88-94%), with a positive predictive value of 64%. For screening for a current major depressive episode, the area under the receiver operator characteristic curve was 0.88 (95% CI, 0.85-0.92); with a cut-point of 10 points its sensitivity was 84% (95% CI, 74-91%) and its specificity 77% (95% CI, 71-83%). The aPHQ-9 was deemed acceptable by more than 80% of participants.

CONCLUSIONS

Indigenous Australians found the aPHQ-9 acceptable as a screening tool for depression. Applying a cut-point of 10 points, the performance characteristics of the aPHQ were good.

Common mental disorders among Indigenous people living in regional, remote and metropolitan Australia: a cross-sectional study

OBJECTIVE

To determine, using face-to-face diagnostic interviews, the prevalence of common mental disorders (CMD) in a cohort of adult Indigenous Australians, the cultural acceptability of the interviews, the rates of comorbid CMD and concordance with psychiatrists' diagnoses.

DESIGN

Cross-sectional study July 2014-November 2016. Psychologists conducted Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I Disorders (SCID-I) (n=544). Psychiatrists interviewed a subsample (n=78).

SETTING

Four Aboriginal Medical Services and the general community located in urban, regional and remote areas of Southern Queensland and two Aboriginal Reserves located in New South Wales.

PARTICIPANTS

Indigenous Australian adults.

OUTCOME MEASURES

Cultural acceptability of SCID-I interviews, standardised rates of CMD, comorbid CMD and concordance with psychiatrist diagnoses.

RESULTS

Participants reported that the SCID-I interviews were generally culturally acceptable. Standardised rates (95% CI) of current mood, anxiety, substance use and any mental disorder were 16.2% (12.2% to 20.2%), 29.2% (24.2% to 34.1%), 12.4% (8.8% to 16.1%) and 42.2% (38.8% to 47.7%), respectively-6.7-fold, 3.8-fold, 6.9-fold and 4.2-fold higher, respectively, than those of the Australian population. Differences between this Indigenous cohort and the Australian population were less marked for 12-month (2.4-fold) and lifetime prevalence (1.3-fold). Comorbid mental disorder was threefold to fourfold higher. In subgroups living on traditional lands in Indigenous reserves and in remote areas, the rate was half that of those living in mainstream communities. Moderate-to-good concordance with psychiatrist diagnoses was found.

CONCLUSIONS

The prevalence of current CMD in this Indigenous population is substantially higher than previous estimates. The lower relative rates of non-current disorders are consistent with underdiagnosis of previous events. The lower rates among Reserve and remote area residents point to the importance of Indigenous peoples' connection to their traditional lands and culture, and a potentially important protective factor. A larger study with random sampling is required to determine the population prevalence of CMD in Indigenous Australians.

Chronic condition self-management support for Aboriginal people: Adapting tools and training

PROBLEM

Chronic conditions are major health problems for Australian Aboriginal people. Self-management programs can improve health outcomes. However, few health workers are skilled in self-management support and existing programs are not always appropriate in Australian Aboriginal contexts.

DESIGN

The goal was to increase the capacity of the Australian health workforce to support Australian Aboriginal people to self-manage their chronic conditions by adapting the Flinders Program of chronic condition self-management support for Australian Aboriginal clients and develop and deliver training for health professionals to implement the program.

STRATEGIES FOR CHANGE

Feedback from health professionals highlighted that the Flinders Program assessment and care planning tools needed to be adapted to suit Australian Aboriginal contexts. Through consultation with Australian Aboriginal Elders and other experts, the tools were condensed into an illustrated booklet called 'My Health Story'. Associated training courses and resources focusing on cultural safety and effective engagement were developed.

EFFECTS OF CHANGE

A total of 825 health professionals  across Australia was trained and 61 people qualified as accredited trainers in the program, ensuring sustainability.

LESSONS LEARNT

The capacity and skills of the Australian health workforce to engage with and support Australian Aboriginal people to self-manage their chronic health problems significantly increased as a result of this project. The adapted tools and training were popular and appreciated by the health care organisations, health professionals and clients involved. The adapted tools have widespread appeal for cultures that do not have Western models of health care and where there are health literacy challenges. My Health Story has already been used internationally.

Depression, Suicidal Behaviour, and Mental Disorders in Older Aboriginal Australians

Aboriginal Australians experience higher levels of psychological distress, which may develop from the long-term sequelae of social determinants and adversities in early and mid-life. There is little evidence available on the impact of these on the mental health of older Aboriginal Australians. This study enrolled 336 Aboriginal Australian participants over 60 years from 5 major urban and regional areas in NSW, utilizing a structured interview on social determinants, and life-time history of physical and mental conditions; current psychosocial determinants and mental health. Univariate and multivariate analyses were utilized to examine the link between these determinants and current depressive scores and suicidality. There was a high rate of life-time depression (33.3%), current late-life depression (18.1%), and suicidal ideation (11.1%). Risk factors strongly associated with late-life depression included sleep disturbances, a history of suicidal behaviour, suicidal ideation in late-life and living in a regional location. This study supports certain historical and psychosocial factors predicting later depression in old age, and highlights areas to target for prevention strategies.

Validity and Acceptability of Kimberley Mum's Mood Scale to Screen for Perinatal Anxiety and Depression in Remote Aboriginal Health Care Settings

BACKGROUND

The Edinburgh Postnatal Depression Scale (EPDS) is widely recommended for perinatal anxiety and depression screening. However, many Aboriginal women find EPDS language complex and confusing, and providers find using it with Aboriginal women challenging. The two part Kimberley Mum's Mood Scale (KMMS) was developed to improve screening: Part 1 is a Kimberley version of EPDS; Part 2 is a psychosocial tool that enables contextualisation of Part 1 scores. We aimed to determine if KMMS is a valid and acceptable method of identifying Kimberley Aboriginal perinatal women at risk of anxiety or depressive disorders compared to a semi-structured clinical interview.

METHODS

Across 15 sites in the Kimberley, Western Australia, 97 Aboriginal women aged 16 years and older who intended to continue with their pregnancy or had a baby within the previous 12 months were administered the KMMS by trained healthcare providers who provided an overall assessment of no, low, moderate or high risk; 91 participants were then independently assessed by a blinded clinical expert using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. A qualitative approach was used to determine KMMS' acceptability.

RESULTS

Part 1 had high internal consistency (Cronbach's alpha, 0.89), and overall KMMS risk equivalence for screening for anxiety or depressive disorders was moderate (sensitivity, 83%; specificity, 87%; positive predictive value, 68%). Participants found the process easy and useful, and healthcare providers found KMMS more useful than EPDS. Part 2 allowed healthcare providers to ask questions that gave participants an opportunity to express themselves, resulting in a deeper understanding between them.

CONCLUSION

KMMS is an effective tool for identifying Kimberley Aboriginal perinatal women at risk of anxiety and depressive disorders. Adoption of KMMS with culturally safe training and support is likely to improve screening processes, and with further validation may have broader applicability across remote Australia.

Getting it Right: study protocol to determine the diagnostic accuracy of a culturally-specific measure to screen for depression in Aboriginal and/or Torres Strait Islander people

INTRODUCTION

A freely available, culturally valid depression screening tool is required for use by primary care services across Australia to screen for depression in Aboriginal and/or Torres Strait Islander populations. This is the protocol for a study aiming to determine the validity, sensitivity and specificity of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9).

METHODS AND ANALYSIS

Cross-sectional validation study. A total of 500 people who self-identify as Aboriginal and/or Torres Strait Islander, are ≥18 years of age, attending 1 of 10 primary healthcare services or service events across Australia and able to communicate sufficiently to answer study questions will be recruited. All participants will complete the aPHQ-9 and the criterion standard MINI International Neuropsychiatric Interview (MINI) 6.0.0. The primary outcome is the criterion validity of the aPHQ-9. Process outcomes related to acceptability and feasibility of the aPHQ-9 will be analysed only if the measure is found to be valid.

ETHICS AND DISSEMINATION

Lead ethical approval was obtained jointly from the University of Sydney Human Research Ethics Committee (project 2014/361) and the Aboriginal Health and Medical Research Council of New South Wales (project 1044/14). Results will be disseminated via the usual scientific forums, including peer-reviewed publications and presentations at international conferences following presentation to, discussion with and approval by participating primary healthcare service staff and community.

TRIAL REGISTRATION NUMBER

ACTRN12614000705684.

Falls risk assessment outcomes and factors associated with falls for older Indigenous Australians

OBJECTIVE

To describe the prevalence of falls and associated risk factors in older Indigenous Australians, and compare the accuracy of validated falls risk screening and assessment tools in this population in classifying fall status.

METHOD

Cross-sectional study of 289 Indigenous Australians aged ≥45 years from the Kimberley region of Western Australia who had a detailed assessment including self-reported falls in the past year (n=289), the adapted Elderly Falls Screening Tool (EFST; n=255), and the Falls Risk for Older People-Community (FROP-Com) screening tool (3 items, n=74) and FROP-Com falls assessment tool (n=74).

RESULTS

32% of participants had ≥1 fall in the preceding year, and 37.3% were classified high falls risk using the EFST (cut-off ≥2). In contrast, for the 74 participants assessed with the FROP-Com, only 14.9% were rated high risk, 35.8% moderate risk, and 49.3% low risk. The FROP-Com screen and assessment tools had the highest classification accuracy for identifying fallers in the preceding year (area under curve >0.85), with sensitivity/specificity highest for the FROP-Com assessment (cut-off ≥12), sensitivity=0.84 and specificity=0.73.

CONCLUSIONS

Falls are common in older Indigenous Australians. The FROP-Com falls risk assessment tool appears useful in this population, and this research suggests changes that may improve its utility further.

Radix Bupleuri ameliorates depression by increasing nerve growth factor and brain-derived neurotrophic factor

BACKGROUND

Chinese herb Radix Bupleuri has been regarded effective to improve treatment of depression, but the molecular mechanism remains unknown. Low levels of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) increase the likelihood of developing the depression. Therefore, we want to know whether Radix Bupleuri affects the levels of these factors.

METHODS

A total 160 hemodialysis patients were diagnosed with depression and randomly assigned to two groups: Radix Bupleuri group (received 1 g root power of Radix Bupleuri in a capsule daily Radix Bupleuri) and control group (receive placebo).

RESULTS

After three-month follow-up, the patients who received Radix Bupleuri had greater improvement in depression symptoms, anxiety symptoms and general functioning via controls after three-month follow-up (P < 0.05). Serum NGF levels were significantly higher in subjects accepted Radix Bupleuris (178.64 ± 52.18 pg/mL) when compared to a control (103.54 ± 31.23 pg/ml) (P < 0.01). Similarly, serum BDNF levels were significantly higher in subjects accepted Radix Bupleuris (1635.26 ± 121.66 pg/ml) when compared to a control (516.38 ± 44.89 pg/ml) (P < 0.01). The serum levels of NGF and BDNF were negatively related with Montgomery-Asberg Depression Rating Scale (MADRS) and positively related with scores of RAND-36 item Health Survey (RAND-36) (P < 0.01).

CONCLUSION

Thus, Radix Bupleuri ameliorates the patients with depression by increasing serum levels of NGF and BDNF. Radix Bupleuri should be developed a new drug for the therapy of depression.

A systematic review: Identifying the prevalence rates of psychiatric disorder in Australia's Indigenous populations

OBJECTIVE

This review aimed to draw on published literature to identify the prevalence rates of psychiatric disorders in Australia's Indigenous populations, Aboriginal and Torres Strait Islander peoples.

METHOD

A systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) model was conducted using the following electronic databases: PubMed, Scopus, Web of Science, MEDLINE, PsycINFO, PsycARTICLES, and Informit Indigenous and Health Collections. Studies were included for analysis if they were empirical quantitative studies reporting prevalence rates for any psychiatric disorder in Indigenous people.

RESULTS

Of the 1584 papers extracted by the search strategy, 17 articles met the eligibility criteria and were reviewed in detail. Methodology, sampling strategy and study design varied greatly across these 17 studies. Prevalence rates varied by disorder and are as follows: major depressive disorder (4.3-51%); mood disorders (7.7-43.1%); post-traumatic stress disorder (14.2-55.2%); anxiety disorders (17.2-58.6%); substance dependence (5.9%-66.2%); alcohol dependence (21.4-55.4%); and psychotic disorders (1.68-25%). While the number of studies on community-based Indigenous populations was limited, available evidence suggested that prevalence rates are higher in prison populations compared with community-based studies.

CONCLUSIONS

It was identified that there is limited evidence on the occurrence of psychiatric disorders for Indigenous people in the general community. More research in this area is essential to provide accurate and reliable estimates and to provide a baseline for evaluating the effectiveness of programs aimed at reducing the high mental health burden experienced by Indigenous Australians. Future research needs to ensure that standardised and validated methods are used to accurately estimate the prevalence of psychiatric disorders among Indigenous Australians.