Designing a Web-Based Navigation Tool to Support Access to Youth Mental Health Services: Qualitative Study

BACKGROUND

Many young people with mental health problems do not readily seek help or receive treatment and support. One way to address low help-seeking behavior is to improve access to information on mental health services and how to navigate the mental health system via a web-based tool. Seeking input from the end users (young people and parents or caregivers) on key features of the tool is imperative to ensure that it is relevant, engaging, and likely to meet their needs and expectations.

OBJECTIVE

This study aims to investigate young person and parent or caregiver views on the design, content, functioning, and user experience of a web-based mental health navigation tool to support connection to mental health services for children and young people aged up to 25 years.

METHODS

A total of 4 online focus groups were conducted: 2 with young people aged 16 years and older (total n=15) and 2 with parents or caregivers (total n=13). Focus groups were structured around a series of guiding questions to explore participants' views on content, features, user experience, and design of a mental health navigation website. Focus groups were audio recorded with detailed notes taken. In addition, 53 young people aged 16-25 years and 97 parents or caregivers completed an online survey, comprising closed- and open-ended questions; open-ended responses were included with the focus group data in the qualitative analysis. All qualitative data were analyzed using thematic analysis.

RESULTS

A total of 2 topic areas and 7 themes were developed. The first topic area covered the types of information needs of young people and parents. Identified themes concerned the scope of the navigation website, as well as the provision of up-to-date and practical information on how to navigate the whole help-seeking process. The second topic area covered website features that would be beneficial and included the consideration of the website design; search engines; supported navigation; and forums, reviews, and user accounts.

CONCLUSIONS

This study provides important insights into the navigation needs of young people and parents or caregivers in seeking mental health services. Key findings identified through this research have directly informed the development of MindMap, a web-based youth navigation tool providing a searchable database of local services, including a clear description, their location, and potential wait times. The website can be navigated independently or with support.

Do emotion intensity, variability, differentiation, co-occurrence, and positive-negative ratios make unique contributions to predicting longitudinal change in psychological distress and well-being?

A burgeoning array of affective indices are proposed to capture features of affect that contribute to mental health and well-being. However, because indices are often investigated separately, it is unclear what-if any-unique role they have. The present study addresses this question in a high-stress naturalistic context by prospectively testing the relative contributions of eight affective indices to psychological outcomes during the first acute lockdown phase of the COVID-19 pandemic. Across six fortnightly waves of data collection, participants (N = 613, aged 19 to 87 years) reported how much they experienced five positive and five negative emotions in response to images showing the health and social impacts of the pandemic. We used these ratings to calculate participant-level indices of intensity, variability, and differentiation for positive and negative emotions separately, and positive-negative co-occurrence and ratios. Psychosocial outcome measures were general psychological distress, loneliness, work, and social impairment specifically due to the pandemic, well-being, and coping. On average, psychosocial functioning improved across the lockdown period, and, for most affective indices, bivariate relationships with psychosocial functioning supported existing theory and empirical work. However, multiple regression analyses suggested that the contributions of the individual indices were rarely unique, with most of the change in psychosocial functioning over time being explained by affect intensity and variability. These findings highlight that affective indices should be studied in concert to build a comprehensive and integrated understanding of their role in mental health and well-being. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Evaluating suicide attitudes and suicide literacy in adolescents

BACKGROUND

Two of the most common modifiable barriers to help-seeking for mental health problems during adolescence are stigma and poor mental health literacy. However, relatively little is known about stigma as it relates to suicide, and knowledge about suicidality in this age group.

AIMS

To assess levels of suicide literacy and suicide attitudes in an adolescent sample, and to identify correlates of these constructs.

METHODS

Data were drawn from the pre-intervention survey of the Sources of Strength Australia Project. A total of 1019 adolescents aged between 11 and 17 years participated. Suicide literacy and attitudes were measured alongside potential correlates including psychological distress, suicidal ideation, mastery, previous exposure to suicidal thinking and behaviour, and demographics.

RESULTS

Participants more strongly endorsed attitudes attributing suicide to isolation/depression, compared to attitudes glorifying or stigmatising suicide. Gaps in knowledge about suicide included the risk factors, signs and symptoms. Key correlates of suicide attitudes and literacy included age, gender and cultural background.

CONCLUSION

Findings highlight the need for further education activities in schools and public awareness campaigns that address the gaps in suicide knowledge and attitudes. Such activities would assist in the identification of suicide risk among young people and improve help-seeking in this population.

Co-ideation and co-design in co-creation research: Reflections from the 'Co-Creating Safe Spaces' project

INTRODUCTION

Numerous frameworks for defining and supporting co-created research exist. The practicalities of designing and conducting co-created research are clearly important, yet the utility of these frameworks and their operationalisation within local contexts and involving a diversity of stakeholders and interests are currently not well-researched.

METHODS

Using an instrumental case study approach, we examined the utility of a published systematic framework designed to improve clarity about co-creation as a concept and approach. The framework is explored based on the first two processes that correspond to our own work to date: co-ideation and co-design.

RESULTS

Our study showed that diverse stakeholders bring challenges regarding research priorities, methods, language and the distribution of power within co-creation processes. Co-creation activities were incremental, adaptable, responsive and made best use of established relationships, structures and collective leadership to meet the competing demands of funders and human research ethics committees, while ensuring the meaningful participation of multiple stakeholders.

CONCLUSION

The findings highlight the iterative, fluid and deeply relational nature of co-created research. Rather than seeking to categorise these processes, we argue that the social relations of research production that provide the structures within which all co-created knowledge is generated are more important drivers of effective knowledge mobilisation and implementation. Thus, close attention to these social relations is needed in co-created research.

PATIENT OR PUBLIC CONTRIBUTION

People with lived experience of emotional distress and/or suicidal crisis, including academic researchers, service and peer workers, carers and advocates were involved in the co-ideation and co-design of this research. All authors identify as people with lived experience, from both academic and nonresearch backgrounds.

Cancer Survivors' Experiences of Navigating the Australian Health Care System for Physical and Mental Health Care Needs

People living with cancer experience many impacts on their health and mental health, and are thus likely to require ongoing health care. The aim of the current study was to investigate the health and mental health care experiences and needs of Australian cancer survivors. A total of 131 people (119 female, 12 male) with lived experience of a cancer diagnosis (at least 12 months ago) participated in an online survey collecting qualitative and quantitative data, advertised via social media groups and paid advertising. Analysis of the written responses was conducted using inductive qualitative content analysis. The findings showed that a major issue facing cancer survivors was difficulties around access to and management of services for both their mental and physical health. There was also a strong preference for increasing access to allied health care, such as physiotherapy, psychology, and remedial massage. There appear to be some inequities in the experiences of cancer survivors, particularly in accessing care. Improving the experiences of health care for physical and mental health cancer survivors should focus on increasing access to and improving the management of services, specifically allied health, through a variety of avenues, including reducing costs, increasing transport, and providing closer and more co-located services.

Co-creating safe spaces: Study protocol for translational research on innovative alternatives to the emergency department for people experiencing emotional distress and/or suicidal crisis

INTRODUCTION

Safe spaces are an alternative to emergency departments, which are often unable to provide optimum care for people experiencing emotional distress and/or suicidal crisis. At present, there are several different safe space models being trialled in Australia. However, research examining the effectiveness of safe space models, especially in community settings, is rare. In this paper, we present a protocol for a study in which we will investigate the implementation, effectiveness, and sustainability of safe space models as genuine alternatives for people who might usually present to the emergency department or choose not to access help due to past negative experiences.

MATERIAL AND METHODS

We will use a mixed methods, co-designed study design, conducted according to the principles of community-based participatory research to obtain deep insights into the benefits of different safe space models, potential challenges, and facilitators of effective practice. We developed the study plan and evaluation framework using the RE-AIM framework, and this will be used to assess key outcomes related to reach, effectiveness, adoption, implementation, and maintenance. Data collection will comprise quantitative measures on access, use, satisfaction, (cost) effectiveness, distress, and suicidal ideation; and qualitative assessments of service implementation, experience, feasibility, acceptability, community awareness, and the fidelity of the models to service co-design. Data will be collected and analysed concurrently throughout the trial period of the initiatives.

DISCUSSION

This study will enable an extensive investigation of safe spaces that will inform local delivery and provide a broader understanding of the key features of safe spaces as acceptable and effective alternatives to hospital-based care for people experiencing emotional distress and/or suicidal crisis. This study will also contribute to a growing body of research on the role and benefits of peer support and provide critical new knowledge on the successes and challenges of service co-design to inform future practice.

Patterns and predictors of alcohol use during the early stages of the COVID-19 pandemic in Australia: Longitudinal cohort study

Background

The COVID‐19 pandemic has resulted in disruptions across many life domains. The distress associated with the pandemic itself, and with public health efforts to manage the outbreak, could result in increased alcohol use. This study aimed to quantify changes in alcohol use during the early stages of the pandemic and factors associated with different patterns of use.

Methods

Data were obtained from a longitudinal survey of a representative Australian adult sample (N = 1296, 50% female, M_age = 46.0) conducted from March to June 2020, during the first wave of the COVID‐19 outbreak in Australia. Change in alcohol consumption was examined using Alcohol Use Disorders Identification Test‐Consumption (AUDIT‐C) scores from waves one, three, five, and seven of the study, each 4 weeks apart. Factors associated with alcohol consumption were examined, including depression (PHQ‐9) and anxiety (GAD‐7) symptoms, health risk tolerance, stress and coping, work and social impairment (WSAS), COVID impacts, and sociodemographic variables. We tested changes in alcohol use across the full sample using a mixed effects repeated measure ANOVA model and a multinomial logistic regression to identify factors assessed at wave 1 that were independently associated with alcohol use.

Results

There was no significant change in AUDIT‐C scores across the study. For most participants, alcohol use did not increase during the early phase of the COVID‐19 pandemic in Australia. COVID‐19 exposure, higher perceived coping, depression symptoms, and male gender were associated with greater odds of increasing or elevated levels of alcohol use. Social changes, which included working from home, had mixed effects on alcohol consumption.

Conclusions

Although no evidence was found for increased alcohol use overall during the early months of the pandemic, several factors were associated with alcohol consumption at risky levels. Greater understanding of motivations for drinking across public and private contexts, along with targeted support for high‐risk groups, could assist in reducing harm associated with alcohol consumption.

The Sources of Strength Australia project: A cluster randomised controlled trial of a peer-connectedness school-based program to promote help-seeking in adolescents

BACKGROUND

Suicide is a significant public health problem and there is a clear need for interventions to improve help seeking for suicide and psychological distress in young people. This trial aimed to assess the effectiveness of the school-based Sources of Strength program in increasing help-seeking intentions and behaviours in adolescents.

METHODS

A cluster, randomised controlled trial was conducted in 13 Australian secondary schools (N = 1633), with each school randomly allocated to the intervention (n = 7) or wait-list control condition (n = 6). Participants in the intervention condition received the Sources of Strength program over two years and all participants completed self-report measures of help-seeking intentions and behaviour at four time-points. Staff and students in the intervention condition also provided qualitative feedback on the perceived impact of the program.

RESULTS

Mixed model repeated measures analyses demonstrated no significant effect of the Sources of Strength program on help-seeking intentions or behaviour at post-intervention or 6- or 18-month follow-up. Staff and students reported, through qualitative feedback, that the program increased awareness of and openness to help seeking and promoted a common language and school community.

LIMITATIONS

The current study only included self-report measures that may have been influenced by situational factors or biases.

CONCLUSIONS

Although the Sources of Strength program may have increased awareness of help seeking, there was no evidence that it is effective in increasing help-seeking intentions or behaviours in this cohort. The program may be more suitable for schools in disadvantaged areas where there may be limited existing connections to trusted adults.

Psychosocial impacts of home-schooling on parents and caregivers during the COVID-19 pandemic

Background

The COVID-19 pandemic has been highly disruptive, with the closure of schools causing sudden shifts for students, educators and parents/caregivers to remote learning from home (home-schooling). Limited research has focused on home-schooling during the COVID-19 pandemic, with most research to date being descriptive in nature. The aim of the current study was to comprehensively quantify the psychosocial impacts of home-schooling on parents and other caregivers, and identify factors associated with better outcomes.

Methods

A nationally representative sample of 1,296 Australian adults was recruited at the beginning of Australian COVID-19 restrictions in late-March 2020, and followed up every two weeks. Data for the current study were drawn from waves two and three. Surveys assessed psychosocial outcomes of psychological distress, work and social impairment, and wellbeing, as well as a range of home-schooling factors.

Results

Parents and caregivers who were home-schooling during the COVID-19 pandemic experienced significantly higher levels of psychological distress and work/social impairment compared to those who were not home-schooling or had no school-aged children. A current mental health diagnosis or lower levels of perceived support from their child’s school negatively affected levels of psychological distress, work and social impairment, and wellbeing in parents and caregivers involved in home-schooling.

Conclusions

The mental health impacts of home-schooling were high and may rise as periods of home-schooling increase in frequency and duration. Recognising and acknowledging the challenges of home-schooling is important, and should be included in psychosocial assessments of wellbeing during periods of school closure. Emotional and instrumental support is needed for those involved in home-schooling, as perceived levels of support is associated with improved outcomes. Proactive planning by schools to support parents may promote better outcomes and improved home-schooling experiences for students.

What could we do differently next time? Australian parents' experiences of the short-term and long-term impacts of home schooling during the COVID-19 pandemic

BACKGROUND

COVID-19 lockdowns have resulted in school closures worldwide, requiring curriculum to be delivered to children remotely (home schooling). Qualitative evidence is needed to provide important context to the positive and negative impacts of home schooling and inform strategies to support caregivers and children as the pandemic continues. This study aimed to explore the experiences of home schooling caregivers at multiple time-points during the pandemic.

METHODS

Data were obtained from a longitudinal survey of a representative Australian sample conducted over 8 waves during 2020 and 2021. Participants who had home schooled at least one child during COVID-19 completed open-ended questions at Wave 4 (May 2020; n = 176), Wave 7 (June 2020; n = 145), and Wave 8 (March 2021; n = 57). Participants were asked to describe what they found positive and challenging about home schooling (Wave 4), what they would do differently if they home schooled their children again (Wave 7), and the longer-term impacts of home schooling on caregivers and children (Wave 8).

RESULTS

91% of participants at Wave 4 reported at least one positive and/or negative aspect of home schooling. At Wave 8, 32% and 29% of participants reported no long-term positive or negative impacts of home schooling respectively. Using a qualitative content analysis approach, six themes were developed from the data, encompassing the impacts of home schooling on parents, and the perceived impacts on children. Impacts on parents included connecting with children, managing the work-life-school balance, and the challenge of home schooling when parents are not teachers. Perceived impacts on children included: quieter and safer learning at home, and the negatives of managing schoolwork load and social isolation. At Wave 7, 56 participants (44%) identified at least one thing they would do differently.

CONCLUSIONS

Despite some participants reporting positive experiences associated with home schooling, it remains challenging for many parents and their children. Supports for parents and children engaged in home schooling should provide clear and flexible guidance on how to balance schoolwork with other competing demands, assist parents who lack confidence in supporting their children's remote learning, and address risks associated with social isolation.

Cause or symptom? A longitudinal test of bidirectional relationships between emotion regulation strategies and mental health symptoms

Previous work has generally conceptualized emotion regulation as contributing to mental health outcomes, and not vice versa. The present study challenges this assumption by using a prospective design to investigate the directionality of underlying relationships between emotion regulation and mental health in the context of a major population-level stressor. We surveyed a large nationally representative sample of adults (18-91 years, N = 704) at three 1-month intervals across the acute lockdown phase of the COVID-19 pandemic in Australia, using standardized measures of depression and anxiety symptoms. At each time point, we also measured the use of two emotion regulation strategies-cognitive reappraisal and emotional suppression-previously associated with adaptive and maladaptive mental health outcomes, respectively. We found cognitive reappraisal was unrelated to mental health symptoms. In contrast, greater emotional suppression was robustly associated with higher symptom levels for both depression and anxiety. Longitudinal analyses revealed this association reflected bidirectional relationships. Higher symptoms of depression and anxiety each predicted greater subsequent use of emotional suppression, and greater use of emotional suppression predicted higher subsequent symptoms. This bidirectionality suggests emotional suppression is both symptomatic and predictive of psychological distress. The lack of a relationship for cognitive reappraisal is discussed with respect to the pandemic context and evidence that high stress might reduce people's ability to use this strategy effectively. Given the strong emphasis on reappraisal in clinical practice, there is a critical need to understand for whom, what and when this strategy is helpful. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Music Engagement Program for people with Alzheimer's disease and dementia: Pilot feasibility trial outcomes

Alzheimer's disease and dementia are common, highly disabling conditions frequently requiring residential care. This exploratory proof-of-concept study aimed to determine if the specialised Music Engagement Program (MEP) was sustainable, acceptable, and effective in improving quality of life, emotional wellbeing, and depression symptoms in this population. Sixteen residents, six staff members, and three family and community members took part in the evaluation of the MEP for people living with dementia in a residential aged-care nursing home in Canberra, Australia. Multiple methods were used. Quantitative evaluation assessed residents' depression symptoms (Cornell scale) at pre- and post-intervention, and emotional wellbeing pre- and post-session. Qualitative interviews with staff, and family and community members addressed the MEP's acceptability and potential sustainability. Results showed residents' mean depression scores were reduced from pre- to post-intervention (p = .039; d_z = 0.72). Interviews established multiple benefits for residents including improved mood, calmness, and reduced aggression. However, staff did not believe it was feasible to continue the MEP sessions beyond the trial period without an external facilitator, citing potential difficulties in adhering to internal activities due to time constraints. This pilot study provides encouraging preliminary evidence for the MEP's acceptability and potential effectiveness for improving depression and wellbeing in this group.

Trajectories of depression and anxiety symptoms during the COVID-19 pandemic in a representative Australian adult cohort

Objectives

To estimate initial levels of symptoms of depression and anxiety, and their changes during the early months of the COVID‐19 pandemic in Australia; to identify trajectories of symptoms of depression and anxiety; to identify factors associated with these trajectories.

Design, setting, participants

Longitudinal cohort study; seven fortnightly online surveys of a representative sample of 1296 Australian adults from the beginning of COVID‐19‐related restrictions in late March 2020 to mid‐June 2020.

Main outcome measures

Symptoms of depression and anxiety, measured with the Patient Health Questionnaire (PHQ‐9) depression and Generalised Anxiety Disorder (GAD‐7) scales; trajectories of symptom change.

Results

Younger age, being female, greater COVID‐19‐related work and social impairment, COVID‐19‐related financial distress, having a neurological or mental illness diagnosis, and recent adversity were each significantly associated with higher baseline depression and anxiety scores. Growth mixture models identified three latent trajectories for depression symptoms (low throughout the study, 81% of participants; moderate throughout the study, 10%; initially severe then declining, 9%) and four for anxiety symptoms (low throughout the study, 77%; initially moderate then increasing, 10%; initially moderate then declining, 5%; initially mild then increasing before again declining, 8%). Factors statistically associated with not having a low symptom trajectory included mental disorder diagnoses, COVID‐19‐related financial distress and social and work impairment, and bushfire exposure.

Conclusion

Our longitudinal data enabled identification of distinct symptom trajectories during the first three months of the COVID‐19 pandemic in Australia. Early intervention to ensure that vulnerable people are clinically and socially supported during a pandemic should be a priority.

Silence is Deadly: A controlled trial of a public health intervention to promote help-seeking in adolescent males

OBJECTIVE

To test the effectiveness of a male-targeted upstream public health intervention in increasing help-seeking intentions for mental disorders and suicide in an adolescent population.

METHOD

A two-arm controlled trial was conducted with 10 schools in the Australian Capital Territory. A total of 594 male adolescents aged between 16 and 18 years participated in the study. Participants in the intervention condition received the single session Silence is Deadly program, while participants in the control condition completed usual classes. All participants completed a pre-intervention, post-intervention, and a 6- to 12-week follow-up survey assessing help-seeking intentions, attitudes, and behaviors.

RESULTS

At follow-up, the Silence is Deadly program was found to significantly increase help-seeking intentions from friends, which was in line with the program's messaging to seek help from and provide support to friends in times of distress or suicide risk. The program did not have an effect on help-seeking intentions for other sources of help or on help-seeking attitudes and behavior.

CONCLUSIONS

The present study provides preliminary support for male-targeted public health interventions for suicide that use male-focused norming and role modeling to improve help-seeking in this population.

Effects of previous exposure to psychotherapeutic strategies on depression and anxiety symptoms during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has seen an increase in depression and anxiety among those with and without a history of mental illness. Commonly used forms of psychological therapy improve mental health by teaching psychotherapeutic strategies that assist people to better manage their symptoms and cope with life stressors. Minimal research to date has explored their application or value in managing mental health during significant broad-scale public health crises.

AIMS

To determine which psychotherapeutic strategies people who have previously received therapy use to manage their distress during the COVID-19 pandemic, and whether the use and perceived helpfulness of these strategies has an effect on symptoms of depression and anxiety.

METHOD

Data (N = 857) was drawn from multiple waves of a representative longitudinal study of the effects of COVID-19 on the mental health of Australian adults, which includes measures of anxiety, depression and experiences with psychotherapy and psychotherapeutic strategies.

RESULTS

Previous engagement in therapy with psychotherapeutic strategies had a protective effect on depressive but not anxiety symptoms. Common and helpful strategies used by respondents were exercise, mindfulness and breathing exercises. Using mindfulness and perceiving it to be helpful was associated with lower levels of depression and anxiety symptoms. No other strategies were associated with improved mental health.

CONCLUSIONS

Prior knowledge of psychotherapeutic strategies may play a role in managing mental health during unprecedented public health events such as a global pandemic. There may be value in promoting these techniques more widely in the community to manage general distress during such times.

The Effect of COVID-19 on Mental Health and Wellbeing in a Representative Sample of Australian Adults

There is minimal knowledge about the impact of large-scale epidemics on community mental health, particularly during the acute phase. This gap in knowledge means we are critically ill-equipped to support communities as they face the unprecedented COVID-19 pandemic. This study aimed to provide data urgently needed to inform government policy and resource allocation now and in other future crises. The study was the first to survey a representative sample from the Australian population at the early acute phase of the COVID-19 pandemic. Depression, anxiety, and psychological wellbeing were measured with well-validated scales (PHQ-9, GAD-7, WHO-5). Using linear regression, we tested for associations between mental health and exposure to COVID-19, impacts of COVID-19 on work and social functioning, and socio-demographic factors. Depression and anxiety symptoms were substantively elevated relative to usual population data, including for individuals with no existing mental health diagnosis. Exposure to COVID-19 had minimal association with mental health outcomes. Recent exposure to the Australian bushfires was also unrelated to depression and anxiety, although bushfire smoke exposure correlated with reduced psychological wellbeing. In contrast, pandemic-induced impairments in work and social functioning were strongly associated with elevated depression and anxiety symptoms, as well as decreased psychological wellbeing. Financial distress due to the pandemic, rather than job loss per se, was also a key correlate of poorer mental health. These findings suggest that minimizing disruption to work and social functioning, and increasing access to mental health services in the community, are important policy goals to minimize pandemic-related impacts on mental health and wellbeing. Innovative and creative strategies are needed to meet these community needs while continuing to enact vital public health strategies to control the spread of COVID-19.

Contextual influences on the impact of a peer worker-led self-stigma program for people with mental health issues: protocol for an interventional implementation science study

Background

Despite significant recent reforms, Australia’s mental health system faces substantial service and workforce shortages, and progress on the reorientation of services to a recovery focus is also slow. Implementing recovery-focused programs led by mental health peer workers is one way of addressing these issues, but uptake of these programs in Australia is patchy and not well evaluated.

This project will investigate the implementation of a peer-led mental health self-stigma program across three diverse settings in an Australian capital city. The project aims to (1) examine the processes and contextual influences on successful implementation of peer work roles and (2) evaluate the impact a peer worker-led program has on individuals and services.

Methods

The project will use an interventional implementation science approach: small-scale, researcher-led implementation of the Honest, Open, Proud program to explore contextual influences, and implementation, service and individual outcomes. The Consolidated Framework for Implementation Research (CFIR) will be used to guide investigation of contextual factors. Implementation outcomes (feasibility, fidelity, acceptability, sustainability) and service outcomes (safety, person-centeredness and effectiveness) will be examined in interviews with a range of staff within the services, checklists of adherence to program protocols and analysis of administrative data. Individual quantitative outcomes will include self-stigma, recovery and quality of life, measured at baseline, end of program and follow-up. Qualitative enquiry will focus on experiences with the peer worker and program.

Quantitative analyses will comprise change scores on service and individual outcome measures. Where possible, differences between settings and the effects of potential confounds will be tested using multi-level linear models, which will account for clustering of individuals within programs and settings. Qualitative data will be analysed using a framework approach, which is an effective way of combining inductive and deductive coding to test and refine a thematic frame.

Discussion

Recovery-focused, peer-led programs have the potential to provide a unique contribution to the management of mental health issues. Currently, there is little information to guide successful implementation of these roles. This project will provide important preliminary data on the factors that affect implementation and the impact peer workers can have.

Trial registration

ANZCTR - Trial Registration ID: ACTRN12619001312134. Registered 26/09/2019

Corrigendum: The Effect of COVID-19 on Mental Health and Wellbeing in a Representative Sample of Australian Adults

[This corrects the article DOI: 10.3389/fpsyt.2020.579985.].

Whose story is it? Mental health consumer and carer views on carer participation in research

BACKGROUND

Mental health carers contribute a unique set of perspectives and lived experiences to research; however, national research ethics guidelines do not specifically address the issues that affect informal carers as participants.

OBJECTIVE

This study sought to explore Australian mental health consumer and carer views on the ethical conduct of research involving mental health carers.

DESIGN

A public forum (n = 14; consumer = 5, carer = 9) and a subsequent series of interviews (n = 10; consumer = 5, carer = 4, both = 1) were conducted to investigate consumer and carer views on mental health research ethics. Data collection and analysis drew strongly on methodological features of grounded theory.

RESULTS

Conducting research involving carers and consumer-carer relationships raises potential concerns related to story ownership. Lived experience stories have shared and separate elements; thus, it is important to consider potential risks to the privacy of non-participants and of social harm to participants' relationships when conducting research in this space. These risks could be minimized and managed through communication between researchers and participants, and within relationships.

CONCLUSIONS

When conducting research involving carers and consumer-carer relationships, researchers may need to facilitate the negotiation of information-sharing boundaries within relationships and the safe and confidential telling of shared stories.

A Peer-Led Electronic Mental Health Recovery App in a Community-Based Public Mental Health Service: Pilot Trial

Background

There is an increasing need for peer workers (people with lived experience of mental health problems who support others) to work alongside consumers to improve recovery and outcomes. In addition, new forms of technology (tablet or mobile apps) can deliver services in an engaging and innovative way. However, there is a need to evaluate interventions in real-world settings.

Objective

This exploratory proof-of-concept study aimed to determine if a peer worker–led electronic mental health (e-mental health) recovery program is a feasible, acceptable, and effective adjunct to usual care for people with moderate-to-severe mental illness.

Methods

Overall, 6 consumers and 5 health service staff participated in the evaluation of a peer-led recovery app delivered at a community-based public mental health service. The peer worker and other health professional staff invited attendees at the drop-in medication clinics to participate in the trial during June to August 2017. Following the intervention period, participants were also invited by the peer worker to complete the evaluation in a separate room with the researcher. Consumers were explicitly informed that participation in the research evaluation was entirely voluntary. Consumer evaluation measures at postintervention included recovery and views on the acceptability of the program and its delivery. Interviews with staff focused on the acceptability and feasibility of the app itself and integrating a peer worker into the health care service.

Results

Consumer recruitment in the research component of the study (n=6) fell substantially short of the target number of participants (n=30). However, from those who participated, both staff and consumers were highly satisfied with the peer worker and somewhat satisfied with the app. Health care staff overall believed that the addition of the peer worker was highly beneficial to both the consumers and staff.

Conclusions

The preliminary findings from this proof-of-concept pilot study suggest that a peer-led program may be a feasible and acceptable method of working on recovery in this population. However, the e-mental health program did not appear feasible in this setting. In addition, recruitment was challenging in this particular group, and it is important to note that these study findings may not be generalizable. Despite this, ensuring familiarity of technology in the target population before implementing e-mental health interventions is likely to be of benefit.

Australian Mental Health Consumer and Carer Perspectives on Ethics in Adult Mental Health Research

Barriers to research arise when national ethical guidelines governing the inclusion of consumers in mental health research are implemented at the local level. Equivalent guidelines for research involving carers are not available. A social science investigation of Australian mental health consumer and carer perspectives on research ethics procedures was conducted in two interlinked stages: (a) a discussion forum with consumers, carers, and lived-experience researchers and (b) in-depth interviews with consumers and carers. Data collection and analysis drew strongly on methodological features of grounded theory. Privacy, confidentiality, and stigmatizing ethics procedures were key issues for consumer and carer participants. Recommendations for research practice include the following: considering the impact of information sharing on participants' relationships and adopting individual-focused approaches to managing research risks.

Mental health research priorities in Australia: a consumer and carer agenda

BACKGROUND

The perspectives of mental health consumers and carers are increasingly recognised as important to the development and conduct of research. However, research directions are still most commonly developed without consumer and carer input. This project aimed to establish priorities for mental health research driven by the views of consumers and carers in Australia.

METHOD

The project was conducted in two studies. Firstly, a face-to-face discussion forum held in the Australian Capital Territory (Study 1; n = 25), followed by a national online survey (Study 2; n = 70). Participants in both studies were members of the community who identified as a mental health consumer, carer or both. In Study 1, participants developed topics for mental health research in small group discussions, then voted on which topics, developed across all groups and sorted into thematic areas, were a priority. An online survey was developed from these research topics. Study 2 participants were asked to rate topics on a 5-point priority scale and rank the relative importance of the highest-rated topics.

RESULTS

At the forum, 79 topics were generated and grouped into 14 thematic areas. Votes on priorities were spread across a large number of topics, with the greatest overall support for research relating to integrating care that is sensitive to past experiences of trauma into mental health service delivery (trauma-informed care). Survey responses were similarly spread, with the majority of research topics rated as important by at least 50% of participants and no clear individual priorities for research identified. Amongst items rated as important by approximately 80% of participants, key research areas included the delivery of services, and consumer and carer involvement.

CONCLUSIONS

Australian mental health consumers and carers demonstrate a strong understanding of the mental health system and its inadequacies. Although clear specific priorities are difficult to establish, consistent areas of focus are services and the role consumers and carers can play in their improvement. However, for consumer and carer views to be at the forefront of research, it is important to regularly update research agendas and work in partnership across the whole research process.

Lived experience researchers partnering with consumers and carers to improve mental health research: Reflections from an Australian initiative

Consumer and carer involvement in mental health research is a growing and developing field. Whilst there has been policy and in-principle support for such involvement from governments around the world, lived experience researchers conducting academic research in partnership with other consumers and carers remains uncommon.

ACACIA

The Australian Capital Territory Consumer and Carer Mental Health Research Unit is based at The Australian National University and employs academic researchers with lived experience to undertake research directly relevant to the needs of mental health consumers and carers with the aim of influencing policy and practice. In this study, we share our experience of developing and conducting research within ACACIA to provide a model for meaningfully engaging mental health consumers and carers throughout the research process.

A Peer-Led Electronic Mental Health Recovery App in an Adult Mental Health Service: Study Protocol for a Pilot Trial

Background

There is growing demand for peer workers (people who use their own lived experience to support others in their recovery) to work alongside consumers to improve outcomes and recovery. Augmenting the workforce with peer workers has strong capacity to enhance mental health and recovery outcomes and make a positive contribution to the workforce within mental health systems and to the peer workers themselves. Technology-based applications are highly engaging and desirable methods of service delivery.

Objective

This project is an exploratory proof-of-concept study, which aims to determine if a peer worker-led electronic mental (e-mental) health recovery program is a feasible, acceptable, and effective adjunct to usual treatment for people with moderate to severe mental illness.

Methods

The study design comprises a recovery app intervention delivered by a peer worker to individual consumers at an adult mental health service. Evaluation measures will be conducted at post-intervention. To further inform the acceptability and feasibility of the model, consumers will be invited to participate in a focus group to discuss the program. The peer worker, peer supervisor, and key staff at the mental health service will also be individually interviewed to further evaluate the feasibility of the program within the health service and further inform its future development.

Results

The program will be delivered over a period of approximately 4 months, commencing June 2017.

Conclusions

If the peer worker-led recovery app is found to be feasible, acceptable, and effective, it could be used to improve recovery in mental health service consumers.

Silence is deadly: a cluster-randomised controlled trial of a mental health help-seeking intervention for young men

Background

Young men are consistently less likely to seek help for mental health problems than their female peers. This is particularly concerning given the high rates of suicide among male adolescents. The school system has been identified as an ideal setting for the implementation of prevention and early intervention programs for young people. The current trial aims to determine the effectiveness of the Silence is Deadly program in increasing positive help-seeking intentions for mental health problems and suicide among male secondary school students.

Methods

This study is a two-arm, cluster-randomised, controlled trial that will compare the Silence is Deadly program to a wait-list control condition. Eight Australian high schools will be recruited to the trial, with male students in grades 11 and 12 (16 to 18 years of age) targeted for participation. The program is an innovative male-tailored suicide prevention intervention, comprising a presentation that emphasises role-modelling and legitimises help-seeking for personal and emotional problems, and a brief video that features celebrity athletes who counter existing male norms around help-seeking and encourage communication about personal and emotional issues. The program also includes a discussion of how to help a friend in distress and ends with a question and answer session. The primary outcome measure for the current study is help-seeking intentions. Secondary outcomes include help-seeking behaviour, help-seeking attitudes, help-seeking stigma, mental health symptoms, and suicidal ideation. Data will be collected pre-intervention, post-intervention, and at 3-month follow-up. Primary analyses will compare changes in help-seeking intentions for the intervention condition relative to the wait-list control condition using mixed-effects repeated-measures analyses that account for clustering within schools.

Discussion

If proven to be effective, this targeted help-seeking intervention for adolescent males, which is currently only delivered in one jurisdiction, could be more widely delivered in Australian high schools. The Silence is Deadly program has the potential to significantly contribute to the mental health of young men in Australia by improving help-seeking for suicidality and mental health problems, allowing this population to better access treatment and support sooner.

Trial registration

Australian New Zealand Clinical Trials Registry, ACTRN12617000658314. Registered on 8 May 2017.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4845-z) contains supplementary material, which is available to authorized users.

Acute care hospital utilization by patients with visual impairment

OBJECTIVE

To assess whether visual impairment contributes to average length of stay (ALOS) within inpatient care facilities.

METHODS

We used the New York State Department of Health's Statewide Planning and Research Cooperative System (SPARCS) data for 1993, containing 1 principal diagnosis code and up to 8 secondary diagnosis codes for approximately 2.6 million hospital discharges. We evaluated ALOS differences in patients with and without visual impairment and in patients with eye pathologic conditions, including eye surgery. Visual impairment is not a primary admitting diagnosis, but may be coded as a secondary diagnosis. Eye pathology comprises a large variety of conditions, including corneal ulcers, abscesses, corneal deposits, edema, cataracts, vitreous hemorrhages, and many other eye disorders (ICD-9-CM codes 360-368.9 and 370-379).

RESULTS

The ALOS was 13.4 days for patients with visual impairment (N = 5764), 11.9 days for patients with either eye pathology or visual impairment (N = 60,085), and 8.2 days for patients with no visual impairment (N = 2,546,586). Using a series of multivariate models that controlled for the variables of age, sex, and payer source, as well as disease, disorders, and ophthalmology procedures, we found that the existence of visual impairment added 2.4 days to the ALOS (P<.001), while eye pathology combined with a secondary diagnosis of visual impairment added 1.8 days to the ALOS (P<.001).

CONCLUSIONS

Visual impairment contributes significantly to hospital length of stay. A better understanding of the functional care needs of patients with visual impairment in an acute care setting and at the time of discharge from the hospital may contribute to reducing excess ALOS and its related costs while improving the quality of patient care.

A therapeutic work program for head-injured adults

The Therapeutic Work Program operates in an ambulatory care setting and aids in assessing and developing prevocational skills in adults with head injuries. The program has eight phases, including initial evaluation, individual and group treatment, and prevocational assessment and treatment. We conducted a phone survey to evaluate the program's effectiveness and found that 79% of the 29 respondents participated in occupational activities (i.e., they were competitive or volunteer employees, homemakers, or students), a greater percentage than reported by other prevocational programs for patients with head injuries.

DNA hybridisation of cervical scrapes: comparison with cytological findings in Papanicolaou smears

One hundred and sixty four cervical scrapes were taken over 26 months from 143 women aged 17 to 53 years, using an Ayre spatula. A smear was prepared from each sample for Papanicolaou staining and for cytological examination for evidence of human papillomavirus (HPV) infection. The cells remaining on the spatula were harvested for DNA analysis. These samples were probed for HPV 6, 16, and 18 and the results of DNA hybridisation and cytology were compared. Cytological changes of HPV (anucleate keratinised and keratinised squamous cells, koilocytic change and dyskeratosis, or multinucleation, or both) were detected in 103 (72%) of the samples where HPV DNA was detected; koilocytic changes were present in only 67 (48%). It is concluded that screening for a range of viral changes is a more sensitive method of detecting HPV infection than screening for koilocytic change alone.

Distribution of epithelial membrane antigen in normal and abnormal endometrial tissue

The distribution of epithelial membrane antigen (EMA) on normal and abnormal endometrial tissue was studied as a method for distinguishing atypical hyperplasia from adenocarcinoma. Histological sections from 47 patients (nine adenocarcinoma, nine atypical hyperplasia, nine cystic hyperplasia, 19 normal endometrium and one sarcoma) were studied with an immunocytochemical alkaline phosphatase technique that demonstrated EMA. At a dilution of 1:1000 the majority of normal tissue was negative whereas all the abnormal tissue stained positively. At a slightly higher dilution all adenocarcinomas expressed the antigen although only a few of the hyperplastic lesions (16%) stained with the antibody. The value of this approach for automated screening is discussed.

Prognostic significance of herpes simplex virus antibody status in women with cervical intraepithelial neoplasia (CIN)

A total of 107 women with abnormal cervical smears showing cytological changes consistent with cervical intraepithelial neoplasia (CIN) 1 or CIN 2 were kept under regular cytological, colposcopic, virological and serological surveillance for an average of 18 months (range 9 months-3 years). Regression of the cervical lesion was noted in 31 (29%) and progression to CIN 3 in nine women (8.4%). We found a positive correlation between the presence of type 2 antibody and progression of CIN 1 and 2 to CIN 3 and a negative association with the presence of type 1 antibody and suggest the antibody status of a woman with CIN 1 or CIN 2 may provide a useful basis for follow-up. We found no association between the outcome of the cervical lesion and active infection with herpes simplex or cytomegalovirus or any other infectious agent or sex-related factors.

Reliability of endometrial aspiration cytology in the assessment of endometrial status

One hundred twenty women attending routine gynecologic clinics were investigated by endometrial aspiration cytology to determine whether outpatient assessment of endometrial status could be used to determine subsequent patient management. The results show that this technique allows recognition and distinction between cystic hyperplasia, adenomatous hyperplasia, and carcinoma, and the time of the menstrual cycle can be assessed when the endometrium is normal. Endometrial aspiration cytology is valuable in gynecologic practice for determining which women with abnormal bleeding, both premenopausal and postmenopausal, require further investigation. Furthermore, the technique has a role to play in monitoring the status of the endometrium in women at high risk of endometrial malignancy, particularly those receiving hormone replacement therapy.

Aspiration cytology versus histology in the assessment of the endometrium of women attending a menopause clinic

The endometrium of 100 women attending a menopause clinic was assessed cytologically, using the Isaacs cell sampler, and then histologically, using the Vabra suction curette. Satisfactory specimens for diagnosis were obtained in 96 per cent of cases with the Isaacs cell sampler and in 62 per cent of cases with the Vabra suction curette. There were eight discrepancies between the diagnoses obtained by the cytological and histological methods and these are analysed. Thirty patients were asked to grade the discomfort experienced during the procedures, and of these 26 found the Vabra method more painful than the Isaacs method.

Relation between the karyopyknotic index and plasma oestrogen concentrations after the menopause

The karyopyknotic index correlated significantly (p less than 0.001) with the plasma oestradiol but not plasma oestrone concentration in 38 postmenopausal women. This ties with previous findings that postmenopausal women with superficial dyspareunia have a more severe degree of vaginal atrophy than asymptomatic women, and that oestradiol is probably more important biologically than oestrone.

Endometrial assessment with Isaacs cell sampler

The value of the Isaacs endometrial cell sampler in the cytologic assessment of the endometrium was studied in 121 unanaesthetised patients aged over 40. Satisfactory aspirates for cytological diagnosis of endometrial state were obtained in 111 patients (91%) whereas endometrial specimens for histological diagnosis were obtained in only 89 patients (79%). In only four out of 83 cases were there diagnostic discrepancies between the aspirates and the curettings. It is concluded that the technique is safe, quick, comfortable, and reliable for assessing endometrial state. It should therefore prove valuable for screening, particularly in the management of menopausal women requiring oestrogen treatment.