Being a close family or friend of someone with bipolar disorder (BD) can lead to experiences of increased stress, anxiety and depressive symptoms related to the burden of caring. However, the lived ...experience of being a carer for a person with BD has not received significant research attention. This study aimed to gain further insight into the experiences of individuals in an informal caring role for someone with BD and determine what additional information and support these people need to take care of both themselves and the person they are caring for. Fifteen qualitative interviews were carried out with carers discussing their lived experiences with utilising coping strategies and supporting someone with BD. Following the interviews, thematic analysis was used to identify five key themes. These themes were: Separation of the person and the disorder, carer health and coping strategies, unpredictability and variability of symptoms, carer disillusionment and silencing, and story sharing and support needs. Overall, the findings highlighted the need for increased in-person and online support specifically tailored for carers with loved ones experiencing BD.
Abstract
Background
Limited attention has been paid to how and why older adults choose to engage with technology-facilitated health care (e-health), and the factors that impact on this. This scoping ...review sought to address this gap.
Methods
Databases were searched for papers reporting on the use of e-health services by older adults, defined as being aged 60 years or older, with specific reference to barriers and facilitators to e-health use.
Result
14 papers were included and synthesised into five thematic categories and related subthemes. Results are discussed with reference to the Unified Theory of Acceptance and Use of Technology2. The most prevalent barriers to e-health engagement were a lack of self-efficacy, knowledge, support, functionality, and information provision about the benefits of e-health for older adults. Key facilitators were active engagement of the target end users in the design and delivery of e-health programs, support for overcoming concerns privacy and enhancing self-efficacy in the use of technology, and integration of e-health programs across health services to accommodate the multi-morbidity with which older adults typically present.
Conclusion
E-health offers a potential solution to overcome the barriers faced by older adults to access timely, effective, and acceptable health care for physical and mental health. However, unless the barriers and facilitators identified in this review are addressed, this potential will not be realised.
ABSTRACT
Aims To evaluate computer‐ versus therapist‐delivered psychological treatment for people with comorbid depression and alcohol/cannabis use problems.
Design Randomized controlled trial.
...Setting Community‐based participants in the Hunter Region of New South Wales, Australia.
Participants Ninety‐seven people with comorbid major depression and alcohol/cannabis misuse.
Intervention All participants received a brief intervention (BI) for depressive symptoms and substance misuse, followed by random assignment to: no further treatment (BI alone); or nine sessions of motivational interviewing and cognitive behaviour therapy (intensive MI/CBT). Participants allocated to the intensive MI/CBT condition were selected at random to receive their treatment ‘live’ (i.e. delivered by a psychologist) or via a computer‐based program (with brief weekly input from a psychologist).
Measurements Depression, alcohol/cannabis use and hazardous substance use index scores measured at baseline, and 3, 6 and 12 months post‐baseline assessment.
Findings (i) Depression responded better to intensive MI/CBT compared to BI alone, with ‘live’ treatment demonstrating a strong short‐term beneficial effect which was matched by computer‐based treatment at 12‐month follow‐up; (ii) problematic alcohol use responded well to BI alone and even better to the intensive MI/CBT intervention; (iii) intensive MI/CBT was significantly better than BI alone in reducing cannabis use and hazardous substance use, with computer‐based therapy showing the largest treatment effect.
Conclusions Computer‐based treatment, targeting both depression and substance use simultaneously, results in at least equivalent 12‐month outcomes relative to a ‘live’ intervention. For clinicians treating people with comorbid depression and alcohol problems, BIs addressing both issues appear to be an appropriate and efficacious treatment option. Primary care of those with comorbid depression and cannabis use problems could involve computer‐based integrated interventions for depression and cannabis use, with brief regular contact with the clinician to check on progress.
This review aimed to identify free, high‐quality, smoking cessation mobile applications (apps) that adhere to Australian smoking cessation treatment guidelines.
A systematic search of smoking ...cessation apps was conducted using Google. The technical quality of relevant apps was rated using the Mobile Application Rating Scale. The content of apps identified as high quality was assessed for adherence to smoking cessation treatment guidelines.
112 relevant apps were identified. The majority were of poor technical quality and only six ‘high‐quality’ apps were identified. These apps adhered to Australian treatment guidelines in part. The efficacy of two apps had been previously evaluated.
In lieu of more substantial research in this area, it is suggested that the high‐quality apps identified in this review may be more likely than other available apps to encourage smoking cessation.
Smoking cessation apps have the potential to address many barriers that prevent smoking cessation support being provided; however few high‐quality smoking cessation apps are currently available in Australia, very few have been evaluated and the app market is extremely volatile. More research to evaluate smoking cessation apps, and sustained funding for evidence‐based apps, is needed.
Many families experience a smooth transition from military to civilian life. However, some can face intense challenges and significant disruption to family functioning, including mental health and ...substance use issues, domestic and family violence, marriage dissatisfaction or family breakdown, and even suicide. While some research has examined these transition experiences of ex‐serving men and women, few studies have focused on their children. Understanding the challenges and opportunities the military–civilian transition poses for young people is crucial if we are to develop effective interventions to meet their needs in the future. This paper reports on findings from a qualitative study that retrospectively explored the experiences of young people from ex‐serving Australian Defence Force families when their parents left the military. Using thematic analyses, three key themes relating to military family dynamics were identified: (i) increased mental health stress, (ii) shifts in family relationships and dynamics, and (iii) domestic violence and maltreatment. These themes are discussed alongside the existing literature, revealing the challenges experienced by young people during the military–civilian transition, but also their innate strengths and resources in coping with this major life event. Implications for the social work profession and for developing effective transition supports for young people from ex‐serving families are considered.
Expanding on the limited work in supportive care for friends and family caregivers of adults with a primary brain tumour, this review sought to examine all available evidence since 2010 on the ...efficacy and feasibility of supportive interventions for this population including non‐controlled studies. A systematic review of the literature was conducted on the feasibility and effectiveness/efficacy of supportive interventions for brain cancer caregivers in line with PRISMA guidelines. 13 studies met the eligibility criteria and were identified for inclusion. Most interventions employed tailored psychoeducation, and expert involvement via psychotherapy or care coordination. Only two interventions demonstrated clinically significant improvements. Findings indicate that dyadic yoga programs, and programs that enhance caregiver mastery to manage patient behavioural problems, may lead to improvements in some clinical outcomes. Results highlight the diverse nature of supportive interventions and indicate that support for primary brain tumour caregivers is currently suboptimal. Our findings illustrate an overall low certainty of evidence, with a need for more adequately powered randomised controlled trials. As the complexities of brain cancer care‐giving are an obstacle to standardised interventions, this review underscores the need for future trials to incorporate complimentary qualitative research methodologies.
To compare computer-delivered and therapist-delivered treatments for people with depression and comorbid addictive disorders.
Randomised controlled clinical trial.
Our study was conducted between ...January 2005 and August 2007 at seven study clinics in rural and urban New South Wales. Participants were 274 people who had a Beck Depression Inventory II (BDI-II) score ≥ 17 and were using alcohol and/or cannabis at harmful levels in the month before baseline. They were self-referred or referred from other sources such as outpatient drug treatment clinics, general practices and non-government support agencies.
Participants were randomly allocated to receive (1) integrated cognitive behaviour therapy and motivational interviewing (CBT/MI) delivered by a therapist; (2) integrated CBT/MI delivered by computer, with brief therapist assistance at the end of each session (clinician-assisted computerised CAC treatment), or (3) person-centred therapy (PCT), consisting of supportive counselling given by a therapist (the control group). All three treatments were delivered according to a manual developed specifically for the study.
Changes in depression, alcohol use and cannabis use at 3 months after baseline; significant predictors of change in the primary outcome variables.
Compared with computer- or therapist-delivered CBT/MI, PCT was associated with significantly less reduction in depression and alcohol consumption at 3 months. CAC therapy was associated with improvement at least equivalent to that achieved by therapist-delivered treatment, with superior results as far as reducing alcohol consumption. Change in depression was significantly predicted by change in alcohol use (in the same direction) and an ability to determine primacy, irrespective of whether this was for drug use or depression. Change in alcohol use was significantly predicted by changes in cannabis use and depression, and change in cannabis use by change in alcohol use. In the regression model, treatment allocation did not independently predict change, but was associated with significant reduction in depression and alcohol use at 3 months.
Over a 3-month period, CBT/MI was associated with a better treatment response than supportive counselling. CAC therapy was associated with greater reduction in alcohol use than therapist-delivered treatment.
ACTRN12610000274077.
Background and aims
Alcohol use and anxiety often co‐occur, causing increased severity impairment. This protocol describes a randomized controlled trial (RCT) that aims to test the efficacy and ...cost‐effectiveness of a web‐based, self‐guided alcohol and anxiety‐focused program, compared with a web‐based brief alcohol‐focused program, for young adults who drink at hazardous levels and experience anxiety. It will also test moderators and mechanisms of change underlying the intervention effects.
Design
This RCT will be conducted with a 1:1 parallel group.
Setting
The study will be a web‐based trial in Australia.
Participants
Individuals aged 17–30 years who drink alcohol at hazardous or greater levels and experience at least mild anxiety (n = 500) will be recruited through social media, media (TV, print) and community networks.
Intervention and comparator
Participants will be randomly allocated to receive a web‐based, integrated alcohol‐anxiety program plus technical and motivational telephone/e‐mail support (intervention) or a web‐based brief alcohol‐feedback program (control).
Measurements
Clinical measures will be assessed at baseline, post‐intervention (2 months), 6 months (primary end‐point), 12 months and 18 months. Co‐primary outcomes are hazardous alcohol consumption and anxiety symptom severity. Secondary outcomes are binge‐drinking frequency; alcohol‐related consequences; depression symptoms; clinical diagnoses of alcohol use or anxiety disorder (at 6 months post‐intervention), health‐care service use, educational and employment outcomes; and quality of life. Mediators and moderators will also be assessed. Efficacy will be tested using mixed models for repeated measures within an intention‐to‐treat framework. The economic evaluation will analyze individual‐level health and societal costs and outcomes of participants between each trial arm, while mediation models will test for mechanisms of change.
Comments
This will be the first trial to test whether a developmentally targeted, web‐based, integrated alcohol‐anxiety intervention is effective in reducing hazardous alcohol use and anxiety severity among young adults. If successful, the integrated alcohol‐anxiety program will provide an accessible intervention that can be widely disseminated to improve wellbeing of young adults, at minimal cost.
Objectives
To investigate the effectiveness of a school‐based multiple health behaviour change e‐health intervention for modifying risk factors for chronic disease (secondary outcomes).
Study design
...Cluster randomised controlled trial.
Setting, participants
Students (at baseline 2019: year 7, 11–14 years old) at 71 Australian public, independent, and Catholic schools.
Intervention
Health4Life: an e‐health school‐based multiple health behaviour change intervention for reducing increases in the six major behavioural risk factors for chronic disease: physical inactivity, poor diet, excessive recreational screen time, poor sleep, and use of alcohol and tobacco. It comprises six online video modules during health education class and a smartphone app.
Main outcome measures
Comparison of Health4Life and usual health education with respect to their impact on changes in twelve secondary outcomes related to the six behavioural risk factors, assessed in surveys at baseline, immediately after the intervention, and 12 and 24 months after the intervention: binge drinking, discretionary food consumption risk, inadequate fruit and vegetable intake, difficulty falling asleep, and light physical activity frequency (categorical); tobacco smoking frequency, alcohol drinking frequency, alcohol‐related harm, daytime sleepiness, and time spent watching television and using electronic devices (continuous).
Results
A total of 6640 year 7 students completed the baseline survey (Health4Life: 3610; control: 3030); 6454 (97.2%) completed at least one follow‐up survey, 5698 (85.8%) two or more follow‐up surveys. Health4Life was not statistically more effective than usual school health education for influencing changes in any of the twelve outcomes over 24 months; for example: fruit intake inadequate: odds ratio OR, 1.08 (95% confidence interval CI, 0.57–2.05); vegetable intake inadequate: OR, 0.97 (95% CI, 0.64–1.47); increased light physical activity: OR, 1.00 (95% CI, 0.72–1.38); tobacco use frequency: relative difference, 0.03 (95% CI, –0.58 to 0.64) days per 30 days; alcohol use frequency: relative difference, –0.34 (95% CI, –1.16 to 0.49) days per 30 days; device use time: relative difference, –0.07 (95% CI, –0.29 to 0.16) hours per day.
Conclusions
Health4Life was not more effective than usual school year 7 health education for modifying adolescent risk factors for chronic disease. Future e‐health multiple health behaviour change intervention research should examine the timing and length of the intervention, as well as increasing the number of engagement strategies (eg, goal setting) during the intervention.
Trial registration
Australian New Zealand Clinical Trials Registry: ACTRN12619000431123 (prospective).
Introduction
Active contact and follow‐up interventions have been shown to be effective in reducing repetition of hospital‐treated self‐harm. The Way Back Support Service (WBSS) is a new service ...funded by the Australian government to provide three months of non‐clinical after‐care following a hospital‐treated suicide attempt. The aim of this study was to investigate the effectiveness of WBSS in reducing deliberate self‐poisoning (DSP) and psychiatric hospital admissions over a 12‐month follow‐up period for a population of DSP patients within the Hunter (Australia) region.
Methods
A non‐randomized, historical controlled (two periods) trial design with intention‐to‐treat analyses. Outcome data were drawn from hospital records.
Results
There were a total of 2770 participants across study periods. There were no significant differences between cohorts for proportion with any, or number of, re‐admissions for DSP in the follow‐up period. For psychiatric admissions, the intervention cohort had a non‐significantly greater proportion with any psychiatric admission and significantly more admissions compared to one of the control cohorts.
Conclusion
The WBSS model of care should be modified to strengthen treatment engagement and retention and to include established, clinical, evidence‐based treatments shown to reduce DSP repetition. Any modified WBSS model should be subject to further evaluation.
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