Biomedical subjects

A F Jorm

Publications and source records attributed to A F Jorm.

At least 37 records · Page 2Linked to original sources

PubMed2001

Predictors of partially met or unmet need reported by consumers of mental health services: an analysis of data from the Australian National Survey of Mental Health and Wellbeing.

OBJECTIVE: We examined data from the 1997 National Survey of Mental Health and Wellbeing to identify factors associated with consumers of mental health help reporting that their needs were unmet or only partially met. Predictor factors included sociodemographic variables, psychological morbidity measures and type of health practitioner seen. METHOD: Five types of mental health help were considered: information, medication, psychological therapy, social interventions and skills training. A respondent's unmet need for each type of mental health help was given one of three values: 0: no unmet need reported; 1: some but not enough help of this type provided; and 2: no help of this type provided although it was needed. Multiple ordered logistic regressions were undertaken to identify predictor variables associated with reporting unmet need for each type of help. RESULTS: Few sociodemographic factors were found to be associated with consumers reporting unmet need for mental health help. Those with less education were more likely to report unmet need for medication. Being male, living alone and being unemployed were associated with unmet need for skills training. Having seen a general practitioner for mental health reasons was found to be associated with reporting unmet need for both information and social interventions. Self-identifying, or being diagnosed, as having an anxiety disorder was associated with reporting unmet need for four of the five types of help. CONCLUSIONS: In this exploratory analysis, we examined factors associated with consumers of mental health help reporting that their needs were unmet or partially met. We found that the needs of those with anxiety problems were not generally well met. Our findings also indicate there is a need to continue to improve collaboration between the medical and community services sectors.

Australia↗

PubMed2001

History of depression as a risk factor for dementia: an updated review.

OBJECTIVE: This review updates an earlier meta-analysis of the data on history of depression as a risk factor for dementia. It also considers the available evidence on the hypotheses proposed to explain the association between history of depression and dementia. METHOD: A meta-analysis was carried out on results from seven case-control and six prospective studies. A qualitative review was carried out on the evidence related to the hypotheses to explain the association. RESULTS: The meta-analysis found evidence to support an association from both case-control studies (estimated relative risk 2.01; 95% CI 1.16-3.50) and prospective studies (estimated relative risk 1.87; 95% CI 1.09-3.20). However, the evidence did not clearly support any one hypothesis explaining the association. The most likely contenders are: (i) depression can be an early prodrome of dementia, (ii) depression brings forward the clinical manifestation of dementing diseases, and (iii) depression leads to damage to the hippocampus through a glucocorticoid cascade. CONCLUSIONS: The possibility that history of depression is a risk factor for dementia needs to be taken seriously and explanations of the association need to be further researched.

Aged↗

PubMed2001

Mental health literacy survey of psychiatrically and generally trained nurses employed in a Singapore psychiatric hospital.

Mental health literacy studies consider the capacity of respondents to recognize certain psychiatric disorders, judge the comparative utility of a range of interventions, and make estimates about outcome and prognostic issues. We report such a study involving a sample of nursing staff employed at a large psychiatric institution in Singapore, and who were provided with separate brief vignettes of mania, schizophrenia and depression. Subjects were highly accurate in 'diagnosing' schizophrenia, less accurate for depression and even less accurate in diagnosing mania. Depression was alternately diagnosed as stress, mania was most commonly misdiagnosed as schizophrenia, and for both psychotic conditions, a percentage returned non-psychotic diagnoses. In terms of treatment options, staff distinctly favoured a 'medical model' and viewed traditional and alternative healing options as distinctly harmful. Analyses contrasted psychiatrically trained and generally trained nurses, but identified few significant differences. Such information has the potential to shape the education and training of mental health professional staff, as well as provide important insights about how nurses may diagnose, view and favour alternative treatments and strategies to assist those with common psychiatric disorders.

Data Collection↗

PubMed2001

Association of hypotension with positive and negative affect and depressive symptoms in the elderly.

BACKGROUND: Previous research associating hypotension with depression has produced inconsistent results. A possible reasons is that depressive symptom scales reflect both high negative affect and low positive affect. AIMS: To examine the association of hypotension with depressive symptoms, negative affect and positive affect. METHOD: Community survey of 340 elderly persons aged 77-99 years. RESULTS: Diastolic hypotension had a weak association with depression, no association with negative affect and a strong inverse association with positive affect. Systolic hypertension was associated with positive affect. Use of antihypertensive medication was independently associated with lower positive affect. CONCLUSIONS: Diastolic hypotension shows a specific association with low positive affect. This association may explain the weak and inconsistent results of earlier studies relating hypotension to depression.

Affect↗

PubMed2001

Life satisfaction among the very old: a survey on a cognitively intact sample aged 90 years or above.

The purpose of the study was to measure life satisfaction and the factors believed to influence it. The study involved 105 very old people, ninety years and above, who were not cognitively impaired, living in the inner part of Stockholm, Sweden. In order to assess life satisfaction, the Life Satisfaction Index-B (LSI-B) and Life Satisfaction Index-Z (LSI-Z) were used. Information about life events, activities, personality and social contacts were collected in order to determine their relative influence on life satisfaction. Factors associated with life satisfaction were also investigated in a content analysis to find out what the elderly themselves believe gives them life satisfaction. Results showedthat health and an emotionally stable personality were, independently of other factors, the most important factors for life satisfaction among the very old.

Aged↗

PubMed2001

Memory complaints as a precursor of memory impairment in older people: a longitudinal analysis over 7-8 years.

BACKGROUND: There is considerable dispute about the validity of memory complaints. While some studies find that complaints are an early indicator of dementia or cognitive decline, there are also many studies showing that complaints are more closely associated with negative affect (depression, anxiety and neuroticism). The present paper used three-wave longitudinal data to test three hypotheses: (1) that memory complaints reflect an evaluation of present and past memory performance; (2) that memory complaints predict future memory performance; and (3) that memory complaints predict current and future negative affect. METHODS: A longitudinal study was carried out with a community sample of people aged 70 and over. Participants were assessed for memory complaints, memory performance and negative affect at three waves separated by 3.6 years and 4.0 years. There were 331 persons with data on all relevant variables. The data were analysed using structural equation modelling. RESULTS: Significant paths in the structural model were found from memory performance to future memory complaints, as well as from memory complaints to future memory performance, supporting hypotheses 1 and 2. Memory complaints were associated with current negative affect, but did not predict future negative affect. CONCLUSIONS: Memory complaints do reflect perceptions of past memory performance and are also an early manifestation of memory impairment. However, current negative affect (anxiety and depression symptoms) shows the greatest association with memory complaints.

Affect↗

PubMed2000

Association of smoking and personality with a polymorphism of the dopamine transporter gene: results from a community survey.

In studies that used mixed volunteer samples, Lerman et al. [1999: Health Psychol 18:14-20] and Sabol et al. [1999: Health Psychol 18:7-13] reported on an association of smoking with a polymorphism of the dopamine transporter gene. We attempted to replicate this association in a nonvolunteer community sample of 861 Caucasians. No associations were found with either smoking initiation or smoking cessation. Sabol et al. [1999] also reported on an association of the dopamine transporter polymorphism with the personality trait of novelty seeking. However, we failed to find any associations with a range of personality traits, including a scale of fun seeking that correlates with novelty seeking. These negative findings suggest that either the original associations are not replicable or that any association is very small.

Adult↗

PubMed2000

COMT and DRD3 polymorphisms, environmental exposures, and personality traits related to common mental disorders.

In a community sample of 2,327 Caucasians, we tested the hypotheses that polymorphisms in the COMT and DRD3 genes are associated with personality traits conferring vulnerability to anxiety, depression, or alcohol misuse, or with current symptoms of these; and that the association is stronger in persons who also have been exposed to stressor experiences. To conserve resources and to allow replication, the genetic analysis was undertaken in two stages. For the COMT polymorphism, no statistically significant associations were found in the first sample of 862 persons. The remainder of the sample was therefore not analysed for that gene. For the DRD3 polymorphism, those in the first sample with at least one of the Ser(9) alleles had significantly higher scores in neuroticism (p=0.006) and behavioral inhibition (p=0.003). There was a trend, failing to meet the 1% significance criterion, for those with this genotype also to have higher depression and anxiety. The groups did not differ in alcohol use. In persons with the Ser(9) allele who were also exposed to stressors, there was a higher level of depression at the 5% level; and the depression level was higher in homozygotes. But when the remainder of the sample (1,465) was analysed, none of the associations reached statistical significance. We conclude that neither the COMT nor DRD3 polymorphisms are associated with anxiety, depression, or alcohol abuse. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:102-107, 2000

Catechol O-Methyltransferase↗

PubMed2000

Assessing candidate genes as risk factors for mental disorders: the value of population-based epidemiological studies.

BACKGROUND: It is now possible to routinely collect DNA for the investigation of genetic risk factors in psychiatric epidemiology. However, concerns have been raised about the investigation of genetic risk factors in population surveys and in case-control studies with population controls, because of spurious associations arising through population stratification. To overcome this problem, some geneticists advocate the use of family controls and studies on isolated populations. However, such approaches may not be the best for psychiatric epidemiology. METHOD: A critical analysis is made of arguments against the investigation of genetic risk factors in studies with population controls. RESULTS: It is argued that concerns about population stratification have been overblown. It is simply a form of confounding and can occur in studies of environmental as well as genetic risk factors. Epidemiologists have traditionally dealt with this and other types of confounding by matching on potential confounders in the design of the study, or stratification by confounders in the analysis. Family controls overcome population stratification, but not other forms of confounding. They are a good choice when the sole interest is genetic risk factors, but psychiatric epidemiologists are typically interested in both genetic and environmental factors. Family controls are poor for examining environmental risk factors because they can give rise to over-matching. Isolated populations may produce genetic associations that do not generalize to other populations, and they may have a restricted range of environments. CONCLUSION: We conclude that population surveys and case-control studies using population controls are suitable for the investigation of both genetic and environmental risk factors and have greater public health relevance than alternative designs.

Epidemiologic Studies↗

PubMed2000

Public belief systems about the helpfulness of interventions for depression: associations with history of depression and professional help-seeking.

BACKGROUND: Previous research has found that there are major differences between public and professional beliefs about the helpfulness of interventions for depression. The public appear to be guided by general belief systems about the helpfulness of medical, psychological and lifestyle interventions rather than by specific knowledge about what interventions are effective for depression. The present paper examines the effect that experiencing depression and receiving treatment might have on these beliefs. METHOD: The study involved a postal survey of 3109 adults from a region of New South Wales, Australia. Respondents were presented with a vignette describing a person with depression. They were asked to rate the likely helpfulness of various types of professional and non-professional help and of pharmacological and non-pharmacological interventions for the person described in the vignette. Respondents also completed the Goldberg Depression Scale and were asked whether they had ever had an episode of depression and whether they had seen a counsellor or a doctor for it at the time. Structural equation modelling was used to investigate the associations of history of depression and professional help-seeking with belief systems. RESULTS: A three-factor model was found to fit the helpfulness ratings, with factors reflecting beliefs in medical, psychological and lifestyle interventions. People who had sought help for depression were less likely to believe in the helpfulness of lifestyle interventions and more likely to believe in medical interventions. As well as these general associations with belief systems, having sought help for depression had a number of specific associations with beliefs. Controlling for general belief systems, those who had sought help were more likely to rate antidepressants, holidays, massage and new recreational pursuits as helpful, and were less likely to rate ECT and family as helpful. Those who had a history of depression but had not sought help were more likely to rate counselling as helpful, and less likely to rate family as helpful. Those with current depressive symptoms were less likely to rate telephone counselling, family and friends as helpful. CONCLUSION: Having sought help for depression is associated with general belief systems about the helpfulness of lifestyle and medical interventions and also has some associations with specific beliefs that may reflect experiences with treatment (e.g. the helpfulness of antidepressants). Those currently depressed or with a history of depression are less likely to regard family as helpful, possibly due to poorer social support. Generally speaking, having sought help is associated with beliefs closer to those of professionals.

Adult↗

PubMed2000

Does old age reduce the risk of anxiety and depression? A review of epidemiological studies across the adult life span.

BACKGROUND: There is considerable disagreement about what happens to the risk of anxiety and depression disorders and symptoms as people get older. METHODS: A search was made for studies that examine the occurrence of anxiety, depression or general distress across the adult life span. To be included, a study had to involve a general population sample ranging in age from at least the 30s to 65 and over and use the same assessment method at each age. RESULTS: There was no consistent pattern across studies for age differences in the occurrence of anxiety, depression or distress. The most common trend found was for an initial rise across age groups, followed by a drop. Two major factors producing this variability in results were age biases in assessment of anxiety and depression and the masking effect of other risk factors that vary with age. When other risk factors were statistically controlled, a more consistent pattern emerged, with most studies finding a decrease in anxiety, depression and distress across age groups. This decrease cannot be accounted for by exclusion of elderly people in institutional care from epidemiological surveys or by selective mortality of people with anxiety or depression. CONCLUSION: There is some evidence that ageing is associated with an intrinsic reduction in susceptibility to anxiety and depression. However, longitudinal studies covering the adult life span are needed to distinguish ageing from cohort effects. More attention needs to be given to understanding the mechanism behind any ageing-related reduction in risk for anxiety and depression with age. Possible factors are decreased emotional responsiveness with age, increased emotional control and psychological immunization to stressful experiences.

Aged↗

PubMed2000

Non-linear relationships in associations of depression and anxiety with alcohol use.

BACKGROUND: Many studies have demonstrated co-morbidity of alcohol abuse/dependence with mood and anxiety disorders but relatively little is known about anxiety and depression across the full continua of alcohol consumption and problems associated with drinking. METHODS: Participants from a general population sample (N = 2725) aged 18-80 years completed the Alcohol Use Disorders Identification Test (AUDIT) and four measures of negative affect (two depression and two anxiety symptom scales) included in a self-completion questionnaire. RESULTS: High consumption, AUDIT total score, and AUDIT problems score were associated with high negative affect scores in participants under 60 years old (ORs in the range 1.80-2.83). Graphical and statistical analyses using continuous measures of alcohol use/problems and negative affect identified non-linear relationships where abstainers and occasional drinkers, as well as heavy and problem drinkers, were at risk of high anxiety and depression levels. This pattern, however, was not found in those aged > or = 60 years. The U-shaped relationship was not an artefact of abstainers being typical of the general population in their distribution of negative affect. CONCLUSIONS: Studies of co-morbidity should acknowledge the possibility of non-linear associations and employ both continuous and discrete measures. Abstainers, as well as heavy drinkers, are at increased risk of symptoms of depression and anxiety disorders. Psychosocial factors may play a role in the U-shaped relationship between alcohol consumption and mortality.

Adolescent↗

PubMed2000

Informant ratings of cognitive decline in old age: validation against change on cognitive tests over 7 to 8 years.

BACKGROUND: Informant questionnaires on cognitive decline are increasingly used as screening tests for dementia. Informants can provide a longitudinal perspective that is not possible with cognitive screening tests administered at one point in time. However, there are limited data on the validity of such questionnaires when judged against longitudinal change on cognitive tests. METHODS: A community sample of elderly people aged > or = 70 was assessed on cognitive tests at baseline and after a follow-up of 7-8 years. The participants were given the Mini-Mental State Examination and tests of episodic memory and mental speed. At follow-up, the short-form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) was completed by informants for 287 of the participants. RESULTS: Elderly people who were rated by informants as having moderate or severe decline had declined significantly on cognitive tests. The IQCODE correlated as highly with cognitive test change scores as these change scores correlated with each other. CONCLUSIONS: The IQCODE is a valid way of assessing cognitive decline when assessment can be carried out only at one point in time.

Age Factors↗

PubMed2000

Distress experienced by participants during an epidemiological survey of posttraumatic stress disorder.

We examined the potential for epidemiological studies of mental disorders, specifically of posttraumatic stress disorder (PTSD), to cause further harm to participants involved. Of 1,000 randomly selected Australian Vietnam veterans, 641 agreed to participate in an epidemiological survey. Participants were asked about distress experienced during the interview when traumatic events were raised. Significant distress attributed to the interview was reported by 75.3% of those with current PTSD, 56.5% of those with past PTSD, and 20.6% of those with no PTSD diagnosis. Distress did not affect participants' use of medical services following the interview nor did it affect their willingness to continue participating in the study. We concluded that research interviews about PTSD may cause short-term distress, but found no evidence of long-term harm.

Adult↗

PubMed2000

Predicting anxiety and depression from personality: is there a synergistic effect of neuroticism and extraversion?

In a longitudinal study of college students, B. S. Gershuny and K. J. Sher (1998) found that high neuroticism and low extraversion had a synergistic effect in predicting anxiety and depression 3 years later. This article attempted to replicate their finding using data from 2 community samples: (a) a cross-sectional survey of 2,677 persons aged 18-79 years, and (b) a longitudinal study in which 441 persons aged 70 or older were followed over 3-4 years. Both studies found that neuroticism predicted anxiety and depression, but there were no Neuroticism x Extraversion interaction effects. These results cast doubt on the generalizability of the original findings.

Adolescent↗

PubMed2000

Association of a functional polymorphism of the serotonin transporter gene with anxiety-related temperament and behavior problems in children: a longitudinal study from infancy to the mid-teens.

A polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) has been associated with anxiety-related personality traits in adults. Initial studies showed that the short allele was associated with higher neuroticism, anxiety and harm avoidance. However, most attempts to replicate these findings have been negative. Because the association of candidate polymorphisms with behavioral traits may vary with stage of development, we investigated the association using participants in a longitudinal study of childhood temperament. DNA was available for 660 children who had been assessed for temperament from 4-8 months to 15-16 years, and for behaviour problems from 3-4 years to 15-16 years. No significant associations were found at most ages. However, at ages 13-14 years and 15-16 years, the long/long genotype was associated with higher anxiety. These findings do not support an association of the short allele with anxiety-related traits in early life.

Adolescent↗

PubMed2000

Risk factors for depression and anxiety in abstainers, moderate drinkers and heavy drinkers.

AIMS: To identify risk factors for depression and anxiety that are more prevalent in abstainers than in moderate drinkers and to estimate their contribution to U-shaped relationships of depression and anxiety with alcohol consumption. DESIGN: Cross-sectional general population sample. SETTING: Canberra, Australia. PARTICIPANTS: 2725 subjects completed questionnaires, including 1128 men and 1258 women aged 18-59 years. MEASUREMENTS: Consumption categories from AUDIT quantity/frequency items: (1) non-drinkers (no alcohol in the past year), (2) occasional drinkers (monthly or less), (3) lower-level drinkers (up to 14 standard drinks per week for men and seven for women), (4) higher-level drinkers (up to 28 and 14 standard drinks per week, respectively), and (5) those drinking at hazardous or harmful levels (over 28 and 14 standard drinks per week, respectively). Goldberg and DSSI/sAD depression and anxiety scales. A range of demographic, socio-economic, socio-environmental and personality factors. FINDINGS: Non-drinkers were more likely than lower-level drinkers to have low status occupations, poor education, current financial hardship, poor social support and recent stressful life events, and scored lower on extraversion, fun-seeking and drive. Many of these characteristics also applied to hazardous/harmful drinkers. In multivariate models, these risk factors accounted for a substantial part of the higher depression and anxiety scores of non-drinkers and occasional drinkers relative to lower-level drinkers. CONCLUSIONS: Abstainers have a range of characteristics known to be associated with anxiety, depression and other facets of ill health, and these factors may contribute significantly to their elevated levels of depression and anxiety.

Adolescent↗

PubMed2000

Medical-care costs associated with posttraumatic stress disorder in Vietnam veterans.

OBJECTIVE: This study examined the relationship between medical-care costs of Vietnam veterans and predictor factors, including posttraumatic stress disorder (PTSD). METHOD: We merged medical-care cost data from the Department of Veterans' Affairs and the Health Insurance Commission with data from an epidemiological study of 641 Australian Vietnam veterans. Posttraumatic stress disorder and other factors were examined as predictors of medical-care cost using regression analysis. RESULTS: We found that a diagnosis of PTSD was associated with medical costs 60% higher than average. Those costs appeared to be partly associated with higher treatment costs for physical conditions in those with PTSD and also related mental health comorbidities. Major predictors of medical-care cost were age ($137 per year for each 5-year increase in age) and number of diagnoses reported ($81 to $112 per year for each diagnosis). Mental health factors such as depression ($14 per year for each symptom reported) and anxiety ($27 per year for each symptom reported) were also important predictors. CONCLUSIONS: The findings indicate that, however they are incurred, high healthcare and, presumably, also economic and personal costs are associated with PTSD. There is an important social obligation as well as substantial economic reasons to deal with these problems. From both perspectives, continued efforts to identify and implement effective prevention and treatment programs are warranted.

Adult↗