Biomedical subjects

A F Jorm

Publications and source records attributed to A F Jorm.

At least 55 records · Page 3Linked to original sources

PubMed2000

Who uses mental health services in Australia? An analysis of data from the National Survey of Mental Health and Wellbeing.

OBJECTIVE: This study sought to identify sociodemographic and psychological measures associated with utilisation of mental health services in Australia, using information collected through the 1997 National Survey of Mental Health and Wellbeing. METHOD: Twenty-one potential predictor variables were selected from the National Survey. Predisposing and enabling factors included age, sex, marital status, labour force status, geographical location and level of education. Predictor variables measuring need for services included the General Health Questionnaire score, a neuroticism scale, diagnoses of affective, anxiety and substance-abuse disorders from the Composite International Diagnostic Interview, and self-identified depression, anxiety and substance abuse. Simple and multiple logistic regressions were undertaken to identify predictor variables associated with use of mental health services from general practitioners, psychiatrists, psychologists and other health professionals. RESULTS: General practitioners were the most commonly reported providers of mental health services with 76% of those receiving any mental health care reporting using this type of service. Using multiple logistic regression, the predictor variables most associated with use of mental health services were measures of the need for such services, such as psychological distress and mental disorder. After controlling for need variables, the sociodemographic variables associated with using services provided by any health professional were being female, level of education and being separated. Living in a remote area was associated with lower use of specialist services, but not with general practitioner services. Older age was associated with less use of psychologists and other health professionals. Income and having a usual language other than English did not affect service use. CONCLUSIONS: The factors most strongly related to Australians' use of mental health services are their having a diagnosed affective, anxiety or substance-abuse disorder and their self-identifying as having depression or anxiety. Although there are regional inequalities in levels of utilisation of mental health services, these are seen more with specialist services than with those provided by general practitioners.

Adolescent↗

PubMed2000

A comparative mental health literacy survey of psychiatrists and other mental health professionals in Singapore.

OBJECTIVE: The objectives of this study are, first, to replicate and extend an Australian approach to assessing mental health literacy by studying a sample of Singapore mental health professionals, and to focus on differences between judgements made by the psychiatrists in comparison with the other mental health professionals. Second, to compare the psychiatrists' judgements with those of Australian psychiatrists. METHOD: The Australian questionnaire, assessing responses in relation to vignettes of major depression and to schizophrenia was extended by adding a third vignette of mania, and by the addition of several region-specific response options. Nearly 500 questionnaires were distributed to representative staff (psychiatrists, nurses and allied health) of a large psychiatric institution in Singapore, with a response rate of 81%. Psychiatrists' judgements were compared with all other hospital staff, and with Australian psychiatrists' judgements. RESULTS: The two principal contrast groups (Singapore psychiatrists and other Singapore mental health professionals) differed slightly in terms of diagnostic accuracy. The psychiatrists differed in favouring a more professionally focused model of intervention, while both professional groups viewed traditional healers and their practices as distinctly unhelpful. Direct comparison of psychiatrist ratings generated in Singapore and in Australia revealed quite similar response profiles. CONCLUSIONS: In addition to generating data of some intrinsic importance, comparison with Australian survey data allows the potential impact of regional and cultural differences, as well as of varying psychiatric practices, to be identified. Responses identified more similarities than differences in the judgements of the psychiatrists from the two countries.

Australia↗

PubMed2000

Attitudes towards people with depression: effects on the public's help-seeking and outcome when experiencing common psychiatric symptoms.

OBJECTIVE: To determine whether people's attitudes towards a person who has experienced depression influence them in (i) the types of actions they take to help themselves if they experience common psychiatric symptoms, and (ii) the degree to which their symptoms improve. METHOD: A postal survey was carried out with 3,109 adults to assess attitudes and symptoms of anxiety and depression. Attitudes were assessed by questions on a depressed person's likely long-term outcome in various areas of life and whether the respondents thought the depressed person was likely to experience discrimination. A follow-up survey was carried out 6 months later with 422 persons who had a high level of symptoms at baseline. These individuals were asked about whether they had taken various actions to relieve their symptoms. RESULTS: The attitude measures did not predict use of actions which involved someone else having to know that the person had psychiatric symptoms, nor use of actions which did not. The attitude measures also did not predict change in anxiety and depression symptoms. CONCLUSIONS: The attitude measures did not predict patterns of help-seeking or outcome for people with common psychiatric symptoms. However, attitudes towards depression were quite benign and the situation could be different for people with severe mental disorders.

Adult↗

PubMed2000

Mental health nurses' beliefs about interventions for schizophrenia and depression: a comparison with psychiatrists and the public.

OBJECTIVE: The main objective of this paper was to investigate and compare mental health nurses' beliefs about interventions for schizophrenia and depression with those of psychiatrists and the public. Factors affecting nurses' beliefs were also investigated. METHOD: This research used methods employed in previous surveys of professional and public beliefs. A postal survey of 673 Australian mental health nurses was carried out. The survey was comprised of a vignette describing a person with either depression or schizophrenia. Participants rated whether particular medical, psychological and lifestyle interventions were helpful, harmful or neither. Factors examined included: nurses' age, sex, degree of contact with similar problems, work setting, level of highest qualification and whether their education was hospital-based or completed within the tertiary sector. RESULTS: The nurses agreed with psychiatrists (but not the public) about the interventions most likely to be helpful, such as antidepressants for depression and antipsychotic medication for schizophrenia. However, there were many differences between nurses, psychiatrists and the public. Nurses were more likely than psychiatrists to believe that certain non-standard interventions such as vitamins, minerals and visiting a naturopath would be helpful. Nurses' beliefs tended to form a bridge between the attitudes of psychiatrists and the public for some of these non-standard interventions. Age, work setting and qualifications were related to nurses' intervention beliefs. CONCLUSIONS: Mental health practitioners need to be aware of a range of beliefs within mental health services. The acknowledgement of differing belief systems is important for high quality, integrated care.

Adolescent↗

PubMed2000

Public beliefs about the helpfulness of interventions for depression: effects on actions taken when experiencing anxiety and depression symptoms.

OBJECTIVE: Previous research has shown that the public have different beliefs to mental health professionals about the helpfulness of interventions for mental disorders. However, it is not known whether the public's beliefs actually influence their behaviour when they develop psychiatric symptoms. METHOD: A postal survey of 3,109 Australian adults was used to assess beliefs about the helpfulness of a broad range of interventions for depression, as well as respondents' current level of anxiety and depression symptoms and any history of treated depression. A follow-up survey of 422 persons who had a high level of symptoms at baseline was conducted 6 months later. These people were asked which interventions they had used to reduce their symptoms. An analysis was carried out to see whether beliefs and other factors at baseline predicted subsequent use of interventions. RESULTS: There were some major discrepancies between the ranking of interventions as likely to be helpful and the ranking of how frequently they were actually used. Interventions involving mental health professionals were often rated as likely to be helpful, but were rarely used in practice. Other simple, cheap and readily available interventions were used the most frequently, but were not the most likely to be rated as helpful. The most consistent predictors across all interventions used were gender, history of treatment, current symptoms and belief in a particular intervention. Of particular interest was the finding that beliefs in the helpfulness of antidepressants predicted their use. However, beliefs were not predictors of use for all interventions. CONCLUSIONS: Beliefs about the helpfulness of an intervention did not always predict actual use of that intervention, although beliefs did predict use of antidepressants. Therefore, campaigns that change public beliefs about effective treatments may also influence actual use of treatments. Interventions preferred by professionals are not frequently used at present. Most people with anxiety and depression symptoms rely primarily on simple self-help interventions, the effectiveness of which has been little researched.

Adult↗

PubMed2000

Item bias in the Center for Epidemiologic Studies Depression Scale: effects of physical disorders and disability in an elderly community sample.

The Center for Epidemiologic Studies Depression Scale (CES-D) is frequently used in studies of elderly individuals. One controversy regarding its use turns on the issue of whether the effect of physical disorder on the CES-D total score reflects genuine effects on depression or item-level artifacts. The present article addresses this issue using medical examination data from 506 community-dwelling individuals aged 75 or older. A form of structural equation modeling, the MIMIC model, is used, enabling the effect of a physical disorder on CES-D total score to be partitioned into bias and genuine depression components. The results show substantial physical disorder-related artifacts with the CES-D total score. Caution is required in the use of CES-D (and possibly other) depression scales in groups in which physical disorders are present, such as in elderly individuals.

Aged↗

PubMed2000

Association of a functional polymorphism of the monoamine oxidase A gene promoter with personality and psychiatric symptoms.

A functional polymorphism in the promoter of the monoamine oxidase gene has recently been described by Sabol et al. This polymorphism is a strong candidate for associations with personality traits and psychiatric symptoms. We report relevant data from a general population sample of 850 Caucasian Australians. We found no associations with anxiety and depression symptoms, with personality traits that predispose to anxiety (neuroticism, behavioral inhibition, negative affect) or to a personality trait related to antisocial behavior (psychoticism).

Adult↗

PubMed2000

Long-term benzodiazepine use by elderly people living in the community.

OBJECTIVE: To investigate the prevalence of long-term benzodiazepine use in an elderly community sample, and factors associated with such use. METHOD: Data came from the Sydney Older Persons Study, a longitudinal study of people aged 75 or over. There were 337 subjects who were interviewed in 1991-93, and subsequently followed up after three and 4.5 years. At the first interview, subjects were assessed for socio-demographic characteristics, physical and mental health, and use of health services. At the first and subsequent interviews, subjects were asked about use of medications, including benzodiazepines. RESULTS: There were 16.6% who were using benzodiazepines at the time of all three interviews, while a further 19.6% were using them at one or two interviews. In a multivariate ordered logit regression model, long-term benzodiazepine use was associated with treatment for nervous conditions, restless sleep, being female, being divorced and greater contact with medical services. CONCLUSIONS: The prevalence of benzodiazepine use in the elderly is high and much of this use is long term. The high prevalence of benzodiazepine use stands in contrast to the findings from national surveys that the elderly living in the community tend to have better mental health than younger age groups. IMPLICATIONS: Efforts are needed to reduce the number of elderly people becoming long-term users. The use of benzodiazepines in this age group is of particular concern, because they may be a risk factor for falls and for cognitive impairment in the elderly.

Aged↗

PubMed2000

Mental health literacy. Public knowledge and beliefs about mental disorders.

BACKGROUND: Although the benefits of public knowledge of physical diseases are widely accepted, knowledge about mental disorders (mental health literacy) has been comparatively neglected. AIMS: To introduce the concept of mental health literacy to a wider audience, to bring together diverse research relevant to the topic and to identify gaps in the area. METHOD: A narrative review within a conceptual framework. RESULTS: Many members of the public cannot recognise specific disorders or different types of psychological distress. They differ from mental health experts in their beliefs about the causes of mental disorders and the most effective treatments. Attitudes which hinder recognition and appropriate help-seeking are common. Much of the mental health information most readily available to the public is misleading. However, there is some evidence that mental health literacy can be improved. CONCLUSIONS: If the public's mental health literacy is not improved, this may hinder public acceptance of evidence-based mental health care. Also, many people with common mental disorders may be denied effective self-help and may not receive appropriate support from others in the community.

Health Knowledge, Attitudes, Practice↗

PubMed2000

Beliefs about outcomes for mental disorders: a comparative study of primary health practitioners and psychiatrists in Singapore.

OBJECTIVES: To compare responses to a mental health literacy survey assessing the likely outcome of three major mental disorders by primary health practitioners (OPD doctors and GPs) and by psychiatrists in Singapore. METHODS: We used two vignettes of Major Depression and Schizophrenia developed in an Australian study. In addition, a third vignette of Mania was developed locally and included. The respondents were required to choose one of the set of prognostic options if the patients received or did not receive professional help, to rate the likely impact of the disorder, and to assess the likelihood of the patient being discriminated against. Psychiatrists' responses were obtained by surveying staff at Woodbridge Hospital, while the primary health practitioners were required to respond to a postal survey. RESULTS: The response rate for the psychiatrists was 70% (69/99), while the Primary health practitioners had an overall response rate of 38% (264/691). The response from OPDs being 51% (77/151) and that of the GPs being 35% (189/540). There was evidence of disorder specificity, with schizophrenia judged as having the worst outcome and depression the best outcome in response to treatment. There was also evidence of group specificity, with the psychiatrists most optimistic and the OPD doctors least optimistic about the outcome following professional intervention. The majority of both the primary health practitioners and the psychiatrists judged that patients would be discriminated against, more so for schizophrenia and mania than for depression. Compared to the OPD doctors, a lower percentage of GPs felt that the patients would be discriminated against. CONCLUSION: Primary health practitioners in Singapore hold more negative views than Singapore psychiatrists about the outcome of professional intervention for three major psychiatric disorders. This finding has implications for education and training for primary health practitioners as well as for treatment of psychiatric patients in the primary health setting.

Attitude of Health Personnel↗

PubMed1999

Smoking and mental health: results from a community survey.

OBJECTIVE: To assess the relationship of smoking with depression and anxiety symptoms and with risk factors for depression. DESIGN AND SETTING: A community survey conducted in Canberra in 1997. PARTICIPANTS: 2725 persons aged 18-79 sampled from the electoral roll. MAIN OUTCOME MEASURES: Smoking was investigated in relation to psychiatric symptoms (anxiety, depression, alcohol misuse), sociodemographic characteristics (age, sex, education, occupational status), social stressors (divorce, unemployment, financial difficulties, negative life events, childhood adversity), personality (extraversion, neuroticism, psychoticism), and social support (family and friends). RESULTS: Smokers had more depression and anxiety symptoms, more stressors and lower socioeconomic status compared with non-smokers. The association between smoking and psychiatric symptoms persisted even when stressors, socioeconomic characteristics and other factors were statistically controlled. CONCLUSIONS: Smoking is associated with poorer mental health. In helping patients to give up smoking, doctors need to be aware that some may have underlying mental health problems that require attention.

Adolescent↗

PubMed1999

Emotional response of participants to a mental health survey.

Following participation in a mental health survey of 2725 adults aged 18-79, respondents were asked if the questionnaire had made them feel distressed or depressed, and if it had been an intrusion on privacy or had made them feel good about themselves. While 5% reported feeling distressed, 3% depressed and 3% were concerned about privacy, 35% reported feeling good about themselves. The participants reporting negative feelings were more likely to be younger women, to be higher on negative personality measures, to report more anxiety and depression symptoms, and to have had more childhood adversity and lower social support. Those who reported positive feelings had higher positive personality scores, more social support and lower anxiety and depression. This group was more likely to be older women. Despite the sensitive nature of many of the questions, only a small percentage of respondents reported distress, while many found that the questionnaire had made them feel good about themselves. This is important information to present to Institutional Ethics Committees and to future participants in such studies.

Adolescent↗

PubMed1999

Diagnosis and treatment of mental disorders: a survey of Singapore mental health professionals.

BACKGROUND: A series of surveys of mental health literacy have been undertaken in Australia, involving members of the general public as well as general practitioners and mental health professionals, whereby respondents consider vignettes of depression and of schizophrenia, offer a diagnosis and rate a series of possible interventions for their judged helpfulness. A similar survey was undertaken in Singapore and is reported in this paper. METHODS: The survey was undertaken at a large state psychiatric hospital with staff (psychiatrists, allied health professionals, psychiatrically and generally trained nursing staff) rating a vignette of mania, in addition to the vignettes derived in Australia for depression and schizophrenia, and with the Australian intervention options extended somewhat to respect Singapore facilities. RESULTS: Responses of those in the four professional groups were compared. The psychiatrists were highly accurate in generating diagnoses, other staff somewhat less so for diagnosing depression (with a percentage instead choosing a diagnosis of stress) and mania (with a percentage instead diagnosing a schizophrenic condition). Reported helpfulness ratings identified those interventions judged consensually as likely to be helpful or harmful, as well as establishing some differences across the four professional groups. CONCLUSIONS: The consensus decisions of helpful treatments for depression and schizophrenia revealed very similar findings to judgements made by Australian professionals. The treated outcome of schizophrenia was judged as somewhat worse than that for mania and depression. While non-medical staff differed from psychiatrists in judging the comparative utility of some drug interventions and lifestyle issues, there was clear evidence of a relatively dominant 'medical model' to recommended treatments, while traditional healing practices and services were rated as distinctly unhelpful.

Adult↗

PubMed1999

Age differences in depression and anxiety symptoms: a structural equation modelling analysis of data from a general population sample.

BACKGROUND: There is debate as to whether the elderly are really at lower risk for depressive disorders, or whether endorsement of symptoms is artefactually low. The present paper assesses the effects of age on anxiety and depression, and examines whether age has direct effects on self-report of individual symptoms independent of its effect on the underlying dimensions of anxiety and depression. METHODS: Structural equation modelling was used to assess the structure of the items and their associations with age and a number of demographic variables. The sample of 2622 participants aged between 18 and 79 years from Canberra (Australia) was drawn from the Electoral Roll. Two instruments were used: the anxiety and depression scales of Goldberg et al. (1988) and the Personal Disturbance Scale from the DSSI of Bedford et al. (1976). RESULTS: Both scales were found to fit satisfactorily to a two factor model. Age correlated negatively with depression. After controlling for the effects of gender, marital status, education and financial difficulty, direct effects of age were found on items from both instruments, indicating that certain depression items were associated with a differential probability of endorsement in older people, even when the level of depression was equal to that of younger people. Items with direct age effects reflected physical (feeling slowed down; waking early) and psychological (hopeless about the future) components of depression. Direct effects of age on items from both anxiety scales were also found. CONCLUSIONS: The nature of the depression and anxiety experienced by younger and older people may differ qualitatively. Depression may be associated with an increase in somatic symptoms linked to physical changes and to an increase in endorsement of items which reflect the narrowing of opportunities in the long-term.

Adolescent↗

PubMed1999

An analysis of diversity in the cognitive performance of elderly community dwellers: individual differences in change scores as a function of age.

This longitudinal study investigated whether age is associated with increases in interindividual variability across 4 ability domains using a sample of 426 elderly community dwellers followed over 3.5 years. Interindividual variability in change scores increased with age for memory, spatial functioning, and speed but not for crystallized intelligence for the full sample and in a subsample that excluded dementia or probable dementia cases. Hierarchical regression analyses indicated that being female, having weaker muscle strength, and having greater symptoms of illness and greater depression were associated with overall greater variability in cognitive scores. Having a higher level of education was associated with reduced variability. These findings are consistent with the view that there is a greater range of responses at older ages, that certain domains of intelligence are less susceptible to variation than others and that variables other than age affect cognitive performance in later life.

Activities of Daily Living↗

PubMed1999

Attitudes towards people with a mental disorder: a survey of the Australian public and health professionals.

OBJECTIVE: The aim of this paper was to compare the Australian public's attitudes towards people who have been treated for a mental disorder with the attitudes of general practitioners, psychiatrists and clinical psychologists. METHOD: The study involved a household survey of 2031 members of the Australian public and a postal survey of 872 general practitioners, 1128 psychiatrists and 454 clinical psychologists. Survey participants were presented with a vignette describing a person with schizophrenia or one with depression. They were asked opinions about the person's long-term outcome in various areas of life after receiving treatment. Participants were also asked whether they thought the person described would be discriminated against by others. RESULTS: Both the public and professionals rated outcomes as poorer and discrimination as more likely for the person with schizophrenia than for the one with depression. The professionals made more negative ratings than the public, although the clinical psychologists had similar attitudes to the public about depression. CONCLUSIONS: Compared to the public, health professionals rate long-term outcomes more negatively and discrimination as more likely. It is possible that these more negative attitudes are realistic, being based on greater knowledge of mental disorders. However, professional attitudes may be biased by greater contact with patients who have chronic or recurrent disorders. Either way, health professionals need to be aware of the effects that their negative attitudes might have on patients and the public.

Adolescent↗

PubMed1999

Activity patterns in very old people: a survey of cognitively intact subjects aged 90 years or older.

AIM: to measure activity patterns in very old people, the factors related to this and the association of different types of activity with well-being. METHODS: a study of 105 people, aged 90 years or older, who were not cognitively impaired, living in Stockholm. The activities carried out during the previous day were recorded and each activity was rated. RESULTS AND CONCLUSIONS: the degrees of intellectual, social and physical activity are independent of each other. Very elderly people tended to have variable but relatively low activity levels over a day. Good health and not moving home were associated with greater intellectual activity. Extraversion and negative life events (such as death of close friend or family member) were associated with greater social activity, while relatively younger age and better health were associated with greater physical activity. There was positive association between physical activity and well-being.

Activities of Daily Living↗

PubMed1999

Carer distress in the general population: results from the Sydney Older Persons Study.

OBJECTIVE: To assess distress in a sample of carers who were selected from a community survey rather than recruited via community-service agencies. METHODS: A community survey was carried out on 630 people aged 75 or over living in Sydney, Australia. Informants nominated by these elderly people were divided into full carer (n = 21), partial carer (n = 187) and non-carer groups (n = 344). Informants completed the General Health Questionnaire (a continuous measure of psychiatric symptoms), the life satisfaction index (a measure of well-being) and the interpersonal bonding measure (a measure of quality of the relationship with the elderly person). Elderly participants had a medical examination, were assessed for disability and were questioned about use of services. RESULTS: Elderly people who had a full carer were more disabled and had more medical diagnoses. Full, but not partial, carers reported more psychiatric symptoms and lower life satisfaction. In multivariate analysis, the main determinant of carer distress was a relationship in which the carer felt controlled by the elderly person. CONCLUSION: When carers are selected from a population-based sample, only those who are full carers are more distressed. However, relationship factors are the most important determinant of distress.

Activities of Daily Living↗