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Biomedical subjects

A F Jorm

Publications and source records attributed to A F Jorm.

At least 91 records · Page 5Linked to original sources
PubMed1997

Impact of pet ownership on elderly Australians' use of medical services: an analysis using Medicare data.

OBJECTIVES: To determine whether pet ownership by elderly people is associated with lower use of health services. DESIGN: Survey of physical and mental health, and retrospective 12-month review of Medicare records of the number of general practitioner and specialist services. PARTICIPANTS AND SETTING: Elderly people living in Canberra (Australian Capital Territory) and Queanbeyan (New South Wales), surveyed in 1994 for the second stage of a larger longitudinal study. RESULTS: Elderly pet owners did not differ from non-owners on any of the physical or mental health measures or in use of health services. CONCLUSION: Given the high use of health services by older people, our findings suggest that the claim that pet ownership leads to savings in health services should be viewed with caution.

Aged↗
PubMed1997

"Mental health literacy": a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment.

OBJECTIVES: To assess the public's recognition of mental disorders and their beliefs about the effectiveness of various treatments ("mental health literacy"). DESIGN: A cross-sectional survey, in 1995, with structured interviews using vignettes of a person with either depression or schizophrenia. PARTICIPANTS: A representative national sample of 2031 individuals aged 18-74 years; 1010 participants were questioned about the depression vignette and 1021 about the schizophrenia vignette. RESULTS: Most of the participants recognised the presence of some sort of mental disorder: 72% for the depression vignette (correctly labelled as depression by 39%) and 84% for the schizophrenia vignette (correctly labelled by 27%). When various people were rated as likely to be helpful or harmful for the person described in the vignette for depression, general practitioners (83%) and counsellors (74%) were most often rated as helpful, with psychiatrists (51%) and psychologists (49%) less so. Corresponding data for the schizophrenia vignette were: counsellors (81%), GPs (74%), psychiatrists (71%) and psychologists (62%). Many standard psychiatric treatments (antidepressants, antipsychotics, electroconvulsive therapy, admission to a psychiatric ward) were more often rated as harmful than helpful, and some nonstandard treatments were rated highly (increased physical or social activity, relaxation and stress management, reading about people with similar problems). Vitamins and special diets were more often rated as helpful than were antidepressants and antipsychotics. CONCLUSION: If mental disorders are to be recognised early in the community and appropriate intervention sought, the level of mental health literacy needs to be raised. Further, public understanding of psychiatric treatments can be considerably improved.

Adolescent↗
PubMed1997

GP attendance by elderly Australians: evidence for unmet need in elderly men.

OBJECTIVES: To examine GP service use by elderly people and, in particular, to compare those who had not consulted a GP in one year with those who were low attenders and those who were high attenders. DESIGN: Medicare data on GP service use were matched to data collected by interview in 1990-1991 and reinterview in 1994 as part of a community study on health and well-being. SETTING: Canberra and Queanbeyan in the Australian Capital Territory. PARTICIPANTS: People aged 70 years and over, living in the community. MAIN OUTCOME MEASURES: The number of visits made to a GP in 12 months. RESULTS: Medicare data were available for 624 of the 897 participants interviewed (70%). While the women non-attenders reported similar levels of physical illness and symptoms to the low attenders, men non-attenders reported significantly higher levels of illness (P < 0.01) than the low-attender group. The health of men who were non-attenders was very similar to men who were high attenders of GP services. Men who had not seen a GP in one year reported significantly more pain (P = 0.002) and less social support than both low attenders and high attenders (P = 0.012 and P = 0.049, respectively). CONCLUSION: We identified a group of men who had not attended a GP in one year, despite significant levels of morbidity. Such a group may benefit from consultation with a GP and could be targeted in any attempt to improve elderly men's health.

Aged↗
PubMed1997

The psychogeriatric assessment scales (PAS): further data on psychometric properties and validity from a longitudinal study of the elderly.

The PAS is a standardized interview which assesses the changes seen in dementia and depression using a set of scales. There are three scales derived from an interview with the subject (cognitive impairment, depression, stroke) and three from an interview with an informant (cognitive decline, behaviour change, stroke). The aim was to provide data on the psychometric properties and validity of the PAS. The scales were originally developed using data from the first wave of a longitudinal study of the elderly. Reported here are further data on the PAS from the second wave of the same study, carried out 3 1/2 years later. The setting was a community survey carried out in the Australian city of Canberra. Seven hundred and nine elderly persons, with a mean age of 80 years, and 641 informants participated. Besides the PAS, participants were administered several other scales: the Mini-Mental State Examination, the Informant Questionnaire on Cognitive Decline in the Elderly, the National Adult Reading Test and the Goldberg anxiety and depression scales. Diagnoses of dementia and depression were made with the Canberra Interview for the Elderly, from which the PAS is derived. Confirmatory factor analysis replicated the five-factor model which underpins the PAS. The PAS was found to correlate with the other scales having similar content and showed correspondence with diagnoses of dementia and depression derived from the Canberra Interview for the Elderly. Longitudinal data supported the validity of the cognitive decline scale as a measure of change. Overall, the results support the original psychometric and validity research on the PAS.

Aged↗
PubMed1997

Some contributions to the epidemiology of dementia and depression.

OBJECTIVE: To give an account of how a research programme in epidemiology at the NHMRC Social Psychiatry Research Unit developed, and an overview of work completed. DATA SOURCES: General population samples of elderly persons; and persons clinically diagnosed as having Alzheimer's disease, or as being free of dementia. STUDY SELECTION: The studies undertaken include integrative analyses of published work; instrument development; cross-sectional and prospective longitudinal surveys of cognitive decline, dementia and depression in general population samples; and a case-control study of Alzheimer's disease. DATA SYNTHESIS: The data are of two types: continuous and categorical measures of morbidity; and measures of personal, social and biological attributes of the sample, including assessment of disablement and use of services. The findings have been both descriptive and analytic. New instruments developed are the Canberra Interview for the Elderly (CIE), the IQCODE and the Psychogeriatric Assessment Scales (PAS). CONCLUSION: Beyond simple estimates of the prevalence of dementia, cognitive impairment and depression, we have focused mainly on aetiology and outcome in community samples. Unexpected opportunities have had a substantial influence on the direction of our work.

Aged↗
PubMed1997

Education and decline in cognitive performance: compensatory but not protective.

The association between education and cognitive change was investigated in a large community sample of elderly people followed up after 3.6 years. Lower education was predictive of decline on the Mini-Mental State Examination (MMSE) and on tests of language and knowledge, but not on tests of cognitive speed, memory or reaction time. The effects of education were not attenuated when adjusted for health, disability or activity level. The findings suggest that education slows the rate of decline on crystallized intelligence, but not other cognitive abilities. Education may compensate for neurodegenerative changes rather than protect against them.

Activities of Daily Living↗
PubMed1997

ICD-10 mild cognitive disorder: its outcome three years later.

OBJECTIVE: The aims were to (i) report the outcome of mild cognitive disorder (MCD) 3.6 years after initial interview and diagnosis; (ii) identify predictors of new cases of MCD. The hypotheses were that (i) persons with MCD are more likely to develop dementia than those without MCD; (ii) symptoms of anxiety or depression predict MCD caseness at follow-up. DESIGN: Longitudinal cohort study. SETTING: Community of elderly people (age 70-97 years). PARTICIPANTS: 612 of 897 elderly subjects (mean 76 years) were reinterviewed. Of the 36 MCD cases originally identified, 25 were available at follow-up. 24 incident cases of MCD were identified. MAIN OUTCOME MEASURES: ICD-10 dementia, DSM-III-R dementia, ICD-10 mild cognitive disorder diagnoses made by the Canberra Interview for the Elderly, tests of anxiety, depression, neuroticism and cognitive performance. MAIN RESULTS: Of the original 25 MCD cases available at follow-up, two had a diagnosis of MCD, and three had a diagnosis of both ICD-10 and DSM-III-R dementia. The prevalence of MCD and DSM-III-R dementia at follow-up was no greater for MCD cases diagnosed at initial interview than in normal subjects at initial interview. There was, however, an increased prevalence of ICD-10 dementia among original MCD cases. At initial interview and at follow-up MCD cases were more anxious and depressed but had similar cognitive performance to normals. For incident cases of MCD the only significant predictor was age. CONCLUSIONS: MCD cannot be seen to be a specific forerunner of dementia. Those with a diagnosis of MCD are distinguished more by their anxiety, depression and neuroticism than by their cognitive deficits.

Aged↗
PubMed1997

Clinical diagnoses and disability of cognitively impaired older persons as predictors of stress in their carers.

BACKGROUND: Aspects of the caring relationship are often promoted as more important than the clinical features of the care recipient in predicting caregiver wellbeing. However, studies of consequences of caring for cognitively impaired people seldom include detailed measures of the diagnostic profile and disability of the care recipient. METHODS: Ninety community-living elderly persons with cognitive impairment were clinically assessed for severity on a range of illnesses. Their disability was examined via informant reports. Informants (88% of whom were primary carers) provided information on the behaviour and personality of the subject and reports of their own (informant) wellbeing. Using multiple regression, features of the subjects' clinical profile (severity of diseases, disability, behavioural problems and personality change) were examined as predictors of informant wellbeing. After controlling for subject clinical profile, we explored the additional associations between informant stress measures and other descriptors of the subject, caregiver and their relationship. RESULTS: The subjects' clinical characteristics, in particular disability and disturbed behaviour, were strong predictors of caregiver wellbeing, accounting for most of the explained variance. After control for the subjects' clinical profile, few of the sociodemographic, caregiver or relationship variables examined had any influence on caregiver outcome measures. The exceptions were caregiver time demands, older subject age and self-identification as primary carer. Coresidence was not associated with caregiver distress. CONCLUSION: Clinical characteristics of the care recipient are determinants of caregiver wellbeing, while socio-demographic, caregiver and relationship characteristics are less influential.

Activities of Daily Living↗
PubMed1997

Belief systems of the general public concerning the appropriate treatments for mental disorders.

A study was conducted to assess the belief systems of the general public concerning the appropriate treatments for mental disorders and correlates of these belief systems. The study was based on the results of a household survey of the general public in Australia, using a national random sample of 2,031 adults aged 18-74 years. Respondents were given a vignette describing either a person with depression or one with schizophrenia, and were asked for their opinions about the helpfulness of various professional and non-professional treatments for the person described. A principal components analysis of the helpfulness ratings gave three factors: a Medical factor with high loadings on all drug treatments (except Vitamins) and on Psychiatric ward and ECT; a Psychological factor with high loadings on Counsellor, Social Worker, Phone counselling, Psychiatrist, Psychologist, Psychotherapy and Hypnosis; and a Lifestyle factor with high loadings on Close family, Close friends, Naturopath, Vitamins, Physical activity and Get out more. The same factors emerged from ratings of the two vignettes. Mean scores on scales constructed from the items with high loadings showed that the public tend to have a negative view of medical treatments and a positive view of psychological and lifestyle ones. However, medical treatments were rated more negatively for depression than for schizophrenia, psychological treatments were rated more positively for schizophrenia, and lifestyle treatments more positively for depression. Age, sex and education of respondents showed few associations with scores on the scales, although the better educated were more in favour of psychological treatments for both depression and schizophrenia and were less opposed to medical treatments for schizophrenia. Respondents who had suffered from the symptoms described in the schizophrenia vignette were more negative towards medical treatments. These findings about public belief systems could have implications for the provision of treatment: where there is a discrepancy in belief system between the patient and the clinician there may be poor adherence to treatment.

Adolescent↗
PubMed1997

Public beliefs about causes and risk factors for depression and schizophrenia.

The objective of this study was to carry out a national survey to assess the Australian public's beliefs about causes and risk factors for mental disorders. A national household survey of 2,031 Australian adults was carried out. Half the respondents were presented with a vignette describing a person with major depression and the other half with a vignette describing schizophrenia. Respondents were asked to rate whether various factors are likely causes of problems such as that described in the vignette and to rate whether various groups are at higher or lower risk. For depression, social environmental factors were often seen as likely causes, which is consistent with the epidemiological evidence. However, genetic factors were considered as a likely cause by only half the population. For schizophrenia, social environmental factors were also often seen as causes, which is in contrast to the weak epidemiological evidence for such a role. Genetic factors attracted more support as a cause of schizophrenia than of depression. These findings point to areas where the mental health literacy of the population could be improved, particularly the over-emphasis on social environmental factors in schizophrenia. Of some concern was the belief of half the population that weakness of character is a likely cause of both depression and schizophrenia. This belief implies a negative evaluation of the sufferer as a person.

Adult↗
PubMed1997

Do cognitive complaints either predict future cognitive decline or reflect past cognitive decline? A longitudinal study of an elderly community sample.

Data from a two-wave longitudinal study of an elderly community sample were used to assess whether cognitive complaints either predict subsequent cognitive decline or reflect past cognitive decline. Cognitive complaints and cognitive functioning were assessed on two occasions three and a half years apart. Cognitive complaints at Wave 1 were found not to predict future cognitive change on the Mini-Mental State Examination, an episodic memory test or a test of mental speed. Similarly, cognitive complaints at Wave 2 were unrelated to past cognitive changes on these tests after statistically controlling for the effects of anxiety and depression. Furthermore, cognitive complaints did not predict either mortality (after controlling for anxiety and depression) or future dementia. These results are evidence against the inclusion of cognitive complaints in diagnostic criteria for proposed disorders such as age-associated memory impairment, mild cognitive disorder and ageing-associated cognitive decline.

Aged↗
PubMed1997

The course of depression in the elderly: a longitudinal community-based study in Australia.

BACKGROUND: We report the outcome of depressive states after 3-4 years in a community sample of the elderly. METHODS: A sample of 1045 persons aged 70+ years in 1990-1 was re-interviewed after 3.6 years. RESULTS: Mortality (21.7%) and refusal or non-availability (10.4%) were higher in those who initially had had a diagnosis or symptoms of depression. Of those with an ICD-10 depressive episode in 1990-1, 13% retained that diagnosis. Of those who were not depressed initially only 2.5% had become cases. Depression was unrelated to age or apolipoprotein E genotype. The best predictors of the number of depressive symptoms at follow-up was the number at Wave 1, followed by deterioration in health and in activities of daily living, high neuroticism, poor current health, poor social support, low current activity levels and high service use. Depressive symptoms at Wave 1 did not predict subsequent cognitive decline or dementia. CONCLUSIONS: Non-random sample attrition is unavoidable. ICD-10 criteria yield more cases than other systems, while continuous measures of symptoms confer analytical advantages. Risk factors for depressive states in the elderly have been further identified. The prognosis for these states is favourable. At the community level, depressive symptoms do not seem to predict cognitive decline, as they do in referred series.

Activities of Daily Living↗
PubMed1997

A prospective study of cognitive function in the elderly.

BACKGROUND: We report on the change in cognitive function in a population sample of elderly people who have been examined on two occasions more than 3 years apart. METHODS: A sample of 1135 persons aged 70-102 years was interviewed at base-line then re-interviewed 3.6 years later with the Canberra Interview for the Elderly, which included tests of episodic memory and cognitive speed as well as the Mini-Mental State Examination and the National Adult Reading Test (NART). RESULTS: Mortality and loss to follow-up reduced the sample to 736, of whom 614 completed at least one test of cognitive performance on both occasions. Cognitive performance decreased with age, except on the NART. Decline over the follow-up period increased as a function of age in all cognitive measures, except the NART. Change in cognitive scores was close to normal distribution. Incident dementia was associated strongly with age and current level of cognitive performance, but not with rate of decline. Cognitive decline and the risk of incident dementia did not differ by gender. CONCLUSIONS: A score indicating possible impairment in the very elderly carries a worse prognosis than for the younger elderly. Decline is almost universal in at least one cognitive area among those over the age of 85.

Aged↗
PubMed1997

Occupational risk factors for Alzheimer disease: a case-control study.

There is evidence to support the role of a number of environmental factors in Alzheimer disease (AD). This study examines the role of chemical and physical exposures in the occupational environment. The sample included 170 patients with AD and 170 medical-practice-based controls, matched for age and sex, who were assessed for histories of occupational exposures to a range of chemical and physical agents, including hydrocarbon solvents, lead, mercury, organophosphates, aluminum, asbestos and other silicates, vibration, and physical underactivity. Occupational histories were obtained from informants for both patients and controls. Exposure was assessed by a panel of occupational hygienists, blinded to the case or control status of each subject, using the occupational histories and the Job-Exposure Matrix of the U.S. National Institute for Occupational Safety and Health. No statistically significant associations were found between any of the exposures and the occurrence of AD, either in the overall study group or in patients with a family history of AD. The findings suggest the absence of any occupational cause for AD.

Aged↗
PubMed1997

Help-seeking in Vietnam veterans: post-traumatic stress disorder and other predictors.

This study investigated factors predicting help-seeking from the Department of Veterans' Affairs (DVA) by Vietnam veterans. Data used were from a national Australian survey of Vietnam veterans' health (n = 641) conducted between July 1990 and April 1993. The survey involved current clinical assessments and retrospective questionnaires, supplemented with health and service records retrieved from the DVA and Army personnel files. Measures included the 1989-90 Australian Bureau of Statistics Health Survey questionnaire, and mental health, sociodemographic and operational deployment history questionnaires. For both current and lifetime diagnoses of post-traumatic stress disorder, a third of the veterans with the disorder had never obtained any health care entitlement from the DVA. Other than physical and mental problems, which accounted for the greatest proportion of the help-seeking odds, significant factors predicting help-seeking included factors such as: predeployment personality, combat exposure, the veterans' own attitudes towards their deployment, experiences during deployment, experiences during repatriation and membership of ex-service organisations. These findings on how post-traumatic stress disorder and other health problems relate to help-seeking patterns could help in developing prevention and care programs for stress disorder.

Australia↗
PubMed1997

Suicidal thoughts and associated factors in an elderly population.

This study examined the prevalence of suicidal thoughts and associated factors in an elderly population. Data for 969 elderly subjects from a population-based study were used, and examinations by physicians, including psychiatric examination and informants' interview, were assessed. In total, 13.3% of the subjects had had suicidal thoughts during the last 2 weeks (10.8% fleetingly and 2.5% frequently). Of those who had had fleeting suicidal thoughts, 26.7% also had major depression, while 50% of those who had frequent suicidal thoughts were depressed. In addition, suicidal thoughts were associated with increased disability in daily living, institutionalization, visual problems and the use of psychotropic drugs. It is concluded that a careful psychiatric assessment is necessary when suicidal thoughts are expressed by an elderly person.

Activities of Daily Living↗
PubMed1997

Helpfulness of interventions for mental disorders: beliefs of health professionals compared with the general public.

BACKGROUND: The study aimed to compare the beliefs of health professionals about the potential helpfulness of various mental health interventions with those of the general public. METHOD: Surveys were carried out in Australia of 872 general practitioners, 1128 psychiatrists, 454 clinical psychologists and 2031 members of the public. Respondents were presented with a case vignette describing either a person with depression or one with schizophrenia. Respondents were asked to rate the likely helpfulness of various types of professional and non-professional help and of pharmacological and non-pharmacological interventions. RESULTS: The professionals gave much high ratings than the public to the helpfulness of antidepressants for depression, and of antipsychotics and admission to a psychiatric ward for schizophrenia. Conversely, the public tended to give much more favourable ratings to vitamins and minerals and special diets for both depression and schizophrenia, and to reading self-help books for schizophrenia. CONCLUSION: The beliefs that health practitioners hold about mental disorders differ greatly from those of the general public. There is a need for mental health education campaigns to help close the gap between professional and public beliefs.

Adolescent↗