Biomedical subjects

Fiona Judd

Publications and source records attributed to Fiona Judd.

At least 19 recordsLinked to original sources

PubMed2006

Use of research by the Australian health promotion workforce.

This paper examines the attitudes and practices of Australian health promotion practitioners toward evidence-based practice (EBP). The study used a survey methodology and questionnaires were sent to 1114 members of the Australian Health Promotion Association. A response rate of 27% (n = 277) was achieved. The data showed that the vast majority of participant's attitudes toward EBP was very welcoming. However, in practice the impact of EBP was limited. Participants identified a range of significant barriers to implementing EBP including organizational culture, policy directives and lack of resources. A range of concerns was also identified regarding the applicability of the medically based EBP model within health promotion, which is based upon a social model of health. The findings highlight the importance of acknowledging the complexity of health promotion interventions and working toward developing an appropriate evidence base.

Adult↗

PubMed2006

The influence of stigma and attitudes on seeking help from a GP for mental health problems: a rural context.

BACKGROUND: Lack of mental health specialists in rural and remote communities suggest that rural communities depend more on general practitioners (GPs) for mental health care. Residents of rural communities are less likely than urban residents to seek help from their GPs for mental health issues. The aim of the current study was to examine whether attitudinal factors including perceived stigma, influenced rural residents seeking help from GPs. METHOD: Help-seeking for psychological issues was retrospectively reported by 300 community residents in rural north-west Victoria. Current distress levels, functional disability, and current or lifetime syndromal disorder were recorded. Attitudes towards seeking professional psychological help, perceptions of stigma about mental illness, and belief in helpfulness of GPs, were also measured. RESULTS: Having a positive attitude towards seeking professional help, and believing that a GP would be helpful, were significant predictors of ever having sought help from a GP for mental health problems. Other independent predictors of help-seeking included having a mood, anxiety or substance use disorder, higher distress levels, and greater functional disability due to physical problems. CONCLUSIONS: Seeking help from a GP for psychological problems was predicted by having a positive attitude towards seeking professional psychological help as well as believing a GP would be helpful in treating psychological problems. Illness variables were also strong predictors of help-seeking behaviour. Contrary to expectations, perceived stigma did not influence help-seeking. The findings of this study highlight the important role of GPs in the treatment of mental health problems in the rural community.

Attitude to Health↗

PubMed2006

Understanding suicide in Australian farmers.

OBJECTIVE: Male farmers in Australia have an elevated risk of suicide. The aims of this study were to investigate the rate of mental health problems amongst farmers compared with non-farmer rural residents and to investigate what additional factors might contribute to an increased risk of suicide amongst farmers. METHOD: This study used a combination of quantitative and qualitative approaches. First, using self-report questionnaire data, we compared rates of mental health problems (a common correlate of suicide) and a number of personality measures between farmers (n=371) and non-farming rural residents (n=380). In addition, semi-structured interviews with farmers (n=32) were used to gain a richer understanding of how the context of farming and mental health interact. RESULTS: Five key findings emerged from the study. First, in the quantitative study, we found no support for the proposition that farmers experience higher rates of mental health problems than do non-farmer rural residents, but we identified potentially important personality differences between farmers and non-farmers, with levels of conscientiousness being significantly higher amongst farmers and levels of neuroticism being significantly lower. A strong association between maleness and farming was also found. In the qualitative study, participants indicated that farming is an environment in which individuals experienced a range of stressors but have limited capacity to acknowledge or express these. In addition, there appeared to be significant attitudinal barriers to seeking help for those who may have mental health problems, particularly male farmers. CONCLUSION: The elevated rate of suicide amongst farmers does not seem to be simply explained by an elevated rate of mental health problems. Individual personality, gender and community attitudes that limit a person's ability to acknowledge or express mental health problems and seek help for these may be significant risk factors for suicide in farmers.

Agriculture↗

PubMed2006

Rural suicide--people or place effects?

OBJECTIVE: To examine factors that may contribute to elevated rates of suicide among rural communities in Australia. METHOD: A wide-ranging literature search reviewed possible factors that may contribute to the geographical variation in suicide. Literature was organized to enable examination of compositional and contextual explanations, as well as collective social functioning and social practices. RESULTS: A variety of factors may contribute to elevated rates of suicide in rural compared with urban areas. Collective and contextual (place) factors seem to be of particular importance as possible contributors to the elevated rate of suicide among rural males. These include rural socioeconomic decline; facilitators and barriers to service utilization such as service availability and accessibility, rural culture, community attitudes to mental illness and help seeking; and exposure to firearms. CONCLUSIONS: Compositional, contextual and collective factors are hypothesized to influence the elevated rate of suicide in rural compared with urban areas. These factors need to be tested in empirical studies that consider both individual and community-based risk factors, and are designed to enable exploration of likely within-rural differences.

Australia↗

PubMed2006

Help-seeking by rural residents for mental health problems: the importance of agrarian values.

OBJECTIVE: To examine the role of stoicism, self-efficacy and perceived stigma in predicting help-seeking by rural residents, for mental health problems. METHOD: A cross-sectional community survey was conducted with a sample of 467 rural residents (58% female), who completed self-report questionnaires assessing current levels of symptomatology, disability, perceived stigma, self-efficacy, stoicism, attitudes towards and experience of seeking help for psychological problems. RESULTS: Overall, 27.6% (n=129) of respondents had sought help from a general practitioner and/or mental halth professional for psychological problems or a mental health issue. More women than men reported having sought such help. Lifetime help-seeking for a psychological problem or mental health issue was positively associated with higher levels of distress and lower levels of stoicism and, to a lesser extent, lower levels of self-efficacy. CONCLUSIONS: Efforts to improve help-seeking by rural residents for mental health problems should focus on understanding and addressing attitudes, such as stoicism which act as barriers to help-seeking.

Adult↗

PubMed2006

Developing new services for eating disorders: an evaluation study.

OBJECTIVE: This paper aims to evaluate the structures and processes of eating disorders services in two regional cities in Australia. METHOD: Stakeholder evaluation undertaken between 2002 and 2005 uses interviews, questionnaires and service delivery data to examine: structure and patient profile of the two services, barriers and success factors and local factors influencing development of the services. RESULTS: The Bendigo service provided secondary consultation and specialist management with upskilling of primary care workers as a key goal. Patients were referred to the service via mental health triage. The Geelong service initially offered assessment only, with direct access for the general public. Treatment was offered from early 2004. The Bendigo service assessed 41 patients, 63% were diagnosed with anorexia nervosa or bulimia nervosa. Most patients had a moderate or severe eating disorder. The Geelong service assessed 186 patients, 55% were diagnosed with anorexia nervosa or bulimia nervosa and 80% of this subset had not previously been treated for an eating disorder. General practitioners identified barriers to development of the services as: problems with capacity building and unrealistic expectations. The success factors were providing a locally based service with credible clinicians and effective communication. CONCLUSIONS: Activity analysis demonstrates that the goals for both services were met. There is a need to measure both short- and long-term patient outcomes in order to fully assess effectiveness and applicability to other settings. Local factors, such as availability of specialist providers, would need to be taken into account.

Anorexia Nervosa↗

PubMed2005

Changing places: the impact of rural restructuring on mental health in Australia.

Significant demographic, social and economic change has come to characterise much of rural Australia, with some authors arguing there are now two sharply differentiated zones, one of growth and one of decline. This restructuring process, which has been similar to other western nations, has had a profound impact upon rural places-socially, economically and physically. Findings from research investigating the relationship between health, place and income inequality suggest that rural 'desertification', which is characterised by decline of the agricultural sector, net population loss and the deterioration of demographic structures, may negatively influence mental health outcomes in these areas. By contrast, the growth in rural areas, which is associated with expanding employment opportunities and the movement of capital and people, may confer positive benefits to mental health. The aim of this study was to investigate differences in mental health and well-being between rural communities experiencing growth and decline as measured by net population change. Utilising a survey methodology, questionnaires were distributed to 20,000 people randomly sampled from the electoral role in rural Australia. We selected four sub-regions from the sample area that were characteristic of areas experiencing population growth and decline in Australia and analysed the results of respondents from these four regions (n = 1334). The analysis provided support for our hypothesis that living in a declining area is associated with poorer mental health status; however, the factors that underpin growth and decline may also be important in influencing mental health. Discussed are the mechanisms by which demographic and social change influence mental health. The findings of this study highlight the diversity of health outcomes in rural areas and suggest that aspects of place in declining rural areas may present risk factors for mental health.

Adult↗

PubMed2005

Role of stigma and attitudes toward help-seeking from a general practitioner for mental health problems in a rural town.

OBJECTIVE: To examine the role of perceived stigma and attitudes to seeking care in predicting help-seeking from a general practitioner (GP) for mental health problems. METHOD: A cross-sectional survey in 2002 with self-report questionnaires assessing current levels of symptomatology, disability, attitudes towards mental illness, knowledge of prevalence and causes of mental illness, contact with mental illness and help-seeking behaviour and preferences and attitudes toward seeking professional psychological help. RESULTS: No significant relationship was found between symptom measures and measures of disability and help-seeking. Variables positively associated with general attitudes to seeking professional psychological help were: lower perceived stigma, and biological rather than person-based causal attributions for schizophrenia. Willingness to discuss mental health issues with a GP was predicted by the perceived helpfulness of the GP and by no other variable. CONCLUSIONS: Causal attributions and perceived stigma rather than participants' levels of symptomatology and disability influence attitudes to help-seeking for mental health issues. Efforts to improve attitudes to help-seeking should focus on reducing stigma and improving mental health literacy regarding the causes of disorders.

Adult↗

PubMed2005

Nature of depression in patients with HIV/AIDS.

OBJECTIVE: Existing research suggests that the rate of depressive illness and depressive symptoms are high in people living with HIV/AIDS, but investigations on the causes of depression provide conflicting results. Social, psychological and biological factors have all been suggested as possible causes of depression in people living with HIV/AIDS. The suggestion that depression may be the result of the neurotropic effects of the virus on the central nervous system leading to an 'organic' or secondary depression has major implications in the treatment of HIV/AIDS. The aim of the current study was to further investigate the nature and underlying aetiology of depression in people living with HIV/AIDS. METHOD: One hundred and twenty-nine people living with HIV/AIDS recruited for the study from outpatients clinics and primary care settings completed a range of self-report symptom measures including the Beck Depression Inventory (BDI), SF-36, SPHERE and a personality measure, the NEO Personality Inventory (NEO-PI). They also completed a battery of neuropsychological tests (CANTAB) and a structured clinical interview (SCID-DSM-IV). Medical and sociodemographic data were also recorded. RESULTS: Approximately one-third scored > or = 14 on the BDI and 27% met criteria for a current 'mood disorder' on the SCID. Depressive symptoms were strongly related to personality style, having a past psychiatric history and current stressful psychosocial situation. There was no association between depression and HIV disease status. There was no evidence in this study cohort of a distinct subtype of 'organic' or secondary depression. CONCLUSIONS: These results suggest that at least for 'well' people living with HIV/AIDS, there is no distinct subtype of depression and early treatment approaches can be modelled on those used for other non-HIV groups. Further longitudinal studies will be required to dissect out the multiple factors underlying depression in HIV/AIDS.

AIDS Dementia Complex↗

PubMed2005

A model of supervision in mental health for general practitioners.

OBJECTIVE: If general practitioners (GPs) are to provide effective ongoing care to patients with mental health difficulties, it is argued that they need access to effective supervision. This paper aims to describe a specific framework for the provision of supervision to GPs involved in mental health-related work in a rural area. CONCLUSIONS: An innovative model of supervision is currently being trialled with GP practices in the Bendigo area of country Victoria. It is essential for a formal supervision framework to be available for GPs in mental health, so that effective outcomes in primary mental health care are maximized, facilitating better support for GPs and better outcomes for patients with mental health difficulties.

Adult↗

PubMed2005

Therapeutic group programme for women with postnatal depression in rural Victoria: a pilot study.

OBJECTIVE: The aim of this study was to examine the effectiveness of a therapeutic group programme, provided by community health workers, in reducing anxiety and depressive symptoms associated with postnatal depression (PND) among women living in a rural setting. METHOD: A prospective repeated measures design was used. Women reporting difficulties in the postnatal period were recruited through community health services. Training was provided to community health workers, who then facilitated a 9 week group programme (cognitive-behavioural strategies) for women with PND. The Edinburgh Postnatal Depression Scale and the Hospital Anxiety and Depression Scale measured depressive and anxiety symptoms before starting the group programme, at the completion of the programme and at two follow-up times. RESULTS: Fourteen women completed the group programme at two sites in rural Victoria. Comparison of mean anxiety and depressive symptom scores revealed a significant reduction in scores from pre- to post-programme. For those women who also completed the follow-up symptom measurement, this reduction in symptoms was maintained. CONCLUSIONS: The results show that therapeutic group work is an effective intervention that can be applied by community health workers in a rural setting. Challenges for clinicians working with women experiencing PND in rural areas and implications for future research are discussed.

Adult↗

PubMed2005

Primary care psychiatry: taking consultation-liaison psychiatry to the community.

OBJECTIVE: To assist psychiatrists who work closely with general practitioners (GPs) at the primary/secondary care interface. CONCLUSION: The role of primary care psychiatrists can be enhanced by a sound appreciation of the general practice context, knowledge of the local mental health services and an understanding of the educational and clinical support needs of GPs.

Community Mental Health Services↗

PubMed2004

Identifying marginal housing for people with a mental illness living in rural and regional areas.

OBJECTIVE: Homelessness among people with a mental illness is a serious issue. The purpose of the present study was to identify the types of housing available for people with a mental illness in the region, to develop an audit tool to assess the housing of patients of the mental health service, and to pilot this audit tool. METHODS: Key informants were interviewed to obtain information about the type of housing options available in the Loddon Campaspe Southern Mallee Region, Victoria, Australia. This information was used to develop a survey to audit the housing status of existing patients of the area mental health service. A pilot study using the survey was completed by case managers for 81 patients who were being case managed by the area mental health service. RESULTS: There was a wide variety of housing options in the region but housing availability was not evenly distributed. Although most patients lived in owned or rented accommodation, a substantial proportion of patients had difficulties with accessing the required services, the affordability of their housing, uncertainty of tenure or were at risk of violence within their housing. CONCLUSIONS: A substantial proportion of patients treated by a rural area mental health service had lived in impoverished housing.

Case Management↗

PubMed2004

Rural Integrated Primary Care Psychiatry Programme: a systems approach to education, training and service integration.

OBJECTIVE: To describe the development of a rural primary care psychiatry programme, within a stepped collaborative care model. CONCLUSION: Development of a system-wide approach to the provision of mental health services offers the opportunity to increase the proportion of people with mental health problems who receive effective treatment. In addition, it enables allocation of resources and matching of interventions to patient preference and clinical need. This is particularly important in rural areas where there is a shortage of specialist mental health services and practitioners.

Community Health Workers↗

PubMed2004

Introducing a professional development programme to a rural area mental health service: the importance of context.

OBJECTIVE: To describe the introduction of an ongoing professional development programme for clinicians in a rural area mental health service. The programme involved a series of workshops delivered by clinical psychologists. The training component of each workshop focused on discrete cognitive behavioural strategies, targeted at the amelioration of anxiety and mood symptoms. CONCLUSIONS: The paper emphasizes contextual aspects of the programme: its setting, the modality of delivery, resourcing issues and maximizing engagement by the participants. Preliminary evaluation data are reviewed, and it is argued that programmes that focus on local capacity building in rural settings are an important component of redressing the urban-rural imbalance in the availability of evidence-based psychological treatments.

Adolescent↗

PubMed2004

Rurality and mental health: the role of accessibility.

OBJECTIVE: The absence of an agreed definition of "rural" limits the utility of existing research into a possible relationship between rurality of residence and mental health. The present study investigates the bipolar dimension accessibility/remoteness as a possible correlate of mental health. METHOD: A continuous area of non-metropolitan Australia was selected to provide a range of scores on the Accessibility/Remoteness Index of Australia (ARIA). A questionnaire measuring demographics, the five-factor model of personality and three aspects of mental health (distress, disability and wellbeing) was mailed to 20 000 adults selected randomly from electoral rolls. RESULTS: Responses were received from 7615 individuals (response rate = 40.5%; 57.1% female). ARIA was not associated with either distress or disability measures, but a small negative association was found between accessibility and two measures of wellbeing. Individuals residing in locales with better access to services and opportunities for interaction reported higher levels of satisfaction with life (SWL) and positive affect (PA). Adjusting statistically for a range of demographic and personality correlates did not alter the effect of ARIA on SWL. The effect on PA remained significant after adjusting for demographics, but not once personality correlates entered the model. CONCLUSIONS: By sampling across a single proposed parameter of rurality, a novel profile of correlations was identified. In accord with existing data, accessibility was not associated with distress or disability. In contrast, accessibility was positively associated with the wellbeing aspect of mental health. Further attention to the measurement of rural place and the exploration of accessibility as a parameter with mental health relevance, is warranted.

Australia↗

PubMed2004

Training case managers to deliver focused psychological strategies.

Anxiety and mood disorders are prevalent in the Australian community and can be functionally disabling. Access to treatment for these disorders can be difficult, particularly in rural areas where there is limited availability of specialist mental health practitioners such as psychiatrists and clinical psychologists. One way to address this problem is to improve the skills of local mental health practitioners in recognizing and providing treatment for these disorders. This paper describes a program that aimed to enhance access to psychological treatment for depression and anxiety by improving the skills of rural mental health case managers through training and education and support by psychiatrists and clinical psychologists. Thirty-two case managers participated in the program which delivered 10 training modules using a cognitive behavioural therapy framework. Case managers consisted primarily of psychiatric nurses, with others having social work or psychology backgrounds. Participants were assessed pre- and post-training using quantitative and qualitative measures. The effect of the training was noted in several areas including attitudinal changes, improved knowledge of psychological therapies, and changes to stated practice. However, there was concern expressed by participants about their competence and confidence to translate skills learned into practice. While the results of such a program are promising, they highlight some of the complexities of delivering such programs in rural settings.

Adult↗

PubMed2004

Interpersonal counselling in general practice.

BACKGROUND: Interpersonal counselling (IPC) derives from interpersonal psycho-therapy (IPT) but is briefer in the number and duration of sessions and is particularly suited to the primary care setting. While depression and other psychological symptoms are not necessarily 'caused' by interpersonal problems, they do occur in a social and interpersonal context. Problem areas commonly associated with the onset of depression are unresolved grief, interpersonal disputes, role transition and interpersonal deficits such as social isolation. OBJECTIVE: This article discusses IPC and how it can be used in the general practice setting. DISCUSSION: The structure of IPC is of a brief treatment of six sessions, each with an explicit focus: assessment, education about the interaction between interpersonal relationships and psychological symptoms, identifying current stress areas and helping the patient deal with these more positively and termination of the IPC relationship. Interpersonal counselling can be utilised general practice to reduce psychological symptoms, restore morale, improve self esteem and the quality of the patient's social adjustment and interpersonal relationships.

Adult↗