Quality of life and psychosocial wellbeing in youth with neuromuscular disorders who are wheelchair Users: A systematic review

Objective: To investigate quality of life (QoL) and psychosocial wellbeing in youth with Neuromuscular Disorders (NMD) who are wheelchair users. Data Sources: Medline, Embase, CINAHL and PsycINFO (January 2004 to April 2016) and reference lists of retrieved full-text papers. Study Selection: Peer-reviewed studies were included when data describing self-reported QoL and psychosocial wellbeing could be separately understood for those using wheelchairs and aged 12-22 years old. 2058 records were independently screened and potentially eligible papers were obtained and examined by all reviewers. Twelve observational and three qualitative studies met the inclusion criteria. Data Extraction: Population representativeness, measurement tools and outcomes, where possible with comparison groups. Two reviewers independently appraised studies for risk of bias to internal validity and generalisability. Data Synthesis: Heterogeneity of measurement and reporting precluded meta-analysis. Data were cross-sectional only. Compared to same age typically developing peers, physical QoL was scored consistently and significantly lower in youth with NMD, whilst psychosocial QoL was not. Psychosocial QoL was highest in youth non-ambulant since early childhood and in those recruited via single tertiary specialist clinics. Mental health and social participation could not be compared to same age populations. Conclusions: Despite low physical QoL, psychosocial QoL in youth with NMD appeared comparable to same age peers. The psychosocial wellbeing of younger adolescents on degenerative disease trajectories appeared most compromised, though the longitudinal impacts of growing up with NMD on mental health and social participation are unknown. Interpretation was hampered by poor description of participant age, gender and physical ability, lack of population based recruitment strategies and inconsistent use of age appropriate measures. Understanding of self-reported QoL and psychosocial wellbeing in youth with NMD transitioning to adulthood is limited

Age and Gender in the Phenomenology of Depression

Objective: Authors investigated the effects of current age, age at onset, and gender on the phenomenology of depression. Methods: A mixed-age sample of 810 Mood Disorders Unit attendees with a diagnosis of unipolar major depressive episode at or near its nadir were interviewed by clinician-rated and self-report instruments assessing symptoms and severity of depression. Results: Differences were found in depressive phenomenology according to current age but not age at onset, confirming previous findings. Age differences on several variables were found in women only. Subjective ratings of depression severity decreased with age, whereas objective, clinician-rated severity increased. Conclusions: The pattern and severity of depression change with increasing age. Longitudinal prospective studies would further elucidate this age-gender relationship. Clinicians should be aware of the decreased likelihood of older patients' reporting of depressive symptoms themselves

Static metrics of impact for a dynamic problem: The need for smarter tools to guide suicide prevention planning and investment

Objectives: This study investigates two approaches to estimate the potential impact of a population-level intervention on Australian suicide, to highlight the importance of selecting appropriate analytic approaches for informing evidence-based strategies for suicide prevention. Methods: The potential impact of a psychosocial therapy intervention on the incidence of suicide in Australia over the next 10 years was used as a case study to compare the potential impact on suicides averted using: (1) a traditional epidemiological measure of population attributable risk and (2) a dynamic measure of population impact based on a systems science model of suicide that incorporates changes over time. Results: Based on the population preventive fraction, findings suggest that the psychosocial therapy intervention if implemented among all eligible individuals in the Australian population would prevent 5.4% of suicides (or 1936 suicides) over the next 10 years. In comparison, estimates from the dynamic simulation model which accounts for changes in the effect size of the intervention over time, the time taken for the intervention to have an impact in the population, and likely barriers to the uptake and availability of services suggest that the intervention would avert a lower proportion of suicides (between 0.4% and 0.5%) over the same follow-up period. Conclusion: Traditional epidemiological measures used to estimate population health burden have several limitations that are often understated and can lead to unrealistic expectations of the potential impact of evidence-based interventions in real-world settings. This study highlights these limitations and proposes an alternative analytic approach to guide policy and practice decisions to achieve reductions in Australian suicide

A decision support tool to inform local suicide prevention activity in Greater Western Sydney (Australia)

Objectives: This study describes the development of a decision support tool to identify the combination of suicide prevention activities and service priorities likely to deliver the greatest reductions in suicidal behaviour in Western Sydney (Australia) over the period 2018–2028. Methods: A dynamic simulation model for the WentWest – Western Sydney Primary Health Network population-catchment was developed in partnership with primary health network stakeholders based on defined pathways to mental health care and suicidal behaviour, and which represented the current incidence of suicide and attempted suicide in Western Sydney. A series of scenarios relating to potential suicide prevention activities and service priorities identified by primary health network stakeholders were investigated to identify the combination of interventions associated with the largest reductions in the forecast number of attempted suicide and suicide cases for a 10-year follow-up period. Results: The largest number of cases averted for both suicide and attempted suicide was associated with (1) post-suicide attempt assertive aftercare (6.1% for both attempted suicide and suicide), (2) improved community support and reductions in psychological distress in the community (5.1% for attempted suicide and 14.8% for suicide), and (3) reductions in the proportion of those lost to services following a mental health service contact (10.5% for both attempted suicide and suicide). In combination, these interventions were forecast to avert approximately 29.7% of attempted suicides and 37.1% of suicides in the primary health network catchment over the 10-year period. Conclusion: This study demonstrates the utility of dynamic simulation models, co-designed with multi-disciplinary stakeholder groups, to capture and analyse complex mental health and suicide prevention regional planning problems. The model can be used by WentWest – Western Sydney Primary Health Network as a decision support tool to guide the commissioning of future service activity, and more efficiently frame the monitoring and evaluation of interventions as they are implemented in Western Sydney

Barriers and facilitators for adherence to antiretroviral therapy in Papua New Guinea

Papua New Guinea (PNG) is in a phase of scaling up access to antiretroviral therapy (ART), and adherence to the newly available drug therapy is becoming an important issue. This paper examines adherence to ART in a sample of 374 HIV-positive people in six provinces in PNG. Participants were recruited to the study using non-probability sampling. Sixty-two % of participants reported complete adherence (no missed or late doses in the past week) and 79% reported not missing any doses in the last week. Revival church members were significantly more likely to report having missing a treatment dose(s) (66%). Those living in the Highlands and those attending Catholic health clinics were significantly more likely to be adherent to their treatment. Age, gender, marital status, education level and employment type did not show significant association with treatment adherence. Adherence rates in PNG are not alarming, indicating that people with HIV can adhere to treatment despite the challenges of living in PNG