Development of a model to explain the sexual beliefs, intentions and behaviours of adolescents and young adults

In the last thirty years there have been many research studies which have examined the reasons why adolescents and young adults engage in sexual behaviours. Most of these studies have lacked a theoretical basis, Consequently there are many links made between variables, but no consistency across studies, or attempts to develop an underlying theory to explain the results. However, there have been theoretical models developed to explain adolescents’ and young adults’ sexual decision making. Unfortunately, many of these models have not been empirically validated. This thesis attempts to address these deficiencies in the literature by utilising a theory of behaviour and applying it to adolescent and young adult sexual decision making. This theory is the Theory of Planned Behaviour (TPB). Two longitudinal studies were conducted to examine the utility of an adaptation of the TPB to sexual decision making among adolescents and young adults. In the first study 58 adolescent males, aged between 14 years and 18 years participated in a longitudinal study using a questionnaire adapted from the Depth of Sexual Involvement Scale. In the second study, 194 young adults (156 female, 38 male) aged between 18 years and 21 years participated in a similar study. The first study found that intention to engage in behaviour was well predicted, although some of the variables in the model, did not in fact, contribute significantly to the prediction. The prediction of behaviour was less strong than that of intention. Study two found that intention to engage in behaviours was well predicted by the model. However, the degree to which intention led to behaviour was not well predicted. Overall, the results of these studies suggest that the TPB is a good theoretical basis from which to launch a systematic and theoretically informed explanation of adolescent and young adult sexual decision making. However, other factors may need to be added to the model to fully describe the decision making process and accurately predict behaviour. Suggestions are made for future research, as well as interventions that may arise as more knowledge is gathered using this paradigm

Clinical utility of the Mood and Anxiety Symptom Questionnaire (MASQ) in a sample of young help-seekers

<p>Abstract</p> <p>Background</p> <p>The overlap between Depression and Anxiety has led some researchers to conclude that they are manifestations of a broad, non-specific neurotic disorder. However, others believe that they can be distinguished despite sharing symptoms of general distress. The Tripartite Model of Affect proposes an anxiety-specific, a depression-specific and a shared symptoms factor. Watson and Clark developed the Mood and Anxiety Symptom Questionnaire (MASQ) to specifically measure these Tripartite constructs. Early research showed that the MASQ distinguished between dimensions of Depression and Anxiety in non-clinical samples. However, two recent studies have cautioned that the MASQ may show limited validity in clinical populations. The present study investigated the clinical utility of the MASQ in a clinical sample of adolescents and young adults.</p> <p>Methods</p> <p>A total of 204 Young people consecutively referred to a specialist public mental health service in Melbourne, Australia were approached and 150 consented to participate. From this, 136 participants completed both a diagnostic interview and the MASQ.</p> <p>Results</p> <p>The majority of the sample rated for an Axis-I disorder, with Mood and Anxiety disorders most prevalent. The disorder-specific scales of the MASQ significantly discriminated Anxiety (61.0%) and Mood Disorders (72.8%), however, the predictive accuracy for presence of Anxiety Disorders was very low (29.8%). From ROC analyses, a proposed cut-off of 76 was proposed for the depression scale to indicate 'caseness' for Mood Disorders. The resulting sensitivity/specificity was superior to that of the CES-D.</p> <p>Conclusion</p> <p>It was concluded that the depression-specific scale of the MASQ showed good clinical utility, but that the anxiety-specific scale showed poor discriminant validity.</p

Turnover of IPS employment specialists: Rates and predictors

Background: There are anecdotal reports of high job turnover of Individual Placement and Support employment specialists. However, no studies have addressed this issue. Objective: To explore whether turnover rates among employment specialists are higher compared to public sector employees along with the correlates of turnover intentions. Methods: A repeated cross-sectional study collected data from 40 employment specialists in Norway using validated scales to measure job perceptions. Turnover intentions were the main outcome. Results: Turnover rate of employment specialists (45.0%) was significantly higher than the average turnover rate of other occupations in the public sector (27.1%) in the same geographical regions (x2 = 6.5, df = 1, p = 0.01). After adjusting for potential confounders, five factors remained significantly associated with turnover intentions in directions as expected: general job satisfaction (β= –0.33, p < 0.05), satisfaction with current work (β= –0.35, p < 0.05), satisfaction with supervision (β= –0.28, p < 0.05), work meaningfulness (β= –0.42, p < 0.05) and Negative emotionality personality trait (β= 0.58, p < 0.05). Conclusions: Addressing turnover will positively impact on productivity and job satisfaction of employment specialists along with continuity of employment support for people with mental health conditions.publishedVersio

The societal impact of individual placement and support implementation on employment outcomes for young adults receiving temporary health-related welfare benefits: a difference-in-differences study

Background Individual placement and support (IPS) is an evidence-based practice that helps individuals with mental illness gain and retain employment. IPS was implemented for young adults at a municipality level through a cross-sectoral collaboration between specialist mental healthcare, primary mental healthcare, and the government funded employment service (NAV). We investigated whether IPS implementation had a causal effect on employment outcomes for all young adults in receipt of a temporary health-related rehabilitation (work assessment allowance, WAA) welfare benefit, measured at the societal level compared to municipalities that did not implement IPS. Method We used a difference in differences design to estimate the effects of IPS implementation on the outcome of workdays per year using longitudinal registry data. We estimate the average effect of being exposed to IPS implementation during four-years of implementation compared to ten control municipalities without IPS for all WAA recipients. Results We found a significant, positive, causal effect on societal level employment outcomes of 5.6 (p = 0.001, 95% CI 2.7–8.4) increased workdays per year per individual, equivalent to 12.7 years of increased work in the municipality where IPS was implemented compared to municipalities without IPS. Three years after initial exposure to IPS implementation individuals worked, on average, 10.5 more days per year equating to 23.8 years of increased work. Conclusions Implementing IPS as a cross sectoral collaboration at a municipality level has a significant, positive, causal, societal impact on employment outcomes for all young adults in receipt of a temporary health-related rehabilitation welfare benefit

Economic analyses of supported employment programmes for people with mental health conditions: a systematic review

Background Employment is intrinsic to recovery from mental health conditions, helping people live independently. Systematic reviews indicate supported employment (SE) focused on competitive employment, including individual placement and support (IPS), is effective in helping people with mental health conditions into work. Evidence is limited on cost-effectiveness. We comprehensively reviewed evidence on the economic case for SE/IPS programmes. Methods We searched PubMed/MEDLINE, EMBASE, PsycINFO, CINAHL, IBSS, Business Source Complete, and EconLit for economic and return on investment analyses of SE/IPS programmes for mental health conditions. Traditional vocational rehabilitation, sheltered work, and return to work initiatives after sickness absence of less than 1 year were excluded. Studies were independently screened by two reviewers. We assessed quality using the Consolidate Health Economic Evaluation Reporting Standards checklist. The protocol was preregistered with PROSPERO-CRD42020184359. Results From 40,015 references, 28 studies examined the economic case for IPS, four IPS augmented by another intervention, and 24 other forms of SE. Studies were very heterogenous, quality was variable. Of 41 studies with quality scores over 50%, 10 reported cost per quality-adjusted life year gained, (8 favourable to SE/IPS), 14 net monetary benefits (12 positive), 5 return on investment (4 positive), and 20 cost per employment outcome (14 favorable, 5 inconclusive, 1 negative). Totally, 24 of these 41 studies had monetary benefits that more than outweighed the additional costs of SE/IPS programmes. Conclusions There is a strong economic case for the implementation of SE/IPS programmes. The economic case is conservative as evidence on long-term impacts of programmes is limited

A meta-regression of the impact of policy on the efficacy of individual placement and support

Objective: Individual placement and support (IPS) has shown consistently better outcomes on competitive employment for patients with severe mental illness than traditional vocational rehabilitation. The evidence for efficacy originates from few countries, and generalization to different countries has been questioned. This has delayed implementation of IPS and led to requests for country-specific RCTs. This meta-analysis examines if evidence for IPS efficacy can be generalized between rather different countries. Methods: A systematic search was conducted according to PRISMA guidelines to identify RCTs. Overall efficacy was established by meta-analysis. The generalizability of IPS efficacy between countries was analysed by random-effects meta-regression, employing country- and date-specific contextual data obtained from the OECD and the World Bank. Results: The systematic review identified 27 RCTs. Employment rates are more than doubled in IPS compared with standard vocational rehabilitation (RR 2.07 95% CI 1.82–2.35). The efficacy of IPS was marginally moderated by strong legal protection against dismissals. It was not moderated by regulation of temporary employment, generosity of disability benefits, type of integration policies, GDP, unemployment rate or employment rate for those with low education. Conclusions: The evidence for efficacy of IPS is very strong. The efficacy of IPS can be generalized between countries

Long term outcomes and causal modelling of compulsory inpatient and outpatient mental health care using Norwegian registry data: protocol for a controversies in psychiatry research project

Objectives: Compulsory mental health care includes compulsory hospitalisation and outpatient commitment with medication treatment without consent. Uncertain evidence of the effects of compulsory care contributes to large geographical variations and a controversy on its use. Some argue that compulsion can rarely be justified and should be reduced to an absolute minimum, while others claim compulsion can more frequently be justified. The limited evidence base has contributed to variations in care that raise issues about the quality/appropriateness of care as well as ethical concerns. To address the question whether compulsory mental health care results in superior, worse or equivalent outcomes for patients, this project will utilise registry‐ based longitudinal data to examine the effect of compulsory inpatient and outpatient care on multiple outcomes, including suicide and overall mortality; emergency care/injuries; crime and victimisation; and participation in the labour force and welfare dependency. Methods: By using the natural variation in health providers' preference for compulsory care as a source of quasi‐randomisation we will estimate causal effects of compulsory care on short‐ and long‐term trajectories. Conclusions: This project will provide valuable insights for service providers and policy makers in facilitating high quality clinical care pathways for a high risk population group