Recognition of, and attitudes towards, people with depression and psychosis with/without alcohol and other drug problems: Results from a national survey of Australian paramedics

Objective Continuing stigma towards mental health problems means that many individuals—especially men—will first present in crisis, with emergency services often the first point of call. Given this situation, the aims of this paper were to assess paramedics’ ability to recognise, and their attitudes towards, males with clinically defined depression and psychosis with and without comorbid alcohol and other drug (AOD) problems. Methods A cross-sectional national online survey of 1230 paramedics throughout Australia. The survey was based on four vignettes: depression with suicidal thoughts, depression with suicidal thoughts and comorbid alcohol problems, and psychosis with and without comorbid AOD problems. Results Just under half of respondents recognised depression, but this decreased markedly to one-fifth when comorbid AOD problems were added to the vignette. In contrast, almost 90% recognised psychosis, but this decreased to just under 60% when comorbid AOD problems were added. Respondents were more likely to hold stigmatising attitudes towards people in the vignettes with depression and psychosis when comorbid AOD problems were present. Respondents endorsed questionnaire items assessing perceived social stigma more strongly than personal stigma. Desire for social distance was greater in vignettes focusing on psychosis with and without comorbid AOD problems than depression with and without comorbid AOD problems. Conclusions Paramedics need a well-crafted multicomponent response which involves cultural change within their organisations and more education to improve their recognition of, and attitudes towards, clients with mental health and AOD problems. Education should focus on the recognition and care of people with specific mental disorders rather than on mental disorders in general. It is essential that education also focuses on understanding and caring for people with AOD problems. Educational interventions should focus on aligning beliefs about public perceptions with personal beliefs about people with mental disorders and AOD problems. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

#WaysToRelax: developing an online alcohol-related health promotion animation for people aged 55 and older

Alcohol use among middle-aged and older adults (55 years and older) is increasingly becoming a public health concern. Despite this, there is relatively little research on the experiences of alcohol use and related concerns among people aged 55 and older to inform tailored and engaging health promotion activities. To address this gap, we aimed to develop an engaging alcohol-related health promotion resource for people aged 55 and older. We drew on a research-into-action approach, which involved: 1) thematic analysis of alcohol-related concerns in online counselling transcripts of 70 people aged 55 and older, 2) a review of health promotion literature, and 3) consultation with consumers of alcohol and other drug services, and carers. The research phase highlighted that people aged 55 and older were concerned that their reliance on alcohol use to manage stress had become a habit they wanted to shift. Alongside this, the literature showed that people aged 55 and older were often dismissive of conventional health promotion activities, and pointed to the benefits of conveying health promotion messages through animation. In response, we developed an animation to stimulate reflection and thought about other ways to relax and manage stress. We drew on health promotion principles to ensure that the animation had a positive message and was engaging without being ageist or paternalistic. It was further refined with input from consumers and carers, who thought the animation was appropriate, appealing and useful. Future activities will include further dissemination and evaluation of the animation and associated activities

Understanding women's perspectives on take-home naloxone to support equitable overdose prevention

Since the late 1990s, Australia has experienced increasing number of opioid overdose hospital admissions and deaths. One response has been the implementation of take-home naloxone initiatives, which involve providing naloxone (a drug that reverses opioid overdose) products and training to those most likely to encounter overdose. Despite its life-saving potential, the administration of naloxone can precipitate opioid withdrawal, an experience associated with a range of undesirable outcomes including nausea, body aches, shivering, confusion, irritability, anger, restlessness and headaches. Naloxone’s potential for producing uncomfortable withdrawal symptoms has also been linked to distress, aggression and, occasionally, violence during revival from overdose. Research suggests that concerns about withdrawal impact naloxone uptake. While research on other overdose responses such as safe injecting facilities emphasises the need for gender sensitive approaches and other research suggests that women often feel obliged to take on caring roles during overdose events even when they felt unsafe, how gender may shape take-home naloxone uptake and use has only been fleetingly acknowledged. A notable exception examines how disproportionate expectations and burdens upon women to care for others in their social lives shapes their experiences with naloxone and overdose response. Similarly, research has documented women who inject drugs having to take on caretaker roles given men in their company are less concerned about the potential for overdose. Women in Hanson et al.’s (2020) study, for example, exercise greater caution about overdose than men, many of which relied on naloxone to reverse overdoses rather than aiming to prevent the overdose itself from occurring. In order to bolster take-home naloxone uptake in ways that support the safety of women who consume opioids, this research examined the potential concerns about naloxone and overdose response that shape their engagement with the initiative. This broadsheet is based on research conducted as part of the project titled ‘Investigating how gender shapes uptake and use of take-home naloxone: A qualitative pilot study’. Led by researchers at La Trobe University’s school of Psychology and Public Health and the Australian Research Centre in Sex, Health and Society, this research aims to better understand barriers to take-home naloxone initiatives and how we can develop gender-sensitive overdose prevention.</p