Disability income support design and mental illness: a summary of the grey literature

Aim: Mental illnesses have many distinctive features such as their fluctuating nature, invisibility and lack of diagnostic clarity that make determining eligibility for disability income support challenging. How do policy-makers deal with these features when designing disability income support? More specifically, ‘How do mental illnesses come to be considered eligible disabilities?’, ‘What tools are used to assess mental illness for eligibility?’, ‘What challenges exist in this process?’ and ‘What approaches are used to address these challenges?’ We aimed to determine what evidence is available to policy-makers in Australia and Ontario (Canada) to answer these questions. Methods: Ten electronic databases and grey literature in both jurisdictions were searched using key words including disability income support, disability pension, mental illness, mental disability, addiction, depression and schizophrenia for articles published between 1991 and June 2013 yielding 1,341 articles of which 20 met the inclusion criteria and were critically appraised. Results: Results revealed that there is limited evidence available on disability income support design and mental illness in the Australian and Ontarian setting. Most of the evidence available is from the grey literature and draws on evidence from case law. Many documents reviewed argued that current policy in Australia and Ontario is frequently based on negative assumptions about mental illnesses rather than available evidence (either peer-reviewed or grey literature). Results showed that problems related to mental illness are largely related to the interpretation of the definition rather than the definition itself. Conclusions: The review confirmed that mental illnesses present many challenges when designing disability income support and that academic as well as grey literature, especially case law, provide insight into these challenges. More research is needed on addressing these challenges identified, particularly in these contexts, with the intention that more evidence on this topic could lead to policies for those with mental illness that are well-informed and do not reinforce societal prejudices

We need to talk about depression and dialysis: but what questions should we ask and does anyone know the answers?

Depression is common in people with chronic kidney disease (CKD). When diagnosed via a gold standard semi-structured psychiatric interview by culturally-competent staff, depression affects one fifth to one quarter of people with CKD, whether in receipt of maintenance dialysis, with non-dialysis treated CKD, or with a functioning transplant (respective prevalence rates 22.8 (95% confidence interval (CI) 18.6 to 27.6)%, 21.4 (95%CI 11.1 to 37.2)% and 25.7 (95%CI 12.8 to 44.9)%)1. These frequencies are clearly in excess of the average population lifetime risk of ~ 9%2. Potential reasons for the high rates of depression in end stage kidney disease (ESKD) include the overlap of some risk factors for both conditions, the alteration of physiological processes associated with ESKD and the psychosocial consequences of living with ESKD3. Depression in people receiving dialysis is associated with lower quality of life, increased hospitalisations and, likely shortened survival3

Text messages to reduce depressive symptoms: Do they work and what makes them effective? A systematic review

Objective: In this systematic review and meta-analysis, we aimed to quantify the effects of text messaging interventions to reduce depressive symptoms and identify variables that might influence the effectiveness of the intervention. Design: Electronic databases including EMBASE, CENTRAL, MEDLINE, CINAHL, PsycINFO and SCOPUS, as well as Clinicaltrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) were searched for randomised controlled trials that sent one or more text messages with health-related content to adults who had been identified by a healthcare provider. Results: Seven trials (nine comparisons), with 1,918 participants, were included in the review, and the pooled analysis revealed a borderline statistically significant reduction in depressive symptom scores between the text messaging intervention and control groups (standardised mean difference [SMD], −0.27; 95% confidence interval [CI], −0.54 to 0.00; p = .00) favouring intervention at the end. Statistically significant reductions were shown in important subgroups, for example, where the primary aim of the messages was to reduce depressive symptoms; in those using the Beck Depression Inventory (BDI) or 9-item Patient Health Questionnaire (PHQ-9) questionnaires; where text message content was targeted at mental well-being, mood improvement and cognitive behavioural therapy information; and when the message frequency was ⩾2 times per week. Conclusion: Text messaging has potential to reduce depressive symptoms. The results of this review should be interpreted with caution, however, due to the methodological limitations of included trials. More research is required before recommendations can be made about the routine use of text messaging for the management of depressive symptoms

Group cognitive behavioural therapy for stroke survivors with depression and their carers

Background: Depression in stroke survivors is common, leads to poorer outcomes and often not treated. A group cognitive behavioural therapy (CBT) program (Brainstorm) for stroke survivors with depression, and their carers has been running as part of usual care since 2007. Objective: To evaluate the implementation and acceptability of Brainstorm, a closed group intervention consisting of up to 10 sessions of education, activity planning, problem solving and thought challenging. Methods: Participating stroke survivors and their carers complete assessment measures at baseline, post-treatment and 1-month and 6-months follow-up. A mixed models for repeated measures data was conducted with depression and anxiety scores for stroke survivors (Beck Depression Inventory-II; Hospital Anxiety and Depression Scale) and the assessment of depression, anxiety and carer burden for carers. Acceptability was assessed by session attendance and written and open participant feedback upon completion of the program. Results: Forty-eight community dwelling stroke survivors and 34 carers attended Brainstorm, with a median attendance of 88% of sessions. Follow-up assessments were completed by 77% (post-treatment), 46% (1-month) and 38% (6-month) of stroke survivors. Stroke survivors’ depression scores decreased from baseline to post-treatment (p<.001); maintained at 1-month (p<.001) but not at 6-month (p=.056). Anxiety scores decreased between baseline and 1-month (p=.013). Carer burden, depression and anxiety scores at 1-month and 6-month follow-up, for carers, were all reduced when compared with baseline (p<.05). Conclusion: The Brainstorm group intervention for depression in stroke survivors appears to have been effectively implemented and is acceptable to stroke survivors and carers

Motivational Interviewing Post-Stroke: An Analysis of Stroke Survivors' Concerns and Adjustment

Our earlier research demonstrated that participation in four sessions of motivational interviewing (MI) early post-stroke has a positive impact on stroke survivors' mood. However, the theoretical underpinnings of MI in supporting adjustment (rather than its traditional use in supporting behavior change) require clarification. This article describes a content analysis of MI transcripts for 10 participants in our previous study, to identify the focus of discussions (patient "concerns") and potential effective components of our MI approach. Patients' post-stroke concerns were shown in 16 categories, including frustration, family impact, and getting well. There was a pattern of change discourse across sessions: "Sustain talk" (reasons for not changing) reduced from Session 1 onward, "change talk" (intent to change) increased then reduced, and "change expressed" (changes achieved) increased from Sessions 1 to 4. MI facilitates healthy adjustment post-stroke in some patients, in turn affecting mood, but clarification of how this effect is achieved requires further exploration

Driving in stroke survivors aged 18–65 years: The Psychosocial Outcomes In StrokE (POISE) Cohort Study

Background: There is limited information regarding return to driving after stroke. Aims: To determine the frequency and predictors of return to driving within 1 month of acute stroke in younger (age 18–65 years) adults. Methods: POISE (Psychosocial Outcomes In StrokE) was a cohort study conducted in Australia between October 2008 and June 2010. Consecutive patients (age 18–65 years) with a recent (≤28 days) acute stroke were recruited. Validated demographic, clinical, mental health, cognitive, and disability measures including return to driving were obtained. Multivariable logistic regression was used to determine factors associated with return to driving within 1 month of stroke. Results: Among 359 participants who were legally able to drive before stroke, 96 (26.7%) returned to driving within 1 month. Compared to those without an early return to driving (n = 263), drivers were more often male, the main income earner, in paid work before stroke and without symptoms of depression or fatigue. Independence in activities of daily living (odds ratio (OR) 30.05, 95% confidence interval (CI) 3.85–234.45), not recalling receiving advice on driving cessation (OR 5.55, 95% CI 2.86–11.11), and having returned to paid work (OR 3.93, 95% CI 1.94–7.96) were associated with early return to driving. Conclusions: One in four young adults resumed driving within a month, contrary to guideline recommendations. These data reinforce the importance of deciding who is responsible for determining fitness to drive after stroke, when, and whether it is reasonable to enforce driving restrictions on those with minimal disability who are fit to return to work. Registration: Australian New Zealand Clinical Trials Registry ANZCTRN 12608000459325

inVestIgating the pSychologIcal and ecONomic impAct of cataRact surgerY in Vietnam: The VISIONARY observational study protocol

<p>Abstract</p> <p>Background</p> <p>Visual impairment caused by cataracts not only affects an individual's quality of life but can also have a profound impact on other important psychological factors and on the economic circumstances of individuals and their households. Cataract surgery is an effective intervention to restore vision and is also associated with other positive consequences including improvements in quality of life, economic and psychological outcomes. While there has been an increase in the number and quality of cataract surgeries performed in Vietnam, the programs currently in place are still unable to meet the existing demand and need for surgery. Data on both the cost-effectiveness of cataract surgery and the economic and psychological impact of untreated cataract in this setting is lacking.</p> <p>Methods/Design</p> <p>This study, investigating the psychological and economic impact of cataract surgery in Vietnam (VISIONARY), will recruit and interview a sample of adults (18 years or over) who are referred for cataract surgery by one of the following sites and their outreach programs: Hue Eye Hospital; Thai Binh Eye Hospital; Binh Dinh Department of Health Eye Hospital and the Vinh Long Department of Health Social Disease Centre. All participants (those who have cataract surgery and those who do not have surgery) will be followed up at six and 12 months.</p> <p>Discussion</p> <p>This study is designed to examine the impact of low vision on household economic circumstances and psychological outcomes as well as to investigate the effectiveness and cost-effectiveness of cataract surgery in Vietnam. It will help to inform international and national non-government organisations working in the country and local policy-makers on priorities for further investment in eye-health services in this setting and their relevance to broader economic development goals.</p

Living clinical guidelines for stroke: Updates, challenges and opportunities

Continued growth in the number of published clinical studies has necessitated changes to the way evidence-based resources such as clinical guidelines are developed and updated. The Australian and New Zealand Clinical Guidelines for Stroke Management (https://informme.org.au/guidelines/clinical-guidelines-for-stroke-management) are based on continual evidence surveillance and timely updates to recommendations as new research is published. In this article, we outline the main updates to recommendations since the guidelines moved into a living mode in 2018, and discuss key challenges and benefits of living guidelines

Update on the EFFECTS study of fluoxetine for stroke recovery: a randomised controlled trial in Sweden

Studies have suggested that fluoxetine might improve neurological recovery after stroke, but the results remain inconclusive. The EFFECTS (Efficacy oF Fluoxetine – a randomisEd Controlled Trial in Stroke) reached its recruitment target of 1500 patients in June 2019. The purpose of this article is to present all amendments to the protocol and describe how we formed the EFFECTS trial collaboration in Sweden. Methods In this investigator-led, multicentre, parallel-group, randomised, placebo-controlled trial, we enrolled non-depressed stroke patients aged 18 years or older between 2 and 15 days after stroke onset. The patients had a clinical diagnosis of stroke (ischaemic or intracerebral haemorrhage) with persisting focal neurological deficits. Patients were randomised to fluoxetine 20 mg or matching placebo capsules once daily for 6 months. Results Seven amendments were made and included clarification of drug interaction between fluoxetine and metoprolol and the use of metoprolol for severe heart failure as an exclusion criterion, inclusion of data from central Swedish registries and the Swedish Stroke Register, changes in informed consent from patients, and clarification of design of some sub-studies. EFFECTS recruited 1500 patients at 35 centres in Sweden between 20 October 2014 and 28 June 2019. We plan to unblind the data in January 2020 and report the primary outcome in May 2020. Conclusion EFFECTS will provide data on the safety and efficacy of 6 months of treatment with fluoxetine after stroke in a Swedish health system setting. The data from EFFECTS will also contribute to an individual patient data meta-analysis