A national survey on COVID-19 second-wave lockdowns on older adults' mental wellbeing, health-seeking behaviours and social outcomes across Australia

Abstract Background The impact of severe second lockdown measures on older adults’ wellbeing is unknown. We aimed to (i) identify the impact of the second lockdown that resulted from the second wave of COVID-19 cases on older Australians’ quality of life; (ii) compare the impact of second wave lockdowns in Victoria, Australia’s second most populous State, to those in other States and Territories not in lockdown. Methods A national cross-sectional study of community-dwelling older adults completed online questionnaires for quality of life, social networks, healthcare access, and perceived impact of COVID-19 between July to September 2020. Tobit regression was used to measure the relationships of healthcare service access and social networks with quality of life of older adults in Victoria compared to those in the rest of Australia. Results A total of 2,990 respondents (mean [SD] age, 67.3 [7.0]; 66.8 % female) participated. At time of data collection, Victoria’s second COVID-19 lockdown had been in force for an average 51.7 days. Median quality of life scores were significantly higher in Victoria compared to the rest of Australia (t2,827=2.25 p = 0.025). Being female (95 % CI, -0.051–0.020), having lower educational attainment (95 % CI, -0.089–-0.018), receiving government benefits (95 % CI, -0.054–-0.024), having small social networks (95 % CI, 0.006–0.009) and self-reported physical chronic health conditions were all independent predictors of lower quality of life. Conclusions Longer-term studies are required to provide more robust evidence of the impact as restrictions lift and normal social conventions return

Improving mental health and social participation outcomes in older adults with depression and anxiety: Study protocol for a randomised controlled trial

Background Increasing both the frequency and quality of social interactions within treatments for anxiety and depressive disorders in older adults may improve their mental health outcomes and quality of life. This study aims to evaluate the clinical efficacy and cost utility of an enhanced cognitive behavioural therapy (CBT) plus social participation program in a sample of older adults with depression and/or anxiety. Methods A total of 172 community-dwelling adults aged 65 years or older with an anxiety and/or depressive disorder will be randomly allocated to either an enhanced CBT plus social participation program (n = 86) or standard CBT (n = 86). Both treatments will be delivered during 12 weekly individual sessions utilising structured manuals and workbooks. Participants will be assessed at pre-treatment, post-treatment, and 12-month follow-up. The primary outcome evaluates mean change in clinician-rated diagnostic severity of anxiety and depressive disorders from baseline to post-treatment (primary endpoint) based on a semi-structured diagnostic interview. Secondary outcomes evaluate changes in symptomatology on self-report anxiety and depression measures, as well as changes in social/community participation, social network, and perceived social support, loneliness, quality of life, and use of health services. Economic benefits will be evaluated using a cost-utility analysis to derive the incremental cost utility ratios for the enhanced CBT program. Discussion Outcomes from this study will provide support for the establishment of improved psychosocial treatment for older adults with anxiety and/or depression. Study outcomes will also provide health systems with a clear means to reduce the impact of poor emotional health in older age and its associated economic burden. In addition to the empirical validation of a novel treatment, the current study will contribute to the current understanding of the role of social participation in older adult wellbeing

Managing family accommodation of OCD in the context of adolescent treatment refusal : a case example

Family accommodation is a common and widely studied phenomenon in families of youth with obsessive-compulsive disorder (OCD). Family accommodation has been associated with increased symptom severity, poorer functional outcomes, and reduced treatment response. While family accommodation is increasingly targeted in family-based treatment of OCD, there are cases where youth refuse treatment. In these circumstances, parent-focused treatments that target reduction of family accommodation can be used to improve outcomes for youth with OCD. This case study illustrates the conceptualization and treatment of family accommodation in childhood OCD in the context of treatment refusal. Treatment was implemented without explicit involvement of the child. Parents reported moderate improvement in OCD symptoms at the end of treatment and a decrease in overall parent-child conflict. The findings illustrate how exposure and response principles can be implemented without direct involvement of the child in cases where youth show low motivation or refusal of treatment.10 page(s

Learning cognitive restructuring in later life: the role of cognitive flexibility on cognitive restructuring skill acquisition in older adults with anxiety and depression

Thesis by publication.Includes bibliographical references.Introduction -- Paper 1. The role of cognitive flexibility in cognitive restructuring skill acquisition among older adults -- Paper 2. Learning cognitive restructuring in later life : the relationship between anxiety and depression, cognitive flexibility and cognitive restructuring skill acquisition in older adults -- Paper 3. Reliability and valiidity of two self-report measures of cognitive flexibility -- Paper 4. The influence of cognitive flexibility on treatment outcome and cognitive restructuring skill acquisition during cognitive behavioural treatment for anxiety and depression in older adults : results of a pilot study -- Thesis discussion.Although there is consistent evidence supporting the efficacy of cognitive behaviour therapy for late-life anxiety and depression, there are still some suggestions that the use of cognitive restructuring should be modified or minimized with older adults due to declines in flexible and abstract thinking. There is some evidence that poorer executive functioning negatively impacts on cognitive behavioural therapy (CBT) efficacy, although it is unclear what specific executive functioning skills are important and what treatment components are affected. Older adults experience some age-related decline in cognitive flexibility skills, including the ability to consider multiple ideas, flexibly switch cognitive sets and inhibit habitual responding; skills which intuitively seem important for the successful use of cognitive restructuring. This thesis aimed to examine the role of cognitive flexibility on cognitive restructuring skill acquisition in older adults through four papers. The first paper examined the role of cognitive flexibility on cognitive restructuring skill acquisition in a normal community-dwelling sample of older adults. The second paper extended these findings, assessing cognitive restructuring skills in older adults with and without anxiety and depression, and the influence of cognitive flexibility on this relationship. The third paper examined the measurement of cognitive flexibility, comparing neuropsychological assessment and self-report measures in older adults. The final paper investigated the role of pre-treatment cognitive flexibility as a predictor of cognitive restructuring skill acquisition at the end of a group CBT intervention for late-life anxiety and depression, and as a predictor of treatment outcome. The results are expected to inform clinical practice for conducting CBT with older adults, and build on emerging research into treatment moderators and mediators for late-life anxiety and depression.Mode of access: World wide web1 online resource (v, 213 pages) illustration

Cultural considerations in alcohol use and misuse

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Treatment of obsessive-compulsive disorder in very young children

There is an increasing awareness that very young children can present with obsessive-compulsive disorder (OCD); however, there is limited evidence for the efficacy of treatment in this age group. Early intervention may have the potential to alter the negative trajectory associated with pediatric OCD and may avoid longstanding dysfunction and impairment resulting in academic, social, and family functioning. Pharmacotherapy generally has poor acceptability among parents of young children, and there is evidence of increased risk of adverse side effect in very young children. There is emerging support for family-based cognitive behavioral therapy and exposure and response prevention as a first-line treatment for preschool OCD. In this chapter, we review the phenomenology, assessment, and treatment of OCD in very young children, as well as the complexities involved with differential diagnosis and developmentally sensitive treatment in this age group. The assessment, case conceptualization, and treatment of a 4-year-old boy are presented to illustrate the complexities of working with preschoolers and their families.14 page(s

Evaluating risks and benefit of deep brain stimulation for treatment-refractory tourette syndrome

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