Australian Indigenous model of mental healthcare based on transdiagnostic cognitive–behavioural therapy co-designed with the Indigenous community: protocol for a randomised controlled trial

Background A four- to seven-fold increase in the prevalence of current mood, anxiety, substance use and any mental disorders in Indigenous adults compared with non-Indigenous Australians has been reported. A lifetime prevalence of major depressive disorder was 23.9%. High rates of comorbid mental disorders indicated a transdiagnostic approach to treatment might be most appropri- ate. The effectiveness of psychological treatment for Indigenous Australians and adjunct Indigenous spiritual and cultural healing has not previously been evaluated in controlled clinical trials. Aims This project aims to develop, deliver and evaluate the effectiveness of an Indigenous model of mental healthcare (IMMHC). Trial registration: ANZCTR Registration Number: ACTRN12618001746224 and World Health Organization Universal Trial Number: U1111-1222-5849. Method The IMMHC will be based on transdiagnostic cognitive–behav- iour therapy co-designed with the Indigenous community to ensure it is socially and culturally appropriate for Indigenous Australians. The IMMHC will be evaluated in a randomised con- trolled trial with 110 Indigenous adults diagnosed with a current diagnosis of depression. The primary outcome will be the severity of depression symptoms as determined by changes in Beck Depression Inventory-II score at 6 months post-interven- tion. Secondary outcomes include anxiety, substance use disorder and quality of life. Outcomes will be assessed at base- line, 6 months post-intervention and 12 months post- intervention. Results The study design adheres to the Consolidated Standards of Reporting Trials (CONSORT) statement recommendations and CONSORT extensions for pilot trials. We followed the Standard Protocol Items for Randomised Trials statement recommenda- tions in writing the trial protocol. Conclusions This study will likely benefit participants, as well as collaborating Aboriginal Medical Services and health organisations. The transdiagnostic IMMHC has the potential to have a substantial impact on health services delivery in the Indigenous health sector

Traumatic life events and risk of posttraumatic stress disorder among the Indigenous population of regional, remote and metropolitan Central-Eastern Australia: a cross-sectional study

Objective Trauma is reported by 70% of the global population and 4% of those exposed develop post-traumatic stress disorder (PTSD), but data from Indigenous populations are limited. We aimed to determine the prevalence, types and age of occurrence of traumatic events among community-living Indigenous Australians and associations with PTSD. Design Lifetime trauma and PTSD were quantified among a broadly representative sample of 544 Indigenous participants using a diagnostic clinical interview. Logistic regression examined predictors of PTSD. Setting Metropolitan, regional and remote areas of Southern Queensland and Northern New South Wales. Participants Indigenous Australians 18 years and older. Outcome measures Prevalence of traumatic life events and risk of PTSD. Results 64.9% of participants (standardised prevalence 62.6%) reported lifetime trauma, with more than one trauma category in 62.3%. Females reported 2.3 times more sexual violence, otherwise no gender differences existed. The prevalence of four common trauma categories were 1.7-3.0 times higher than in the Australian population; physical violence being the highest relative risk. Although overall childhood trauma was not increased, sexual or physical violence before age 15 was twice more common than in the Australian population. The standardised prevalence of 12-month PTSD was 13.3% (95% CI 10.4 to 16.1), 16.1% (95% CI 12.2 to 19.9) in females and 8.2% (95% CI 5.3 to 11.1) in males, three times the Australian rates. In multiple regression analysis, independent predictors of PTSD were female gender (OR 2.1), rural residence (OR 3.0), trauma under age 10 (OR 2.2), sexual (without physical) violence (OR 2.5), physical (without sexual) violence (OR 2.3), and both sexual and physical violence (OR 5.0). Conclusion Indigenous Australians are more likely to experience potentially harmful traumas and develop PTSD than other Australians. Mitigation of trauma among Indigenous Australians, particularly childhood exposure and sexual or physical violence, is essential to reduce their high burden of PTSD

Short-Term Psychodynamic Psychotherapy for Functional Somatic Disorders: A Meta-Analysis of Randomized Controlled Trials

Introduction: Functionalsomatic disorders (FSD) are common and costly, thereby driving the need for the development of effective brief treatment options. Short-term psychodynamic psychotherapy (STPP) is one candidate treatment method. Objective: To review and meta-analyze, where possible, randomized controlled trials (RCTs) of STPP for FSD. Methods: Following a systematic search of the literature, we performed a meta-analysis of available RCT groups to determine the effects of STPP on a range of outcomes after treatment, and medium- and long-term follow-ups. Results: In meta-analyses of 17 RCTs, STPP significantly outperformed minimal treatment, treatment as usual, or waiting list controls on somatic symptom measures at all time frames, with small to large magnitude effect sizes. Descriptive reviews of 5 RCTs suggest that STPP performed at least as well as other bona fide psychological therapies. Limitations of this meta-analysis include small samples of studies and possible publication bias. Conclusions: STPP is a valid treatment option for diverse FSD conditions resulting in somatic symptom reductions that persist over time. STPP should be included in FSD treatment guidelines.status: Published onlin