Values and long-term care decision-making for frail elderly people

This project explored the values considered by elderly people, their younger relatives, and health professionals in decisions about residential long - term care, aiming to contribute to the literature on prospectively held values. The mixed methods design utilised a medical record review of 60 frail elderly hospital patients, a stratified survey of 3,015 adults in the South Australian community, and interviews with 36 stakeholders ( 10 elderly people, 10 younger relatives, and 18 health professionals ). The medical record review confirmed that the hospital patients and their outcomes resembled those described internationally. It was used to develop a hypothetical vignette, used in the later studies. Survey responses suggested that when considering a hypothetical long - term care decision, community members put the elderly person ' s physical health and safety first. Situational variables ( the elderly person ' s autonomy, environmental adaptation, and caregiver burden ) appeared secondary, albeit less so with increasing age of the respondent. Thematic analysis of the interviews demonstrated that elderly stakeholders considering a hypothetical decision were more likely to mention autonomy values, and less likely to mention safety values, than were relatives or health professionals. However, elderly stakeholders were also more likely to suggest restrictive solutions, such as residential placement and proxy decision - making. This finding raised methodological issues concerning ' third person ' vignettes, in that respondents might be responding as proxy decision - makers, rather than as if the hypothetical decision applied to themselves. The project confirmed that, in this context, prospectively held values resembled the retrospectively described values identified by McCullough, Wilson, Teasdale, Kolpakchi and Shelly ( 1993 ). Hence, the retrospective literature could be applied. The project supported the importance and complexity of psychosocial predisposing factors when applying the Andersen Behavioral Model ( Andersen, 1995 ) to long - term care decisions. Additionally, the Ecological Theory of Aging ( Nahemow, 2000 ) and the MacArthur Model of Successful Aging ( Andrews, Clark, & Luszcz, 2002 ) were found to be relevant to long - term care decisions for individuals and populations. It was concluded that both clinically, and at a policy level, discussions of long - term care could be more effective if they focussed on maintenance of elderly people ' s autonomy and control, rather than on their physical health and safety.Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 2006

Understanding Australian university students’ mental health help‐seeking: An empirical and theoretical investigation

Objective To investigate correlates of Australian university students’ help‐seeking intentions and actual service usage, testing and extending new models based on the Theory of Planned Behaviour and the Behavioural Model of Health Services Use. Method 611 Australian domestic students (209 males and 402 females, mean age = 21-years; SD = 5.6) completed standardised measures and commented on facilitators, barriers, benefits, and potential improvements to student mental health services. Results A model based on Chinese university student data also fit the Australian data best. Bootstrapping revealed relationships between several predictors (knowledge concerning mental health and services, evaluated and perceived need, anticipated benefits, stigma concerns, and Asian values) and help‐seeking intentions were significantly mediated by attitudes toward help‐seeking and subjective norms. Logistic regression analysis identified predictors of service usage: help‐seeking intentions, perceived behavioural control, gender, study major, knowledge of mental health, social support, income, self‐rated mental health status, perceived need for help, and Asian values. Conclusions Practitioners need to consider psycho‐educational and marketing approaches to engage students, raise awareness of available services, increase understanding of mental illness and treatments, and reduce stigmatized attitudes

Understandings and experiences of adherence to secondary prevention for patients with cardiovascular disease and comorbid depression or anxiety

Over 20% of cardiovascular disease (CVD) patients have a comorbid mental health disorder, resulting in an increased risk of recurring major adverse cardiac events (MACE) and mortality. Despite the higher risk, patients with comorbid depression or anxiety disorders are twice as likely to be non-adherent to secondary prevention. Therefore, better understanding of the adherence experiences of this subgroup is needed to inform service delivery and enhance adherence for this higher risk group. This study aims to explore the perceptions, understandings, and experiences of adherence to secondary prevention amongst 33 cardiac patients with diagnosed depression and/or anxiety disorder. Participants were recruited as part of the Cardiovascular Health in Anxiety or Mood Problems Study. Semi-structured interviews were conducted and data were analysed via inductive thematic analysis. Patient understandings of adherence to secondary prevention were limited, with medication compliance considered the marker of adherence. Further, participants did not perceive unintentional nonadherence to constitute non-adherence, rather an intent to engage was viewed as defining adherence. Participants also reported that a lack of practitioner understanding and management around their mental health negatively impacted the practitioner-patient relationship and their engagement with secondary prevention. Results highlight that unique barriers, especially around management of comorbid mental health exist for this subgroup. Additionally, adherence to secondary prevention might be limited by patients' narrow understandings of adherence as the intent to engage and as medication compliance

The long-term effects of mindfulness-based cognitive therapy as a relapse prevention treatment for major depressive disorder

BackgroundMindfulness-based Cognitive Therapy (MBCT) is a relapse prevention treatment for major depressive disorder.MethodAn observational clinical audit of 39 participants explored the long-term effects of MBCT using standardized measures of depression (BDI-II), rumination (RSS), and mindfulness (MAAS).ResultsMBCT was associated with statistically significant reductions in depression from pre to post treatment. Gains were maintained over time (Group 1, 1-12 months, p = .002; Group 2, 13-24 months, p = .001; Group 3, 25-34 months, p = .04). Depression scores in Group 3 did begin to worsen, yet were still within the mild range of the BDI-II. Treatment variables such as attendance at "booster" sessions and ongoing mindfulness practice correlated with better depression outcomes (p = .003 and p = .03 respectively). There was a strong negative correlation between rumination and mindful attention (p ConclusionIt is suggested that ongoing MBCT skills and practice may be important for relapse prevention over the longer term. Larger randomized studies of the mechanisms of MBCT with longer follow-up periods are recommended.Kate L. Mathew, Hayley S. Whitford, Maura A. Kenny and Linley A. Denso

Understanding the relationship between pathological gambling and gambling-related cognition scores: the role of alcohol use disorder and delusion proneness

Published online: 18 Feb 2014There is considerable evidence for an association between pathological gambling and scores on validated psychometric measures of erroneous gambling-related cognitions. However, a potential problem with this literature is that samples of pathological gamblers score higher on indicators of co-morbidity (e.g. substance misuse) that are also associated with poorer decision-making and reasoning abilities. We aimed to examine the relationship between pathological gambling and gambling-related erroneous beliefs after controlling for alcohol misuse. A sample of 140 regular gamblers completed a detailed psychological assessment including measures of pathological gambling (NORC DSM-IV Screen Self-Administered), delusion proneness (the Peters et al. Delusions Inventory), alcohol use (the Alcohol Use Disorders Identification Test) and gambling beliefs (Gambling-Related Cognitions Scale). Pathological gamblers scored higher than other regular gamblers on all these measures. Although alcohol use disorder was not directly related to delusion proneness, a combination of higher alcohol use disorder and delusion proneness was associated with higher gambling-related cognition scores. Our findings confirm previous evidence supporting an association between pathological gambling and greater endorsement of erroneous gambling-related cognitions. Alcohol misuse and delusion proneness may be factors that strengthen this association.Reza Abdollahnejad, Paul Delfabbro and Linley Denso

Investigating the Effect of Mindfulness Training on Heart Rate Variability in Mental Health Outpatients: A Pilot Study

Depression is associated with increased cardiac morbidity and mortality in people with and without cardiac risk factors, and this relationship is, in part, mediated by heart rate variability (HRV). Increased heart rate and reduced HRV are common in depressed patients, which may explain their higher cardiac risk. This pilot study investigated whether mindfulness-based cognitive therapy (MBCT) promoted objective changes in (1) HRV, and (2) depressive symptoms and quality of life, in mental health outpatients. Twenty-seven adults meeting criteria for DSM-IV Axis I disorders completed an 8-week MBCT program. Data were collected on three occasions, 8 weeks apart; twice before and once after MBCT. Participants completed the Short Form-36 and the Center for Epidemiological Studies Depression Scale (CES-D) at each test period. Heart rate and HRV were measured during electrocardiographic monitoring before and after a cognitive stressor. At baseline, 78% of participants met criteria for depression (CES-D ≥16). Multivariate analyses revealed a significant treatment effect for SF-36 physical summary score and depression (as a dichotomous variable), but not for HRV. This pilot study highlights the immediate psychological and health benefits of MBCT. Low power may have influenced the lack of a finding of an association between HRV and MBCT. However, the feasibility of the study design has been established, and supports the need for larger and longer-term studies of the potential physiological benefits of MBCT for cardiac health.Alexis Wheeler, Linley Denson, Chris Neil, Graeme Tucker, Maura Kenny, John F. Beltrame, Geoffrey Schrader and Michael Proev