Managing panic disorder in general practice

BACKGROUND: Panic disorder (PD) is common in the community and contributes to significant distress and decreased quality of life for people who suffer from it. Most people with PD will present in the first instance to their general practitioner or hospital emergency department for assistance, often with a focus on somatic symptoms and concerns. OBJECTIVE: This article aims to assist the GP to manage this group of patients by providing an outline of aetiology, approaches to assessment, and common management strategies. DISCUSSION Although GPs have an important role to play in ruling out any causal organic basis for panic symptoms, the diagnosis of PD can usually be made as a positive diagnosis on the basis of careful history taking. Thorough and empathic education is a vital step in management. The prognosis for PD can be improved by lifestyle changes, specific psychological techniques, and the judicious use of pharmacotherapy

Hope, despair and transformation: Climate change and the promotion of mental health and wellbeing

<p>Abstract</p> <p>Background</p> <p>This article aims to provide an introduction to emerging evidence and debate about the relationship between climate change and mental health.</p> <p>Discussion and Conclusion</p> <p>The authors argue that:</p> <p>i) the direct impacts of climate change such as extreme weather events will have significant mental health implications;</p> <p>ii) climate change is already impacting on the social, economic and environmental determinants of mental health with the most severe consequences being felt by disadvantaged communities and populations;</p> <p>iii) understanding the full extent of the long term social and environmental challenges posed by climate change has the potential to create emotional distress and anxiety; and</p> <p>iv) understanding the psycho-social implications of climate change is also an important starting point for informed action to prevent dangerous climate change at individual, community and societal levels.</p

Optimising the primary mental health care workforce: how can effective psychological treatments for common mental disorders best be delivered in primary health care?

The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Optimising allied health psychological treatments in primary health care: Piloting a randomised controlled trial of social worker training in focused psychological strategies (The SW-fps Study)

The SW-fps Study was part of a broader body of research which aims to improve access to evidence-based psychological treatments in primary health care. Over the last decade, major mental health reforms in Australia, such as the Better Outcomes and Better Access programs, have greatly increased community access to psychological treatments through a range of funding models designed to support provision of psychological treatments by allied health providers. More recently social workers, amongst other allied health professionals, are beginning to utilise the Medicare incentives to provide psychological treatments in primary mentalThe research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

The ‘Abstainer Question’: relationships between alcohol use and suicidal ideation in Australian online help-seekers

Background: When compared to social drinkers, high levels of suicidal ideation have been observed in both heavy alcohol consumers and abstainers. Heavy alcohol use or abstention may indicate different risk pathways to the development of suicidal ideation (SI). Methods: Visitors to a mental health website (N = 1,561) completed a survey, and latent profile analysis (LPA) was used to explore differences in risk factor patterns. Risk factors explored included psychological distress, help-seeking intent, financial wellbeing, thwarted belongingness and perceived burdensomeness. Results: Most participants (75.1%) reported SI in the past four weeks. A three-class LPA model emerged as the optimal fit: (1) low SI/lower alcohol; (2) high SI/lower alcohol; (3) high SI/high alcohol. Members of the high SI/lower alcohol profile displayed significantly higher psychological distress, thwarted belongingness, and perceived burdensomeness; lower financial wellbeing and help-seeking intentions than both other profiles. Members of the high SI/high alcohol profile were more likely to be male and already receiving help for their psychological distress. Members of the high SI/lower alcohol profile were more likely to be younger and report lower help-seeking intent. Limitations: Our study design was cross-sectional, utilising a largely young, female, English-speaking, help-seeking sample that had chosen to visit a mental health website. Conclusions: While the links between heavy alcohol use and suicide risk are well documented, these findings suggest that practitioners should also be alert for abstention patterns, as they may be indicators of underlying psychosocial concerns that a client could be reluctant to disclose

Political leadership on climate change: The role of health in Obama-era U.S. climate policies

Urgent and ambitious climate action is required to avoid catastrophic climate change and consequent health impacts. Political will is a critical component of the ambitious climate action equation. The current level of political will observed for many national governments is considered inadequate, with numerous political leaders yet to commit to climate action commensurate with the projected risks and responsibilities for their respective jurisdictions. Under the leadership of the Obama administration, however, the United States of America arguably provided an example to the contrary. Strategically utilising an available legislative lever, the Obama administration pursued comparatively ambitious climate change mitigation policies, with health as a core motivation. Analysis of Obama-led climate policies and policy-making strategies provides valuable insight into the utility of health as a motivator for climate action. It also reaffirms that strong political leadership constitutes an essential element in the pursuit of increasingly ambitious climate change policies, particularly in the face of strong opposition.Annabelle Workman received an Australian Government Research Training Program scholarship and funding from the EU Centre on Shared Complex Challenges through the University of Melbourne during the conduct of this research

The Political Economy of Health Co-Benefits: Embedding Health in the Climate Change Agenda

A complex, whole-of-economy issue such as climate change demands an interdisciplinary, multi-sectoral response. However, evidence suggests that human health has remained elusive in its influence on the development of ambitious climate change mitigation policies for many national governments, despite a recognition that the combustion of fossil fuels results in pervasive short- and long-term health consequences. We use insights from literature on the political economy of health and climate change, the science-policy interface and power in policy-making, to identify additional barriers to the meaningful incorporation of health co-benefits into climate change mitigation policy development. Specifically, we identify four key interrelated areas where barriers may exist in relation to health co-benefits: discourse, efficiency, vested interests and structural challenges. With these insights in mind, we argue that the current politico-economic paradigm in which climate change is situated and the processes used to develop climate change mitigation policies do not adequately support accounting for health co-benefits. We present approaches for enhancing the role of health co-benefits in the development of climate change mitigation policies to ensure that health is embedded in the broader climate change agenda.Annabelle Workman receives a Strategic Australian Postgraduate Award scholarship and was affiliated with the EU Centre on Shared Complex Challenges until December 2017. Kathryn Bowen receives funding from the National Health and Medical Research Council. The original manuscript was significantly improved thanks to the invaluable comments of two anonymous reviewers

Embedding effective depression care: using theory for primary care organisational and systems change

Background: depression and related disorders represent a significant part of general practitioners (GPs) daily work. Implementing the evidence about what works for depression care into routine practice presents a challenge for researchers and service designers. The emerging consensus is that the transfer of efficacious interventions into routine practice is strongly linked to how well the interventions are based upon theory and take into account the contextual factors of the setting into which they are to be transferred. We set out to develop a conceptual framework to guide change and the implementation of best practice depression care in the primary care setting.Methods: we used a mixed method, observational approach to gather data about routine depression care in a range of primary care settings via: audit of electronic health records; observation of routine clinical care; and structured, facilitated whole of organisation meetings. Audit data were summarised using simple descriptive statistics. Observational data were collected using field notes. Organisational meetings were audio taped and transcribed. All the data sets were grouped, by organisation, and considered as a whole case. Normalisation Process Theory (NPT) was identified as an analytical theory to guide the conceptual framework development.Results: five privately owned primary care organisations (general practices) and one community health centre took part over the course of 18 months. We successfully developed a conceptual framework for implementing an effective model of depression care based on the four constructs of NPT: coherence, which proposes that depression work requires the conceptualisation of boundaries of who is depressed and who is not depressed and techniques for dealing with diffuseness; cognitive participation, which proposes that depression work requires engagement with a shared set of techniques that deal with depression as a health problem; collective action, which proposes that agreement is reached about how care is organised; and reflexive monitoring, which proposes that depression work requires agreement about how depression work will be monitored at the patient and practice level. We describe how these constructs can be used to guide the design and implementation of effective depression care in a way that can take account of contextual differences.Conclusions: ideas about what is required for an effective model and system of depression care in primary care need to be accompanied by theoretically informed frameworks that consider how these can be implemented. The conceptual framework we have presented can be used to guide organisational and system change to develop common language around each construct between policy makers, service users, professionals, and researchers. This shared understanding across groups is fundamental to the effective implementation of change in primary care for depressio

Current needs for the improved management of depressive disorder in community healthcare centres, Shenzhen, China: a view from primary care medical leaders.

BACKGROUND: The prevalence of depressive disorder in Shenzhen is higher than for any other city in China. Despite national health system reform to integrate mental health into primary care, the majority of depression cases continue to go unrecognized and untreated. Qualitative research was conducted with primary care medical leaders to describe the current clinical practice of depressive disorder in community healthcare centres (CHC) in Shenzhen and to explore the participants' perceptions of psychological, organizational and societal barriers and enablers to current practice with a view to identifying current needs for the improved care of depressive disorder in the community. METHODS: Seventeen semi-structured, audio-recorded interviews (approx. 1 h long) were conducted in Melbourne (n = 7) and Shenzhen (n = 10) with a convenience sample of primary care medical leaders who currently work in community healthcare centres (CHC) in Shenzhen and completed any one of the 3-month long, Melbourne-based, "Monash-Shenzhen Primary Healthcare Leaders Programs" conducted between 2015 and 2017. The interview guide was developed using the Theoretical Domain's Framework (TDF) and a directed content analysis (using Nvivo 11 software) was performed using English translations. RESULTS: Despite primary care medical leaders being aware of a mental health treatment gap and the benefits of early depression care for community wellbeing, depressive disorder was not perceived as a treatment priority in CHCs. Instead, hospital specialists were identified as holding primary responsibility for formal diagnosis and treatment initiation with primary care doctors providing early assessment and basic health education. Current needs for improved depression care included: (i) Improved professional development for primary care doctors with better access to diagnostic guidelines and tools, case-sharing and improved connection with mentors to overcome current low levels of treatment confidence. (ii) An improved consulting environment (e.g. allocated mental health resource; longer and private consultations; developed medical referral system; better access to antidepressants) which embraces mental health initiatives (e.g. development of mental health departments in local hospitals; future use of e-mental health; reimbursement for patients; doctors' incentives). (iii) Improved health literacy to overcome substantive mental health stigma in society and specific stigma directed towards the only public psychiatric hospital. CONCLUSIONS: Whilst a multi-faceted approach is needed to improve depression care in community health centres in Shenzhen, this study highlights how appropriate mental health training is central to developing a robust work-force which can act as key agents in national healthcare reform. The cultural adaption of the depression component of the World Health Organisation's mental health gap intervention guide (mhGAP-IG.v2) could provide primary care doctors with a future training tool to develop their assessment skills and treatment confidence