Relationship of social factors including trust, control over life decisions, problems with transport and safety, to psychological distress in the community

PURPOSE: Psychological distress encompasses anxiety and depression with the previous studies showing that psychological distress is unequally distributed across population groups. This paper explores the mechanisms and processes which may affect the distribution of psychological distress, including a range of individual and community level socioeconomic determinants. METHODS: Representative cross-sectional data was collected for respondents aged 16+ from July 2008 to June 2009, as a part of the South Australian Monitoring and Surveillance System (SAMSS) using Computer Assisted Telephone Interviews (CATI). Univariate and multivariate analyses (n = 5,763) were conducted to investigate the variables that were associated with psychological distress. RESULTS: The overall prevalence of psychological distress was 8.9%. In the multivariate model, females, those aged 16–49, respondents single with children, unable to work or unemployed, with a poorer family financial situation, earning $20,000 or less, feeling safe in their home some or none of the time, feeling as though they have less then total control over life decisions and sometimes experiencing problems with transport, were significantly more likely to experience psychological distress. CONCLUSIONS: This paper has demonstrated the relationship between low-income, financial pressure, less than optimal safety and control, and high-psychological distress. It is important that the groups highlighted as vulnerable be targeted in policy, planning, and health promotion and prevention campaigns

Utility of the Health of the Nation Outcome Scales (HoNOS) in Predicting Mental Health Service Costs for Patients with Common Mental Health Problems : Historical Cohort Study

BACKGROUND: Few countries have made much progress in implementing transparent and efficient systems for the allocation of mental health care resources. In England there are ongoing efforts by the National Health Service (NHS) to develop mental health 'payment by results' (PbR). The system depends on the ability of patient 'clusters' derived from the Health of the Nation Outcome Scales (HoNOS) to predict costs. We therefore investigated the associations of individual HoNOS items and the Total HoNOS score at baseline with mental health service costs at one year follow-up.METHODS: An historical cohort study using secondary care patient records from the UK financial year 2012-2013. Included were 1,343 patients with 'common mental health problems', represented by ICD-10 disorders between F32-48. Costs were based on patient contacts with community-based and hospital-based mental health services. The costs outcome was transformed into 'high costs' vs 'regular costs' in main analyses.RESULTS: After adjustment for covariates, 11 HoNOS items were not associated with costs. The exception was 'self-injury' with an odds ratio of 1.41 (95% CI 1.10-2.99). Population attributable fractions (PAFs) for the contribution of HoNOS items to high costs ranged from 0.6% (physical illness) to 22.4% (self-injury). After adjustment, the Total HoNOS score was not associated with costs (OR 1.03, 95% CI 0.99-1.07). However, the PAF (33.3%) demonstrated that it might account for a modest proportion of the incidence of high costs.CONCLUSIONS: Our findings provide limited support for the utility of the self-injury item and Total HoNOS score in predicting costs. However, the absence of associations for the remaining HoNOS items indicates that current PbR clusters have minimal ability to predict costs, so potentially contributing to a misallocation of NHS resources across England. The findings may inform the development of mental health payment systems internationally, especially since the vast majority of countries have not progressed past the early stages of this development. Discrepancies between our findings with those from Australia and New Zealand point to the need for further international investigations

Identifying the quality of life effects of urinary incontinence with depression in an Australian population

Background: To explore the additive effect of urinary incontinence, in people with comorbid depression, on health related quality of life. Methods: Males and females, 15 to 95 years (n = 3010, response rate 70.2%) were interviewed face to face in the 1998 Autumn South Australian Health Omnibus Survey. Results: Self-reported urinary incontinence was found in 20.3% (n=610), and depression as defined by the PRIME-MD in 15.2% (n=459) of the survey population. Urinary incontinence with comorbid depression was found in 4.3% of the overall population. Univariate analysis showed that respondents with urinary incontinence and comorbid depression were more likely to be aged between 15 and 34 years and never married when compared to those with incontinence only. Multivariate analysis demonstrated that in people with incontinence, the risk of having comorbid depression was increased by an overall health status of Fair or Poor, or the perception that their incontinence was moderately or very serious. Respondents reporting that they experienced incontinence with comorbid depression scored significantly lower than those experiencing incontinence without depression on all dimensions of the SF-36. The interaction of the presence of incontinence and the presence of depression was significantly associated with the dimensions of physical functioning. Conclusions: Depression and incontinence both reduce QOL. When they occur together there appears to be an additive effect which affects both physical and mental health, perhaps by increasing a person’s negative perceptions of their illness. Clinicians should identify and manage comorbid depression when treating patients who have incontinence to improve their overall QOL.Jodie C Avery, Nigel P Stocks, Paul Duggan, Annette J Braunack-Mayer, Anne W Taylor, Robert D Goldney and Alastair H MacLenna

Are some Aspects of National Suicide Prevention Programs Contributing to the Problem?

Til tross for at mange land har gjennomført nasjonale selvmordsforebyggende programmer, har flere av demrapportert at de ikke observert noen reduksjon. Enkelte av disse landene har til og med rapportertøkning i selvmordsraten. Selv om det er mulig at sosiale faktorer står for slike økninger, og at selvmordsforebyggende initiativer derfor bør forsterkes,bør vi også stilles det alternative spørsmålet: Bidrar forebyggingsprogrammene som er introdusert til å økeproblemet i stedet for det motsatte? En rekke studier som antyder at det kan være tilfelle. Dette gjelder spesielt forebygging knyttet til mediene og offentlige utdanningsprogrammer, der vimangler evidens for at programmene fører til bedring i hjelpesøkende atferd hos risikoutsatte personer.Muligheten for at intense mediekampanjer rett og slett kan normalisere selvmordsatferd som en lettforståelig vanlig reaksjon på problemer, har også blitt reist som en mulighet. Det er viktig å undersøke dette spørsmålet videre, ikke bare for å sikre at eksisterende programmerfaktisk har overbevisende effekt, men også for å sikre at vi bare innfører nye forebyggingsprogrammer nårde har blitt grundig undersøkt.Despite the introduction of National suicide prevention programs, a number of countries have reported not only no reduction, but increases in suicide rates. While it is possible that social factors have inexorably raised the rates, and that initiatives should be increased, an alternative question should be asked: are the programs introduced contributing to the problem? There are a number of studies which suggest that that may be the case. This is particularly so with regard to the media and public education programs, with an absence of evidence for the effective translation of appropriate help-seeking action in vulnerable persons. The possibility that intense media campaigns may simply normalise suicidal behaviour as a readily understood common reaction has also been raised, as has the possibility that repeated media campaigns may lead to a negative attitude towards the message portrayed.  It appears important to pursue this question further, and not only to ensure that existing programs have convincing outcome data, but to only introducenew programs when they have been subjected to rigorous review

Attempted suicide : correlates of lethality : a study of young women who have attempted suicide by drug overdose

xx, 562 leavesThesis (M.D.) -- University of Adelaide, Dept. of Psychiatry, 197

Reply

Reply to: Letter to the Editor: A Comment on Robert D. Goldney's “A Historical Note on Suicide During the Course of Treatment for Depression” by Ronald W. Maris, IN: Suicide and Life-Threatening Behavior, 2007; 37 (5):600-601Robert D. Goldne