Physical activity and depression in men: Increased activity duration and intensity associated with lower likelihood of current depression.

OBJECTIVES: Depression is a significant public health issue for men, however men are less likely to use mental health services. Alternative interventions, such as physical activity, may be of value for this population. This study sought to determine what levels and intensity of physical activity are associated with lower depression prevalence in Australian men. METHODS: Using baseline data from 13,884 participants in the Australian Longitudinal Study on Male Health we compared current depression in men who completed the recommended 150 min of physical activity in the past week with men who did not. Duration of activity was examined using logistic regression with restricted cubic splines. Intensity of physical activity was examined by isotemporal substitution of hours of moderate activity with hours of vigorous activity. RESULTS: Men who completed at least 150 min/week of activity had lower odds of moderate/severe depression symptoms. Duration of activity was inversely associated with moderate/severe depression symptoms. Among physically active men, each additional hour of moderate activity replaced with vigorous activity was associated with lower odds of depression. LIMITATIONS: This is a cross-sectional study and so cannot determine causal direction in the relationship between physical activity and depression symptoms observed. Self-report measures of physical activity are widely used but are not as accurate as biometric measurement. CONCLUSIONS: In adult men, meeting minimum recommendations is associated with lower current depression. Increased duration and greater intensity of activity were both associated with further reduction in prevalence. Promoting higher levels of physical activity is potentially an intervention for improving men's mental wellbeing.

Does Mental Health First Aid training improve the mental health of aid recipients? The training for parents of teenagers randomised controlled trial.

BACKGROUND: There is well-established evidence that Mental Health First Aid (MHFA) training improves knowledge about how to support someone developing a mental health problem, but less evidence that this support improves the mental health of the recipient of aid. This randomised controlled trial aimed to assess the long-term effects of MHFA training of parents on the mental health of their adolescent children. METHODS: 384 Australian parents of an adolescent aged 12-15 were randomised to receive either the 14-h Youth MHFA course or the 15-h Australian Red Cross Provide First Aid course. Outcomes were assessed at baseline, 1-year, and 2-year follow-up in both parents and adolescents. Primary outcomes were cases of adolescent mental health problems, and parental support towards their adolescent if they developed a mental health problem, rated by the parent and adolescent. Secondary outcomes included parent knowledge about mental health problems, intentions and confidence in supporting a young person, stigmatizing attitudes, and help-seeking for mental health problems. RESULTS: Parent and adolescent reports showed no significant difference between training groups in the proportion of cases of adolescents with a mental health problem over time (ps > .05). There was also no significant difference between training groups in the quality of parental support provided to their adolescent at 1- or 2-year follow-up (ps > .05). In contrast, some secondary outcomes showed benefits from the Youth MHFA training relative to the control, with increased parental knowledge about mental health problems at 1-year (d = 0.43) and 2-year follow-up (d = 0.26), and increased confidence to help a young person (d = 0.26) and intentions to provide effective support (d = 0.22) at 1-year follow-up. CONCLUSIONS: The study showed some improvements in mental health literacy in training recipients, but could not detect changes in the mental health of adolescents and the support provided to them by their parents if they had a mental health problem. However, there was a lack of power to detect primary outcome effects and therefore the question of whether MHFA training leads to better outcomes in the recipients of aid remains to be further explored. TRIAL REGISTRATION: ACTRN12612000390886 , registered retrospectively 5/4/2012.

'teen Mental Health First Aid': a description of the program and an initial evaluation.

BACKGROUND: Many adolescents have poor mental health literacy, stigmatising attitudes towards people with mental illness, and lack skills in providing optimal Mental Health First Aid to peers. These could be improved with training to facilitate better social support and increase appropriate help-seeking among adolescents with emerging mental health problems. teen Mental Health First Aid (teen MHFA), a new initiative of Mental Health First Aid International, is a 3 × 75 min classroom based training program for students aged 15-18 years. METHODS: An uncontrolled pilot of the teen MHFA course was undertaken to examine the feasibility of providing the program in Australian secondary schools, to test relevant measures of student knowledge, attitudes and behaviours, and to provide initial evidence of program effects. RESULTS: Across four schools, 988 students received the teen MHFA program. 520 students with a mean age of 16 years completed the baseline questionnaire, 345 completed the post-test and 241 completed the three-month follow-up. Statistically significant improvements were found in mental health literacy, confidence in providing Mental Health First Aid to a peer, help-seeking intentions and student mental health, while stigmatising attitudes significantly reduced. CONCLUSIONS: teen MHFA appears to be an effective and feasible program for training high school students in Mental Health First Aid techniques. Further research is required with a randomized controlled design to elucidate the causal role of the program in the changes observed.

A multifaceted intervention to improve mental health literacy in students of a multicampus university: a cluster randomised trial.

PURPOSE: The aim of the current study was to assess whether a multifaceted intervention could improve mental health literacy, facilitate help seeking and reduce psychological distress and alcohol misuse in students of a multicampus university in Melbourne, Australia. METHODS: In this cluster randomized trial, nine university campuses were paired (some pairs included more than one campus), with one of each pair randomly assigned to either the intervention or control condition. The interventions were designed to be whole-of-campus and to run over 2 academic years with their effectiveness assessed through recruitment of a monitoring sample of students from each campus. Interventions included emails, posters, campus events, factsheets/booklets and mental health first aid training courses. Participants had a 20-min telephone interview at baseline and at the end of academic years 1 and 2. This assessed mental health literacy, help seeking, psychological distress and alcohol use. The primary outcomes were depression and anxiety levels and alcohol use and pertained to the individual level. RESULTS: There were no effects on psychological distress and alcohol use. Recall of intervention elements was greater in the intervention group at the end of year 2. Students in the intervention group were more likely to say they would go to a drug and alcohol centre for alcohol problems at the end of 6 months. CONCLUSION: Although education and awareness may play a role in improving mental health literacy, it is likely that, to achieve changes in psychological distress, interventions would need to be more personalized and intensive.

Evaluation of the acceptability and usefulness of an information website for caregivers of people with bipolar disorder.

BACKGROUND: Bipolar disorder is associated with extreme mood symptoms, disability and suicide risk. Close family or friends often have a primary role in supporting an adult with bipolar disorder. However, not all support is helpful and there is little publicly accessible evidence-based information to guide caregivers. Caregiver burden increases the risk of caregiver depression and health problems. To help fill the information gap, expert clinicians, caregivers and consumers contributed to the development of guidelines for caregivers of adults with bipolar disorder using the Delphi consensus method. This paper reports on an evaluation of the acceptability and usefulness of the online version of the guidelines, http://www.bipolarcaregivers.org. METHODS: Visitors to the website responded to an initial online survey about the usefulness of the information (N=536). A more detailed follow-up feedback survey was emailed to web users who were adult caregivers of adults with bipolar disorder a month later (N=121). The feedback was analyzed quantitatively and qualitatively to establish user appraisals of the online information, whether and how caregivers applied the information and ways it could be improved. RESULTS: The majority of users (86.4% to 97.4%) found the various sections of the website useful. At follow-up, nearly 93% of caregivers reported that the information was relevant to them and 96% thought it would help others. Most respondents said that the information was supportive and encouraged adaptive control appraisals. However, a few respondents who were experiencing complex family problems, or who cared for a person with severe chronic bipolar disorder did not appraise it as positively. Nevertheless, over two-thirds of the caregivers reported using the information. Optional interactive features were recommended to maximize benefits. CONCLUSIONS: Overall, http://www.bipolarcaregivers.org was appraised positively and used. It appears useful to close family and friends seeking basic information and reassurance, and may be an inexpensive way to disseminate guidelines for caregivers. Those who care for people with more severe and chronic bipolar disorder, or who have complex family problems might benefit from more specialized interventions, suggesting the importance of a stepped-care approach to supporting caregivers. The potential of evidence-based, collaboratively developed information websites to enhance caregiver and consumer outcomes merits further investigation.

The Australian public's beliefs about the harmfulness of antipsychotics: associated factors and change over 16 years.

Negative views of psychiatric medications are common in many countries. Relatively little is known about beliefs about antipsychotic medications. A 2011 national survey of 2024 Australian adults assessed beliefs about their helpfulness or harmfulness for a person with either early or chronic schizophrenia and the associations with sociodemographic characteristics, exposure to schizophrenia, recognition of schizophrenia, and beliefs about other interventions, long-term outcomes, causes, and stigmatising attitudes. Changes since previous surveys (conducted in 1995 and 2003/4) were also assessed. Results showed that 19% of Australian adults believe that antipsychotics would be harmful for a person with early schizophrenia and 14% for chronic schizophrenia. This group was more likely to be male, born overseas, have less exposure to schizophrenia, show poorer schizophrenia recognition, have less positive views about other standard interventions, be less pessimistic about long-term outcomes and have greater stigmatising attitudes. Comparison with previous surveys showed that overall belief in the harmfulness of antipsychotics for schizophrenia decreased between 1995 and 2003/4 and between 1995 and 2011. The higher proportions of males and those from non-English speaking backgrounds believing in harmfulness suggest that education about the role of antipsychotics in the treatment of schizophrenia should focus on these groups.

The prevalence and correlates of psychological distress in Australian tertiary students compared to their community peers.

OBJECTIVE: To examine differences between university students, vocational education and training (VET) students, tertiary students combined and non-students in the prevalence of psychological distress and the socio-demographic and economic characteristics associated with psychological distress. METHOD: The Kessler Psychological Distress Scale was used to estimate the prevalence of moderate (16-21) and high (22-50) distress with data from three national surveys: the 2007 Household, Income and Labour Dynamics in Australia (HILDA) survey, the 2007-08 National Health Survey (NHS), and the 2007 National Survey of Mental Health and Wellbeing (NSMHWB). Multinomial logistic regression models were also estimated using the HILDA survey to examine any differences in the characteristics associated with moderate and high distress between the groups. RESULTS: There was evidence of a higher prevalence of moderate distress in tertiary students than non-students in the HILDA survey (27.1% vs. 21.2%, p < 0.05) and the NSMHWB (27.4% vs. 19.5%, p < 0.05), but not the NHS (26.1% vs. 22.5%, p > 0.05). However, standardized rates for age and gender attenuated the difference in moderate distress in the HILDA survey and the NSMHWB. The prevalence of high distress was similar between the groups in all three surveys. The multinomial regression analyses using the HILDA survey showed the following subgroups of students to be at a greater risk of high distress relative to those with low distress: younger university students, and university and VET students with financial problems. Compared to VET students and non-students, younger university students and those who worked 1-39 hours per week in paid employment were at a greater risk of high distress. CONCLUSIONS: There is evidence that tertiary students have a greater prevalence of moderate, but not high distress than non-students. Financial factors increase the risk of high distress and are likely to take on more importance as the participation rate of socio-economically disadvantaged students increases.

Mental health first aid guidelines: an evaluation of impact following download from the World Wide Web.

AIM: Mental health first aid guidelines provide the public with consensus-based information about how to assist someone who is developing a mental illness or experiencing a mental health crisis. The aim of the current study was to evaluate the usefulness and impact of the guidelines on web users who download them. METHOD: Web users who downloaded the documents were invited to respond to an initial demographic questionnaire, then a follow up about how the documents had been used, their perceived usefulness, whether first-aid situations had been encountered and if these were influenced by the documents. RESULTS: Over 9.8 months, 706 web users responded to the initial questionnaire and 154 responded to the second. A majority reported downloading the document because their job involved contact with people with mental illness. Sixty-three web users reported providing first aid, 44 of whom reported that the person they were assisting had sought professional care as a result of their suggestion. Twenty-three web users reported seeking care themselves. A majority of those who provided first aid reported feeling that they had been successful in helping the person, that they had been able to assist in a way that was more knowledgeable, skilful and supportive, and that the guidelines had contributed to these outcomes. CONCLUSIONS: Information made freely available on the Internet, about how to provide mental health first aid to someone who is developing a mental health problem or experiencing a mental health crisis, is associated with more positive, empathic and successful helping behaviours.

Mental health of Indigenous Australians: a review of findings from community surveys.

OBJECTIVE: To assemble what is known about the mental health of Indigenous Australians from community surveys. DATA SOURCES: A systematic search was carried out of publications and data sources since 2000 using PubMed, PsycINFO, Australian Medical Index, the National Library of Australia and datasets known to the authors. STUDY SELECTION: Surveys had to involve representative sampling of a population, identify Aboriginal and Torres Strait Islander people and include a measure of mental health. DATA EXTRACTION: 11 surveys were found. Data were extracted on prevalence rates for Indigenous people by age and sex, along with comparison data from the general population, where available. DATA SYNTHESIS: Across seven studies, Indigenous adults were consistently found to have a higher prevalence of self-reported psychological distress than the general community. However, two studies of Indigenous adolescents did not find a higher prevalence of psychological distress. Two surveys of parents and carers of Indigenous children and adolescents found a higher prevalence of behaviour problems. CONCLUSIONS: There is an inequality in mental health between Indigenous and non-Indigenous Australians that starts from an early age. This needs to be a priority for research, preventive action and health services.

National depression and anxiety indices for Australia.

OBJECTIVE: This study aimed to develop a National Depression Index and a National Anxiety Index to measure the depression and anxiety status of the Australian population, to compare data between surveys, and to compare relative risk in different population groups. METHOD: The indices were developed using cross-sectional data from four surveys: the 1997 and 2007 National Surveys of Mental Health and Wellbeing (NSMHWB) and the 2001 and 2004/5 National Health Surveys (NHS). Six items from the K10 that most closely related to the ICD-10 diagnosis of depression and four that most closely related to a diagnosis of an anxiety disorder were used to create separate scales. The indices were developed by estimating the predicted probabilities of depression and anxiety on these separate K10 scales in the 2007 NSMHWB and then applying these predicted probabilities to the same scales in the other surveys. The 1997 NSMHWB and 2001 NHS were used as benchmarks for the respective surveys, with values greater than or less than 100 on the indices indicating a higher or lower probability of depression and anxiety in the subsequent survey year. Overall mean risks of depression and anxiety were examined along with differences in mean risk by age, household income, employment status and geographic location for males and females. RESULTS: There was an overall increase in the mean risk of anxiety between the 1997 and 2007 NSMHWB but no significant difference in the mean risk of depression. Significant increases in the mean risk of anxiety were observed for women aged 45-64, for employed men and women, and for women living in the inner city and non-regional rural areas. CONCLUSIONS: The increase in the mean risk of anxiety may support the need for public education to focus on anxiety disorders, particularly for middle-aged women and for employed men and women.

Sources of information about mental health and links to help seeking: findings from the 2007 Australian National Survey of Mental Health and Wellbeing.

PURPOSE: The aim of this paper is to provide an analysis of data from the National Survey of Mental Health and Wellbeing (NSMHWB) on the factors associated with the use of sources of information on mental health. A further aim is to examine the associations between the use of information sources and professional help-seeking. METHODS: Data from the 2007 NSMHWB were used. The survey sample comprised 8,841 residents of private dwellings across Australia aged 16-85 years. RESULTS: Television was the most common source of information about mental health issues in the previous 12 months (accessed by 20.5% of respondents) followed by pamphlets and brochures (accessed by 15.6% of respondents). Having an anxiety or affective disorder, female gender, higher levels of education and having a family member with a mental health problem was associated with the seeking of information on mental health issues from the internet, non-fiction books and brochures/pamphlets. Accessing information on the internet was associated with increased use of any mental health services, GPs and mental health professionals (MHPs). CONCLUSIONS: The results suggest that promotion of internet resources may offer the opportunity to increase help seeking for mental health problems and may offer the opportunity to engage those least likely to seek professional help, notably young males.

Mental health first aid training by e-learning: a randomized controlled trial.

OBJECTIVE: Mental Health First Aid training is a course for the public that teaches how to give initial help to a person developing a mental health problem or in a mental health crisis. The present study evaluated the effects of Mental Health First Aid training delivered by e-learning on knowledge about mental disorders, stigmatizing attitudes and helping behaviour. METHOD: A randomized controlled trial was carried out with 262 members of the Australian public. Participants were randomly assigned to complete an e-learning CD, read a Mental Health First Aid manual or be in a waiting list control group. The effects of the interventions were evaluated using online questionnaires pre- and post-training and at 6-months follow up. The questionnaires covered mental health knowledge, stigmatizing attitudes, confidence in providing help to others, actions taken to implement mental health first aid and participant mental health. RESULTS: Both e-learning and the printed manual increased aspects of knowledge, reduced stigma and increased confidence compared to waiting list. E-learning also improved first aid actions taken more than waiting list, and was superior to the printed manual in reducing stigma and disability due to mental ill health. CONCLUSIONS: Mental Health First Aid information received by either e-learning or printed manual had positive effects, but e-learning was better at reducing stigma.

Help-seeking for substance use, anxiety and affective disorders among young people: results from the 2007 Australian National Survey of Mental Health and Wellbeing.

OBJECTIVE: To provide a more detailed analysis of the relationship between type and severity of mental disorders (substance use, anxiety and affective disorders) and help-seeking in those aged 16-24 years compared to those aged 25-44 and 45-85 years. METHOD: Data from the National Survey of Mental Health and Wellbeing (NSMHWB) which was conducted in 2007. The survey sample comprised residents of private dwellings across Australia aged 16-85 years. RESULTS: More than one in four Australians aged 16-24 years experienced a mental disorder in the preceding 12 months. This compared to one in five in those aged 16-85 years. Fewer than one in four 16-24-year-olds with a 12-month mental disorder accessed health services in a 12-month period compared with just over one in three of those aged 16-85. The gap in help-seeking was primarily related to higher rates of substance use disorders and low help-seeking associated with these, particularly in young men. CONCLUSIONS: Findings from the 2007 NSMHWB show that the gap in help-seeking in young people with mental health problems is largely due to high rates of substance use disorders and the low rates of help-seeking associated with these. In order to address this gap there is a need for better coordination and integration of mental health and alcohol and drug services within primary care settings. Population health approaches that tackle erroneous beliefs about alcohol and related harms and improve overall mental health literacy are also needed.

Mental health first aid training for high school teachers: a cluster randomized trial.

BACKGROUND: Mental disorders often have their first onset during adolescence. For this reason, high school teachers are in a good position to provide initial assistance to students who are developing mental health problems. To improve the skills of teachers in this area, a Mental Health First Aid training course was modified to be suitable for high school teachers and evaluated in a cluster randomized trial. METHODS: The trial was carried out with teachers in South Australian high schools. Teachers at 7 schools received training and those at another 7 were wait-listed for future training. The effects of the training on teachers were evaluated using questionnaires pre- and post-training and at 6 months follow-up. The questionnaires assessed mental health knowledge, stigmatizing attitudes, confidence in providing help to others, help actually provided, school policy and procedures, and teacher mental health. The indirect effects on students were evaluated using questionnaires at pre-training and at follow-up which assessed any mental health help and information received from school staff, and also the mental health of the student. RESULTS: The training increased teachers' knowledge, changed beliefs about treatment to be more like those of mental health professionals, reduced some aspects of stigma, and increased confidence in providing help to students and colleagues. There was an indirect effect on students, who reported receiving more mental health information from school staff. Most of the changes found were sustained 6 months after training. However, no effects were found on teachers' individual support towards students with mental health problems or on student mental health. CONCLUSIONS: Mental Health First Aid training has positive effects on teachers' mental health knowledge, attitudes, confidence and some aspects of their behaviour. TRIAL REGISTRATION: ACTRN12608000561381.

Patterns and incidence of gamma-hydroxybutyrate (GHB)-related ambulance attendances in Melbourne, Victoria.

OBJECTIVE: To examine the nature and extent of ambulance attendances involving gamma-hydroxybutyrate (GHB) and to compare these with heroin-related attendances in Melbourne, Victoria. DESIGN: Retrospective analysis of a database of ambulance service records on attendances at non-fatal drug overdoses, March 2001-October 2005. PARTICIPANTS AND SETTING: Patients who took GHB and were attended to by an ambulance, as recorded by Metropolitan Ambulance Service (Melbourne) paramedics. MAIN OUTCOME MEASURES: Transportation to hospital by ambulance; other outcomes included number, age, sex and Glasgow Coma Score (GCS) of patients, characteristics of attendances (in public or private space, others present, police co-attendance). RESULTS: There were 618 GHB-related ambulance attendances across the 46 months of data collection; 362 involving GHB only and 256 involving the concurrent use of GHB and other drugs. These figures compare to 3723 heroin overdoses observed during the same period. The number of GHB-related attendances increased by around 4% per month, which was a higher rate of increase than that found for heroin overdose attendances. Most patients were younger than 25 years, were attended in public spaces, and had a GCS <10. Around 90% of patients were transported to hospital, compared with 21% of heroin overdose attendances. CONCLUSIONS: Ambulance attendance data can be used to index GHB-associated harms. The clear increases in GHB-related ambulance attendances over time highlights the need for further research on how best to respond to this emergent drug-related harm.

The incidence and characteristics of volatile substance use related ambulance attendances in metropolitan Melbourne, Australia.

While there has been substantial community discussion and concern expressed about volatile substance use (VSU), there has been little research on the use and related harms of these substances compared to other drugs. In this study we address a need in existing epidemiological research on VSU harms by describing the incidence and characteristics of VSU ambulance attendances between August 1998 and May 2004 across metropolitan Melbourne relative to heroin attendances, a drug class that has received more research attention. Our analysis showed that the crude rate of VSU attendance (5.03 per 100,000 population) over the period was substantially lower than the rates of heroin "involved" and heroin "overdose" attendances (33.40 and 54.87 per 100,000, respectively). Mean age of VSU cases was 20, with users on average 8 years younger than heroin cases. Two-thirds of VSU cases were male, with the likelihood of male attendance similar to heroin involved, but significantly less likely than heroin overdose. VSU attendances were geographically more evenly distributed than heroin attendances, with VSU cases more likely to occur at public and outdoor spaces. VSU cases were also less likely to be in an altered conscious state than heroin cases, but more likely to be co-attended by police and accept transportation to hospital. We conclude that VSU and heroin related harms occurred in different cohorts across metropolitan Melbourne, and that ambulance data can supplement existing data sources to inform policy and programme development, and the monitoring of VSU harms.

Characteristics of non-fatal opioid overdoses attended by ambulance services in Australia.

OBJECTIVE: To examine the feasibility of establishing a database on non-fatal opioid overdose in order to examine patterns and characteristics of these overdoses across Australia. METHODS: Unit record data on opioid overdose attended by ambulances were obtained from ambulance services in the five mainland States of Australia for available periods, along with information on case definition and opioid overdose management within these jurisdictions. Variables common across States were examined including the age and sex of cases attended, the time of day and day of week of the attendance, and the transportation outcome (whether the victim was left at the scene or transported to hospital). RESULTS: The monthly rate of non-fatal opioid overdose attended by ambulance was generally highest in Victoria (Melbourne) followed by NSW, with the rates substantially lower in the remaining States over the period January 1999 to February 2001. Non-fatal opioid overdose victims were most likely to be male in all States, with the proportion of males highest in Victoria (77%), and were aged around 28 years with ages lowest in Western Australia (m=26) and highest in NSW (m=30). Most of the attendances occurred in the afternoon/early evening and towards the later days of the working week in all States. The rates of transportation varied according to ambulance service practice across the States with around 94% of cases transported in Western Australia and around 18% and 29% of cases transported in Melbourne and NSW respectively. CONCLUSIONS: It is feasible to establish a database of comparable data on non-fatal opioid overdoses attended by ambulances in Australia. This compilation represents a useful adjunct to existing surveillance systems on heroin (and other opioid) use and related harms.

Patterns and characteristics of ambulance attendance at heroin overdose at a local-area level in Melbourne, Australia: implications for service provision.

The monitoring of heroin use and related harms is undertaken in Australia with a view to inform policy responses. Some surveillance data on heroin-related harms is well suited to inform the planning and delivery of heroin-related services, such as needle and syringe provision. This article examines local-area variation in the characteristics of nonfatal heroin overdoses attended by ambulances in Melbourne over the period June 1998 to October 2000 to inform the delivery of services to the heroin-using population in Melbourne. Five so-called hot spot local government areas were considered in relation to the remainder of the Melbourne metropolitan area. Significant local-area variations in the characteristics of nonfatal heroin overdoses were evident over the study period, including the number of heroin overdoses, the age and sex of the people attended, the time of the attendance, the likelihood of hospitalization, and the likelihood of police coattendance. The implications of the findings are discussed in terms of service provision (e.g., opening hours) within the five hot spot local government areas, and it is argued that the analyses undertaken could easily be applied to other jurisdictions for which comparable data are available.