Web-Based Interventions to Help Australian Adults Address Depression, Anxiety, Suicidal Ideation, and General Mental Well-being: Scoping Review.

BACKGROUND: A large number of Australians experience mental health challenges at some point in their lives. However, in many parts of Australia, the wait times to see general practitioners and mental health professionals can be lengthy. With increasing internet use across Australia, web-based interventions may help increase access to timely mental health care. As a result, this is an area of increasing research interest, and the number of publicly available web-based interventions is growing. However, it can be confusing for clinicians and consumers to know the resources that are evidence-based and best meet their needs. OBJECTIVE: This study aims to scope out the range of web-based mental health interventions that address depression, anxiety, suicidal ideation, or general mental well-being and are freely available to Australian adults, along with their impact, acceptability, therapeutic approach, and key features. METHODS: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews (PRISMA-ScR [PRISMA extension for Scoping Reviews]) guided the review process. Keywords for the search were depression, anxiety, suicide, and well-being. The search was conducted using Google as well as the key intervention databases Beacon, Head to Health, and e-Mental Health in Practice. Interventions were deemed eligible if they targeted depression, anxiety, suicidal ideation, or general mental well-being (eg, resilience) in adults; and were web-based, written in English, interactive, free, and publicly available. They also had to be guided by an evidence-based therapeutic approach. RESULTS: Overall, 52 eligible programs were identified, of which 9 (17%) addressed depression, 15 (29%) addressed anxiety, 13 (25%) addressed general mental well-being, and 13 (25%) addressed multiple issues. Only 4% (2/52) addressed distress in the form of suicidal ideation. The most common therapeutic approach was cognitive behavioral therapy. Half of the programs guided users through exercises in a set sequence, and most programs enabled users to log in and complete the activities on their own without professional support. Just over half of the programs had been evaluated for their effectiveness in reducing symptoms, and 11% (6/52) were being evaluated at the time of writing. Program evaluation scores ranged from 44% to 100%, with a total average score of 85%. CONCLUSIONS: There are numerous web-based programs for depression, anxiety, suicidal ideation, and general well-being, which are freely and publicly available in Australia. However, identified gaps include a lack of available web-based interventions for culturally and linguistically diverse populations and programs that use newer therapeutic approaches such as acceptance and commitment therapy and dialectical behavior therapy. Despite most programs included in this review being of good quality, clinicians and consumers should pay careful attention when selecting which program to recommend and use, as variations in the levels of acceptability and impact of publicly available programs do exist.

Diagnosing and managing work-related mental health conditions in general practice: new Australian clinical practice guidelines.

INTRODUCTION: In Australia, mental health conditions (MHCs) arising from workplace factors are a leading cause of long term work incapacity and absenteeism. While most patients are treated in general practice, general practitioners report several challenges associated with diagnosing and managing workplace MHCs. This guideline, approved by the National Health and Medical Research Council and endorsed by the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine, is the first internationally to address the clinical complexities associated with diagnosing and managing work-related MHCs in general practice. MAIN RECOMMENDATIONS: Our 11 evidence-based recommendations and 19 consensus-based statements aim to assist GPs with: the assessment of symptoms and diagnosis of a work-related MHC; the early identification of an MHC that develops as a comorbid or secondary condition after an initial workplace injury; determining if an MHC has arisen as a result of work factors; managing a work-related MHC to improve personal recovery or return to work; determining if a patient can work in some capacity; communicating with the patient's workplace; and managing a work-related MHC that is not improving as anticipated. CHANGES IN MANAGEMENT AS RESULT OF THE GUIDELINE: This guideline will enhance care and improve health outcomes by encouraging: the use of appropriate tools to assist the diagnosis and determine the severity of MHCs; consideration of factors that can lead to the development of an MHC after a workplace injury; more comprehensive clinical assessments; the use of existing high quality guidelines to inform the clinical management of MHCs; consideration of a patient's capacity to work; appropriate communication with the workplace; and collaboration with other health professionals.

Exploring General Practitioners' Views and Experiences of Providing Care to People with Borderline Personality Disorder in Primary Care: A Qualitative Study in Australia.

The prevalence of people seeking care for Borderline Personality Disorder (BPD) in primary care is four to five times higher than in the general population. Therefore, general practitioners (GPs) are important sources of assessment, diagnosis, treatment, and care for these patients, as well as important providers of early intervention and long-term management for mental health and associated comorbidities. A thematic analysis of two focus groups with 12 GPs in South Australia (in discussion with 10 academic, clinical, and lived experience stakeholders) highlighted many challenges faced by GPs providing care to patients with BPD. Major themes were: (1) Challenges Surrounding Diagnosis of BPD; (2) Comorbidities and Clinical Complexity; (3) Difficulties with Patient Behaviour and the GP⁻Patient Relationship; and (4) Finding and Navigating Systems for Support. Health service pathways for this high-risk/high-need patient group are dependent on the quality of care that GPs provide, which is dependent on GPs' capacity to identify and understand BPD. GPs also need to be supported sufficiently in order to develop the skills that are necessary to provide effective care for BPD patients. Systemic barriers and healthcare policy, to the extent that they dictate the organisation of primary care, are prominent structural factors obstructing GPs' attempts to address multiple comorbidities for patients with BPD. Several strategies are suggested to support GPs supporting patients with BPD.

The AgED Study. Age-related eye disease (AgED) in South Australian general practice: are we blind to early detection and intervention?

The AgED Study aimed to evaluate the detection, awareness and management of age-related eye disease (AgED) in South Australian general practice. Three South Australian metropolitan general practices were recruited and all patients aged 75 years and older were invited to participate. A cross-sectional postal questionnaire and retrospective audit of consenting patients' medical records was performed. On average, patients had their last eye check 9 months ago; the majority (64.9%) performed by an optometrist. Only 7.6% had visited their GP for their last eye check, mostly (90.5%) for a mandatory 'Fitness to Drive' medical assessment. There were marked differences in GP recording v. self-reported AgED and a marked discrepancy in the prevalence rates of AgED, visual impairment and blindness in this study compared with Australian population-based prevalence surveys. Despite the lack of GP documentation of eye disease, the majority of patients engaged in timely eye checks with either an optometrist or ophthalmologist, and their overall visual function and vision-related quality of life (QoL) were satisfactory.

Banding Together: An Investigation of Post-Surgery Support Groups for Laparoscopic Adjustable Gastric Banding Patients.

Though advocated as useful for patients, there is little in the literature regarding the use and effectiveness of bariatric support groups. This study investigated characteristics and experiences of bariatric patients who did and did not attend offered groups. Seventy-eight postoperative laparoscopic adjustable gastric banding patients from a private bariatric clinic completed mailed self-report questionnaires. Almost 60% reported having attended the clinic groups, with most wanting to meet other patients and obtain information rather than access psychological assistance. Participants reported generally positive experiences of attending. Nonattendance was often attributed to practical barriers. Satisfaction with support from others was not related to past or predicted future attendance, but higher psychological distress was related to and predictive of greater intention to attend future groups. Likely future attenders also held more positive beliefs about the groups than those who were unlikely to attend. Further research is required into potential positive and negative consequences of attendance, and characteristics of those who are likely to benefit or be harmed by attending. Interventions addressing stereotypes about support groups may help patients make informed decisions about whether to attend a bariatric support group.

Difficulties in disclosing the diagnosis of dementia: a qualitative study in general practice.

BACKGROUND: Dementia is an insidious and stigmatised condition, and research indicates that GPs find communicating this diagnosis particularly problematic. Delays in diagnosis may impede optimal patient care. Little research has been published on Australian GPs' perceptions of barriers to disclosing the diagnosis of dementia. AIM: To explore GPs' perceptions of barriers to disclosing the diagnosis of dementia. DESIGN AND SETTING: Qualitative study in the general practice consultation context. METHOD: Semi-structured, audiorecorded interviews were conducted with GPs from three capital cities and one regional centre in Australia. Interviews were transcribed verbatim and thematic analysis was conducted. RESULTS: GPs' lack of confidence in having a correct diagnosis, concern to act in patients' best interests, and the stigma associated with the 'dementia' label influenced the disclosure process. GPs found it challenging to identify dementia in the consultation context. It was difficult to raise the issue when both the patient and their family/carer(s) ignore/are unaware of symptoms of cognitive decline. Referral to a specialist was favoured to confirm suspicions, although this did not always result in a definitive diagnosis. Opinions differed as to whether the GP or the specialist was better placed to deliver the diagnosis. GPs preferred disclosure to the patient with his/her family/carer(s) present; associated issues of confidentiality and the importance of offering hope emerged. The severity of the patient's dementia also guided the diagnostic disclosure process. GPs often used euphemisms for dementia when disclosing the diagnosis, to soften the message. CONCLUSION: Complex issues surround the disclosure of dementia. Communicating this diagnosis remains particularly challenging for many GPs.

How acceptable are one-off consultations for consumers? Further information on Item 291.

OBJECTIVE: The aim of this paper is to evaluate consumer and carer views of one-off psychiatric assessments, Item 291 in the Australian Medicare system. METHOD: Following general practitioner referral to a psychiatrist, consumers were invited to enroll in this study and provide: demographic data; a one-off face-to-face recorded interview 6-8 weeks following psychiatric assessment; and longitudinal assessment of their mental health, using the DASS, K10 and WHOQoL (prior to psychiatric assessment, 6-8 weeks after assessment and 3-4 months later). RESULTS: Consumer and carer enrollment were very difficult to obtain. Sufficient consumers (8) enrolled to provide meaningful qualitative data. Most had good mental health literacy, had severe and chronic mental health problems, and appreciated the opportunity to access a mental health expert and receive a management plan. Overall, GPs had appropriately informed consumers of the process. Following assessment, the GP and consumer were implementing the suggested management plan. Negative statements included instances of failure to improve, insufficient appointments with the psychiatrist, and concern with GP follow-up. CONCLUSION: One-off psychiatric assessments using Item 291 appear highly acceptable to referred consumers. Qualitative outcomes showed trends towards an improvement in mental health, in an appropriate target group.

Allied mental health referral. Trends in the Adelaide Hills Division of General Practice.

BACKGROUND: Referrals to allied health professionals as part of Access To Allied Psychological Services (ATAPS) and More Allied Health Services (MAHS) at the Adelaide Hills Division of General Practice were examined to gain insight into the characteristics of referred patients and the characteristics of referring general practitioners. METHODS: Data held by the division for the two allied mental health programs was extracted for the period July 2001 to December 2005. The analysis identified characteristics of patients and GPs that were associated with referrals to each program. RESULTS: One hundred and sixteen GPs made 2451 referrals. Female patients accounted for 72% of referrals. Men were more likely to be referred to MAHS than women, and were more likely to be referred by a male GP. Mean Kessler Psychological Distress Scale scores were 31.3 for ATAPS and 27.7 for MAHS referred patients. DISCUSSION: This study identified significant trends in the use of these programs. Further research is needed to understand factors driving these trends.

Management of recurrent depression.

BACKGROUND: Depression is a potentially recurring or chronic disorder. The provision of evidence based treatment and effective practice organisation is central to chronic disease management, and these principles can be applied to managing depression. OBJECTIVE: This article outlines the principles of chronic disease management, including the use of management plans and a team care approach, and their application to the management of depression. DISCUSSION: Treatment approaches that systematically assist patients in managing their chronic disease are more effective than those based on acute care. Depression treatment guidelines are available, as well as primary care initiatives which facilitate comprehensive and long term mental health care, including relapse prevention strategies. A number of risk factors for depression relapse have been identified, and research has recommended that novel intensive relapse prevention programs need to be developed.

Assessment of English-language proficiency for general practitioner registrars.

INTRODUCTION: English-language proficiency of medical practitioners is an issue attracting increasing attention in medical education. To best provide language education support, it is essential that learning needs are assessed and that useful feedback and advice are provided. We report the outcomes of a language assessment that was embedded within the context of a comprehensive general practice learning-needs analysis. METHODS: A group of general practitioner registrars (N = 18) training in Adelaide, South Australia, participated in the learning-needs analysis. The analysis used reliable, validated rating scales that provided information on both verbal and written language skills. These scales were used in the context of an objective structured clinical interview. The interviews were videotaped to enable multiple ratings per candidate. Following the learning-needs analysis, ratings were collated and fed back individually to participants according to a feedback report and template. RESULTS: Of this sample, 5 (28%) were found to have no need for any assistance with either spoken or written language, 5 had poor handwriting, 5 were considered to have minor difficulties, and 3 (17%) were identified as having substantial spoken and written English-language difficulties. These outcomes allowed medical educators to focus the language education support offered to the general practitioner registrars appropriately. CONCLUSIONS: Language skills can be usefully assessed within a more comprehensive learning-needs analysis. In combination with this assessment, the provision of specific feedback and recommendations for appropriate language-learning opportunities is essential.

Small group peer support for GPs treating mental health problems.

Peer support groups are a mutual aid system in which the facilitator helps group members to help each other. General practice peer support is seen as the provision of support in small groups by general practitioner colleagues. As part of the Better Outcomes in Mental Health Care Initiative, funding was made available to develop a unique model of peer support for GPs involved in mental health care. It aimed to meet the needs of GPs for support, sharing of knowledge and skills, ongoing education and skills development, while fostering self care. The model involved a GP facilitator training program and manual, which is now available for wider use.