A systematic review of naturalistic interventions in refugee populations.

Naturalistic interventions with refugee populations examine outcomes following mental health interventions in existing refugee service organisations. The current review aimed to examine outcomes of naturalistic interventions and quality of the naturalistic intervention literature in refugee populations with the view to highlight the strengths and limitations of naturalistic intervention studies. Database search was conducted using the search terms 'refugee', 'asylum seeker', 'treatment', 'therapy' and 'intervention. No date limitations were applied, but searches were limited to articles written in English. Seven studies were identified that assessed the outcome of naturalistic interventions on adult refugees or asylum seekers in a country of resettlement using quantitative outcome measures. Results showed significant variation in the outcomes of naturalistic intervention studies, with a trend towards showing decreased symptomatology at post-intervention. However, conclusions are limited by methodological problems of the studies reviewed, particularly poor documentation of intervention methods and lack of control in the design of naturalistic intervention studies. Further examination of outcomes following naturalistic interventions is needed with studies which focus on increasing the rigour of the outcome assessment process.

Suicidal ideation and resilience in family carers of people with dementia: a pilot qualitative study.

OBJECTIVES: Family carers of people with dementia have higher than average rates of depression, anxiety and hopelessness. While these are all risk factors for suicide, there has been no research on suicidal ideation in this population. The aims of this pilot study were to conduct an initial exploration of carers' experiences of suicidality and identify factors associated with risk and resilience, which could be used to guide further research. METHOD: A descriptive qualitative approach was taken. In-depth interviews were conducted with nine carers of people with dementia (four male, five female) and transcripts were analysed thematically. RESULTS: Three themes were identified in the data - 'experiences of suicidal ideation', 'risk factors' and 'resilience'. Four of the nine participants had experienced suicidal thoughts and two had made preparations for a suicidal act. Risk factors included pre-existing mental health problems, physical health conditions, and conflict with other family or care staff. Factors positively associated with resilience included the use of positive coping strategies, faith, social support and personal characteristics. CONCLUSION: Some people contemplate suicide while caring for a family member with dementia. Further research is required to confirm the rate of suicidal ideation in the caring population and the relative contribution of factors associated with risk and resilience. In the meantime, service providers and health professionals should be taking steps to identify and support carers currently experiencing suicidal thoughts.

Promoting value in dementia care: staff, resident and family experience of the capabilities model of dementia care.

OBJECTIVES: This Australian study examined individual experiences of the implementation of the Capabilities Model of Dementia Care (CMDC) and subsequent outcomes for the care of residents with dementia living in long-term care. Furthermore, this study aimed to explore those factors that facilitated and inhibited the implementation of the new model of care. METHODS: The CMDC was developed and then tested in a non-randomised clinical trial. Staff, residents and family experiences of their involvement and perceptions of the model were captured at the end of 12 months. Semi-structured interviews and focus groups were conducted with the 25 participants (12 nursing staff, 6 residents with dementia, 7 family members). Questions varied depending on the participant group but were designed to assess experiences of and changes to care during the intervention. Inductive thematic analysis was used to identify the experiences of the implementation of the CMDC. RESULTS: Five themes included: general reflections on nursing care, implementation of the CMDC intervention, positive outcomes of the CMDC intervention, challenges in the implementation of the CMDC, difficulty sustaining care and tensions between participants' perspectives of care. CONCLUSION: Positive change resulted from implementation of the CMDC, however, staff mentorship was identified as a key to sustaining changes in practice.

The effect of massage on agitated behaviours in older people with dementia: a literature review.

AIMS AND OBJECTIVES: To review the literature on massage used to manage agitated behaviours in older people with dementia, assess its efficacy as a non-pharmacological approach and provide recommendations for future research. BACKGROUND: Agitation has traditionally been managed with chemical or physical restraint. There has been a growing interest in complementary therapies such as massage. DESIGN: A literature review. METHODS: Cooper's five-stage model of synthesising research guided the review process. The search terms 'massage', 'agitation' and 'dementia' were defined, and 10 databases were searched in October 2011. No date limitations were applied, although searches were limited to articles written in English. For relevant records, full-text copies were obtained and assessed in terms of inclusion criteria and methodological quality using the Validity Rating Tool (VRT). Data were extracted using a form constructed with reference to the checklist of items to consider in data extraction, produced by the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Thirteen studies met the inclusion criteria and were assessed on the VRT. One study was considered of adequate methodological quality to be included in the review. This prospective study found that massage significantly reduced levels of agitation in 52 cognitively impaired residents in two long-term care facilities. CONCLUSIONS: There is a severe paucity of research that considers the effects of massage on managing agitated behaviours in older people with dementia. Whilst conclusions cannot be drawn from the one study included in this review, it did provide evidence to support the use of massage as a non-pharmacological approach to managing agitation in older people with dementia. More research, of better methodological quality, is needed. RELEVANCE TO CLINICAL PRACTICE: There is a need for health practitioners to be aware of the limited evidence for massage as an intervention for agitation and to provide opportunities to validate massage practice.

A longitudinal study of mental health in refugees from Burma: the impact of therapeutic interventions.

OBJECTIVE: The present study seeks to examine the impact of therapeutic interventions for people from refugee backgrounds within a naturalistic setting. METHODS: Sixty-two refugees from Burma were assessed soon after arriving in Australia. All participants received standard interventions provided by a resettlement organisation which included therapeutic interventions, assessment, social assistance, and referrals where appropriate. At the completion of service provision a follow-up assessment was conducted. RESULTS: Over the course of the intervention, participants experienced a significant decrease in symptoms of post-traumatic stress disorder, anxiety, depression and somatisation. Pre-intervention symptoms predicted symptoms post-intervention for post-traumatic stress, anxiety and somatisation. Post-migration living difficulties, the number of traumas experienced, and the number of contacts with the service agency were unrelated to all mental health outcomes. CONCLUSIONS: In the first Australian study of its kind, reductions in mental health symptoms post-intervention were significantly linked to pre-intervention symptomatology and the number of therapy sessions predicted post-intervention symptoms of post-traumatic stress. Future studies need to include larger samples and control groups to verify findings.