Motivational interviewing techniques - facilitating behaviour change in the general practice setting.

BACKGROUND: One of the biggest challenges that primary care practitioners face is helping people change longstanding behaviours that pose significant health risks. OBJECTIVE: To explore current understanding regarding how and why people change, and the potential role of motivational interviewing in facilitating behaviour change in the general practice setting. DISCUSSION: Research into health related behaviour change highlights the importance of motivation, ambivalence and resistance. Motivational interviewing is a counselling method that involves enhancing a patient's motivation to change by means of four guiding principles, represented by the acronym RULE: Resist the righting reflex; Understand the patient's own motivations; Listen with empathy; and Empower the patient. Recent meta-analyses show that motivational interviewing is effective for decreasing alcohol and drug use in adults and adolescents and evidence is accumulating in others areas of health including smoking cessation, reducing sexual risk behaviours, improving adherence to treatment and medication and diabetes management.

High levels of psychological distress in MSM are independent of HIV status.

This study assessed psychological distress (PD) in men who have sex with men (MSM) accessing primary health clinics in Australia. Relationships between PD, HIV status and substance use were explored. A cross-sectional convenience sample of 250 MSM completed the Personality Assessment Screener (PAS). One-third (n = 83) scored in the PAS clinically significant range, suggesting significant mental health symptoms. Negative Affect (27 per cent clinically significant), Suicidal Thinking (29 per cent clinically significant) and Amphetamine use significantly positively correlated with PD. There were no significant differences between HIV diagnostic groups on PD. A third of MSM displayed PD. Psychological screening may provide valuable information for improving the psychological well-being of MSM, regardless of their HIV status.

The relationship between personality disorders and mental health, substance use severity and quality of life among injecting drug users.

OBJECTIVE: To determine the relationship between personality disorders (PDs) and substance use severity, mental health symptoms and disorders and quality of life (QoL) among injecting drug users (IDUs). DESIGN, SETTING AND PARTICIPANTS: A cross-sectional study of 103 IDUs accessing a needle and syringe program and a primary health centre in Melbourne, Australia. MAIN OUTCOME MEASURES: Presence of PDs was assessed using the International Personality Disorder Examination ICD-10 Screener. Axis I mental health disorders, psychological distress and QoL were also assessed. RESULTS: Ninety per cent of participants scored positive for one or more PD. Having a Cluster A or Cluster B PD was associated with greater severity of substance use. The presence of a current mental health disorder was associated with all types of PD except dissocial PD. Only Cluster C PDs were associated with self-reported levels of psychological distress. Cluster C PDs were more strongly associated with substance use, mental health and QoL variables than Cluster A or B, although the number of PDs present had the strongest associations with these variables. CONCLUSIONS: IDUs had high rates of PD symptoms, which were associated with the presence of concurrent mental health disorders, more severe levels of psychological distress and substance use and low perceived QoL. IDUs require comprehensive models of care, including access to mental health practitioners with expertise in co-occurring disorders.

The development of peer educator-based harm reduction programmes in Northern Vietnam.

INTRODUCTION: Injecting drug use remains an important risk factor for transmission in Vietnam, with an estimated 50% of the 290 000 people living with HIV/AIDS reporting injecting drug use as a risk factor. Despite this, effective harm reduction interventions are generally lacking. This paper describes the implementation of peer-based harm reduction programmes in two rural provinces of Vietnam. DESIGN AND METHODS: Peer educators were trained in basic HIV prevention, including harm reduction. After significant preparation work with the Provincial AIDS Committees of Bac Giang and Thanh Hoa and other relevant national, provincial and local authorities, the interventions were commenced. Harm reduction interventions were delivered through outreach as well as on-site. This included needle and syringe distribution and collection. RESULTS: Community advocacy occurred throughout the life of the project. Local authorities and peers believed that while there was a general reduction in stigma and discrimination, legal barriers associated particularly with the carrying of injecting equipment remained. This impacted upon the ability of peer educators to work with their clients. CONCLUSION: Peer-based delivery of harm reduction intervention is acceptable. Harm reduction interventions, including needle and syringe programmes, are feasible and acceptable in these two rural Vietnamese provinces. Community acceptance and uptake of these interventions is key to successful expansion across the region. Active participation by families of drug users seems crucial. This initiative demonstrates that despite a difficult policy environment, peer-delivered needle and syringe programmes are feasible within a rural Asian environment as long as there is adequate local political and community support.

Depression, social support and adherence to highly active antiretroviral therapy in people living with HIV/AIDS.

BACKGROUND: The present study investigated the prevalence of depression in HIV-positive individuals and its association with adherence to highly active antiretroviral therapy (HAART). METHODS: HIV-positive (n = 80) and HIV-negative (n = 20) participants were assessed for depression and adherence via clinical interview and self-reporting. RESULTS: Fourteen percent of the HIV-seropositive group met the criteria for current mood disorder compared with 5% of controls. Similarly, 39% of the HIV-seropositive participants met the criteria for a past major depressive episode compared with 15% of controls. Non-adherence to HAART was reported by 30.5% of those prescribed HAART and was significantly associated with living alone and relationship status. CONCLUSIONS: The present study found compromised psychological health in people living with HIV infection. It is recommended that health professionals continue to screen for depression, relationship status and living situation to ensure adherence to HAART.

Reliability and validity of the Kessler 10 and Patient Health Questionnaire among injecting drug users.

OBJECTIVE: To examine the reliability and validity of the Kessler 10 (K10) and the Patient Health Questionnaire (PHQ) in a sample of injecting drug users (IDUs). METHOD: Participants were 103 IDUs with a current substance use disorder accessing a needle and syringe programme. Presence of mental health disorders was assessed using the Mini International Neuropsychiatric Interview (MINI). RESULTS: Both the K10 and PHQ had high levels of internal consistency and concurrent validity. Individuals with a positive screen on the K10 were ten lines more likely to have a current affective disorder, while those with a positive PHQ screen had nearly 14 times the risk. CONCLUSIONS: The K10 and PHQ are recommended as brief screening and diagnostic tools for current affective disorders among IDUs.