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Parkville, Australia

McGregor L.S.,Monash University | Melvin G.A.,Monash University | Newman L.K.,Center for Womens Mental Health | Newman L.K.,University of Melbourne
American Journal of Orthopsychiatry | Year: 2015

In recent years there has been increased debate and critique of the focus on psychopathology in general, and posttraumatic stress disorder (PTSD) in particular, as a predominant consequence of the refugee experience. This study was conducted to broaden the conceptualization and examination of the outcomes of the refugee experience by jointly examining how adaptive processes, psychosocial factors, and psychopathology are implicated. A mixed-methods approach was used to specifically examine whether adolescents' (N=10) accounts of their refugee and resettlement experiences differed according to their level, "high" or "low," of PTSD symptomatology. The superordinate themes of cultural belongingness and identification, psychological functioning, family unit functioning and relationships, and friendships and interpersonal processes, were identified as having particular relevance for the study's participants and in distinguishing between participants with high and low levels of PTSD symptomatology. Findings were characterized by marked differences between adolescents' accounts according to their symptomatology levels, and may thereby inform important avenues for future research as well as clinical prevention and intervention programs with refugee youth. © 2015 American Orthopsychiatric Association.

Laios L.,Center for Womens Mental Health | Rio I.,General Practice Liaison Unit | Judd F.,University of Melbourne
Australasian Psychiatry | Year: 2013

Objective: The objective of this article is to highlight the debate about universal routine screening and psychosocial assessment in the perinatal period, and suggest an alternative/additional approach to improving maternal perinatal mental illness. Conclusions: Universal routine screening and psychosocial assessment in the perinatal period has been introduced in Australia despite a lack of evidence that this affects perinatal maternal morbidity. Furthermore, this approach is not designed to detect maternal illnesses such as schizophrenia, bipolar disorder, borderline personality disorder, although it is these women and their infants who have the highest rates of morbidity and mortality. We propose that any approach to improving maternal perinatal mental health should be tailored to particular situations and populations, with mental health care (inclusive of all mental illness, not just depression) integrated into, and thus a routine aspect of, maternity care provided to all women throughout the perinatal period. © The Royal Australian and New Zealand College of Psychiatrists 2013.

Shawyer F.,Monash University | Meadows G.N.,Monash University | Judd F.,Center for Womens Mental Health | Martin P.R.,Griffith University | And 2 more authors.
BMC Psychiatry | Year: 2012

Background: Depression is a common condition that typically has a relapsing course. Effective interventions targeting relapse have the potential to dramatically reduce the point prevalence of the condition. Mindfulness-based cognitive therapy (MBCT) is a group-based intervention that has shown efficacy in reducing depressive relapse. While trials of MBCT to date have met the core requirements of phase 1 translational research, there is a need now to move to phase 2 translational research - the application of MBCT within real-world settings with a view to informing policy and clinical practice. The aim of this trial is to examine the clinical impact and health economics of MBCT under real-world conditions and where efforts have been made to assess for and prevent resentful demoralization among the control group. Secondary aims of the project involve extending the phase 1 agenda to an examination of the effects of co-morbidity and mechanisms of action.Methods/Design: This study is designed as a prospective, multi-site, single-blind, randomised controlled trial using a group comparison design between involving the intervention, MBCT, and a self-monitoring comparison condition, Depression Relapse Active Monitoring (DRAM). Follow-up is over 2 years. The design of the study indicates recruitment from primary and secondary care of 204 participants who have a history of 3 or more episodes of Major Depression but who are currently well. Measures assessing depressive relapse/recurrence, time to first clinical intervention, treatment expectancy and a range of secondary outcomes and process variables are included. A health economics evaluation will be undertaken to assess the incremental cost of MBCT.Discussion: The results of this trial, including an examination of clinical, functional and health economic outcomes, will be used to assess the role that this treatment approach may have in recommendations for treatment of depression in Australia and elsewhere. If the findings are positive, we expect that this research will consolidate the evidence base to guide the decision to fund MBCT and to seek to promote its availability to those who have experienced at least 3 episodes of depression.Australian New Zealand Clinical Trials Registry: ACTRN12607000166471. © 2012 Shawyer et al; licensee BioMed Central Ltd.

Stafford L.,Center for Womens Mental Health | Stafford L.,University of Melbourne | Berk M.,Deakin University | Berk M.,Mental Health Research Institute | And 2 more authors.
BMC Cardiovascular Disorders | Year: 2013

Background: We report on the prospective association between smoking and depression and health-related quality of life (HRQOL) in patients with coronary artery disease (CAD). Methods: Prospective study of 193 patients with assessment of depression occurring 3-, 6- and 9- months (T1, 2, and 3, respectively) following discharge from hospital for a cardiac event. HRQOL was assessed at T3. T1 depression was assessed by clinical interview; T2 and T3 depression was assessed by self-report. Smoking at time of cardiac event was assessed by self-report. Multivariate analyses controlled for known demographic, psychosocial and clinical correlates of depression. Results: Smoking at the time of index cardiac event increased the likelihood of being diagnosed with Major Depressive Disorder (MDD) at T1 by 4.30 [95% CI, 1.12-16.46; p < .05]. The likelihood of receiving a diagnosis of minor depression, dysthymia or MDD as a combined group was increased by 8.03 [95% CI, 2.35-27.46; p < .01]. Smoking did not reliably predict depression at T2 or T3 and did not reliably predict persistent depression. Smoking increased the likelihood of being classified as depressed according to study criteria at least once during the study period by 5.19 [95% CI, 1.51-17.82; p < .01]. Smoking independently predicted worse mental HRQOL. Conclusions: The findings support a role for smoking as an independent predictor of depression in CAD patients, particularly in the first 3 months post-cardiac event. The well-established imperative to encourage smoking cessation in these patients is augmented and the findings may add to the evidence for smoking cessation campaigns in the primary prevention of depression. © 2013 Stafford et al.; licensee BioMed Central Ltd.

Stafford L.,Center for Womens Mental Health | Stafford L.,University of Melbourne | Berk M.,University of Melbourne | Berk M.,Australia Orygen Research Center | Berk M.,Mental Health Research Institute
Journal of Clinical Psychiatry | Year: 2011

Objective: Depression is associated with immune activation as well as oxidative stress. Statins have in vitro and in vivo antiinflammatory and antioxidative properties. We prospectively investigated whether the use of statins was associated with a reduced risk of development of depression in individuals who have had a cardiac event or intervention. Method: Participants were recruited between May 2005 and March 2006 from the Geelong Hospital, Geelong, Australia, a tertiary hospital in regional Australia that serves a catchment area shown to be representative of the broader Australian community. Patients who were hospitalized for angioplasty, myocardial infarction, or coronary artery bypass graft surgery (N = 193) were followed up prospectively for 9 months to assess development of depression. Depression data were collected 3 months postdischarge (T1) by structured clinical interview (using the Mini International Neuropsychiatric Interview, version 5) and 9 months postdischarge (T2) by self-report (using the Hospital Anxiety and Depression Scale). Major depressive disorder, minor depression, and dysthymia were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Data on statins were collected from medical records. The association between statin therapy and depression was tested using both linear and logistic regression models controlling for clinical, psychological, and demographic confounders. Results: At discharge, 157 participants (81.3%) were receiving statin therapy. Adjusting for possible confounders, taking statins at discharge had a protective effect on depression at T1, reducing the likelihood of dysthymia, minor depression, or major depression by 69% (95% CI, 0.097-0.972; P = .045). At the T2 end point, statin therapy again had a protective effect and was associated with a 79% reduction in the likelihood of depression (95% CI, 0.052-0.876; P = .032). The linear regression model to predict depression at T2 was significantly different from zero (F11,180 = 8.686, P < .001) and explained 36.3% of the variance in depression. Conclusions: The use of statins was associated with significant reduction in the risk of depression in individuals who have had a cardiac event. This supports the role of oxidative and inflammatory processes in depression and opens the door to rational and novel pathophysiologically based therapies distinct from conventional antidepressants. © Copyright 2010 Physicians Postgraduate Press, Inc.

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