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(2023)ThesisBurnout is hot topic in public discourse, with members of the general public quick to self-diagnose as suffering from the syndrome. However, there is a lack of consensus among scientists and practitioners as to how burnout should best be conceptualised and whether/how it should be diagnosed. This thesis reports five studies examining self-diagnosed burnout and how it should best be defined, measured and distinguished from clinical depression. The literature review presented in Part I critiques the currently promulgated three-factor conceptualisation of burnout and highlights the inconclusive research findings regarding burnout’s overlap with depression. Part II contains three studies designed to re-define the burnout syndrome. In Study 1, qualitative and quantitative analyses were used to identify key syndromal features of self-diagnosed burnout. In Study 2, a series of bifactor analyses was undertaken to derive a new definitional model and preliminary measure of the syndrome. In Study 3, mixture modelling was used to examine whether the new burnout definition was best modelled dimensionally or categorically. The results of Part II indicated that burnout as experienced by the general population is characterised by several symptoms beyond the traditional triadic symptom model, and that categorical differences in burnout may exist between those with and without a history of mental illness. Part III contains two studies undertaken to evaluate the degree of overlap between burnout and depression. Study 4 assessed for qualitative differences between burnout and depression experienced by participants who reported having experienced both states. Study 5 compared participants with self-diagnosed burnout to participants with clinically-diagnosed depression across several symptom and causal variables. The results of Part III indicated that the new definitional burnout model derived in Part II showed poor differentiation overall between burnout and depression, but that several other phenomenological, symptom and causal differences are likely to exist between the two states. The results of Study 5 also suggested that burnout overlaps more with non-melancholic than melancholic depression. When taken together, as discussed in Part IV, the studies in this thesis extend knowledge of how self-diagnosed burnout should be defined and illuminate how burnout both converges with and diverges from clinical depression.
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(2023)ThesisFirst responders report elevated rates of posttraumatic stress disorder (PTSD) compared to the general community. Workplace preventative strategies are urgently needed to reduce this burden. Research on the prevention of PTSD remains limited, and few studies have been conducted within this high-risk population. Interventions that target modifiable risk factors for PTSD may be promising and evidence is emerging for yoga – a type of mind-body exercise (MBE) intervention – for treatment of PTSD. However, it remains unclear if this type of training may be effective in preventing the development of PTSD in first responders. This thesis aimed to address these gaps by determining (a) what modifiable cognitive-emotional risk factors are associated with PTSD in trauma-exposed first responders and (b) the effectiveness of a workplace MBE intervention in preventing the development of PTSD in active-duty first responders. These aims are met through four studies. Paper 1 detailed a cross-sectional study investigating modifiable cognitive-emotional strategies associated with PTSD in first responders. Paper 2 involved a systematic review and meta-analysis of controlled studies evaluating the effectiveness of MBE interventions in preventing the development of PTSD in trauma-exposed populations. Paper 3 evaluated the effectiveness of a workplace MBE intervention through a randomised controlled trial on active-duty first responders. Finally, Paper 4 examined the feasibility, acceptability, and usability of a web-based MBE intervention for first responders. The thesis results show the importance of a maladaptive cognitive-emotional strategies on probable PTSD amongst first responders. MBE interventions showed potential in preventing the development of PTSD in trauma-exposed populations. Further, a workplace MBE intervention was effective in reducing PTSD symptoms in active-duty first responders in the short-term as well in improving modifiable risk factors associated with PTSD. Feasibility, acceptability, and usability were demonstrated for the web-based version of the training. Overall, the results suggest that MBE is a promising intervention to prevent the development of PTSD amongst active-duty first responders. Given the current burden of mental health problems and gap in evidence-based preventative strategies, these findings provide preliminary evidence for MBE as a viable workplace preventative strategy for first responders.
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(2024)ThesisSuicide is a leading cause of death among young people, both globally and within Australia. Digital mental health interventions (DMHIs) have emerged as a potential solution that may curb suicide rates through mitigating suicidal ideation. However, poor engagement has hindered the adoption of DMHIs in healthcare settings due to concerns that suboptimal use may undermine their efficacy. The chief objective of this thesis was to develop and pilot a digital strategy for supporting engagement with LifeBuoy – a smartphone application (app) that helps young people with suicidal ideation. In the process, it (i) examined the link between engagement with DMHIs and clinical outcomes, (ii) synthesised existing literature on strategies for promoting engagement with DMHIs, (iii) explored user perceptions of engagement with DMHIs, (iv) designed a strategy to support engagement with LifeBuoy, and (v) examined implementation outcomes of the developed strategy. A robust positive association between engagement and post-intervention outcomes was found (Chapter 2). However, evidence on the efficacy of existing technology-supported strategies for promoting engagement with DMHIs was inconclusive (Chapter 3). According to users of mental health apps, strategies should provide digestible and practical content, be visually attractive, and leverage on platforms familiar to app users (Chapter 4). Specific ways in which principles of participatory design were applied to integrate lived experience and research to design a digital engagement strategy for LifeBuoy were described (Chapter 5). Finally, implementation data revealed moderate levels of support for the acceptability and appropriateness of the strategy (Chapter 6). This thesis has advanced the literature in several important ways. It established the relationship between engagement and outcomes in DMHIs. It extended existing evidence on the efficacy of technology-supported engagement strategies, noting that the lack of user involvement in the design process may be linked to the observed lack of efficacy. It was the first to explore users’ perceptions of the acceptability of various characteristics of engagement strategies and describe how participatory design principles could be applied in the design of a bespoke digital engagement strategy. Finally, it was the first study to examine implementation-related outcomes for an engagement strategy for a DMHI targeting suicidal ideation. Implications and future directions are discussed.