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(2005)Journal ArticleThis study assessed psychological adjustment and quality of life relative to population-based norms and knowledge about hereditary hemochromatosis in a sample of 101 patients who attended a hemochromatosis clinic. Participants were assessed prior to their clinic visit, and two weeks and 12 months after attendance, using self-administered questionnaires. Mean Mental Health Component Scores from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) (45.3, 95% CI 43.2, 47.4) were as compromised as those found amongst stroke victims (45.9, 95% CI 42.8, 49.0) who had participated in a national health survey. Recall of the genetic testing result was less than optimal, in that only 69.3% of those with genetic testing results knew whether they carried one or two mutations. This study demonstrates that patients would benefit from routine assessment of psychological distress and referral to mental health professionals of those whose levels of distress suggest a need for clinical intervention. Results also show that patients may benefit from strategies aimed at improving recall of genetic testing results.
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(2012)Journal ArticleBackground: Unexpected panic attacks may represent a non-specific risk factor for future depression and anxiety disorders. The examination of panic symptoms and associated latent severity levels may lead to improvements in the identification, prevention, and treatment of panic attacks and subsequent psychopathology for ‘at risk’ individuals in the general population. Methods: The current study utilised Item Response Theory to assess the DSM-IV symptoms of panic in relation to the latent severity level of the panic attack construct in a sample of 5,913 respondents from the National Epidemiologic Survey on Alcohol and Related conditions. Additionally, differential item functioning (DIF) was assessed to determine if each symptom of panic targets the same level of latent severity between different sociodemographic groups (male/female, young/old). Results: Symptoms indexing ‘choking’, ‘fear of dying’, and ‘tingling/numbness’ are some of the more severe symptoms of panic whilst ‘heart racing’, ‘short of breath’, ‘tremble/shake’, ‘dizzy/faint’, and ‘perspire’ are some of the least severe symptoms. Significant levels of DIF were detected in the ‘perspire’ symptom between males and females and the ‘fear of dying’ symptom between young and old respondents. Limitations: The current study was limited to examining cross-sectional data from respondents who had experienced at least one panic attack across their lifetime. Conclusions: The findings of the current study provide additional information regarding panic symptoms in the general population that may enable researchers and clinicians to further refine the detection of ‘at-risk’ individuals who experience threshold and sub-threshold levels of panic.
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(2012)Journal ArticleInternet based cognitive behavioural therapy (CBT) is efficacious for the treatment of anxiety and depression. The current study aimed to examine the effectiveness of internet based CBT prescribed by primary care clinicians for the treatment of depression and generalised anxiety disorder. Psychological distress data from 302 patients who completed an online CBT course for depression and 361 patients who completed an online CBT course for generalised anxiety disorder were subjected to growth mixture analysis. For both disorders psychological distress decreased across each lesson in a quadratic trend. Two classes of individuals were identified with different trajectories of change: a large group of individuals who responded well to the courses and a smaller group of individuals with a lower response. Both groups were similar with respect to sociodemographic characteristics however the low responders tended to have higher levels of symptom severity and psychological distress at baseline in comparison to the responders. For the majority of patients (75-80%) the internet CBT courses for depression and generalised anxiety disorder were effective. Further research is required to identify and effectively treat the smaller proportion of patients who did not improve during internet CBT.
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(2012)Journal ArticleBackground: Old age respondents may systemically differ in their responses to measures of psychological distress over and above their actual latent distress levels when compared to younger respondents. The current study aimed to investigate the potential for age-related bias(es) in the Kessler 6 psychological distress scale (K6) items. Methods: Data from the 2007 Australian National Survey of Mental Health and Wellbeing were analysed using Item Response Theory to detect the presence of item bias in each of the K6 items. The potential for item bias was assessed by systematically comparing young (16-34), middle age (35-64), and old age (65-85) respondents. The significance and magnitude of the item bias between the age groups was assessed using the log-likelihood ratio method of differential item functioning. Results: After statistical adjustment, there were no biases of significant magnitude influencing the endorsement of K6 items between young and middle age respondents or between middle age and old age respondents. There was a bias of significant magnitude present in the endorsement of the K6 item addressing levels of fatigue between young and old age respondents. Conclusions: Despite the identification of significant item bias in the endorsement of K6 items between the age groups, the magnitude and influence of the bias on total K6 scores is likely to have little influence on the overall interpretation of group data when comparing psychological distress across the lifespan. Researchers should take some caution however when examining individual levels of fatigue related to psychological distress in older individuals.
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(2011)Journal ArticleObjective: To present scoring rules for predicting DSM-IV mental illness in the past 12 month using the Kessler Psychological Distress Scale in the Australian population. Method: The method described in Kessler et al., [1] was closely followed using data from the 2007 Australian Survey of Mental Health and Wellbeing. A series of 93 nested logistic regression models were generated and compared to estimate the predicted probabilities of mental illness for each survey respondent using scores on the Kessler Psychological Distress Scale. The best model was selected using information theoretic criteria. Concordance between the predicted probabilities of mental illness generated by the best models with DSM-IV defined mental illness, assessed using the Composite International Diagnostic Interview, was determined using receiver operating characteristic analysis. Results: The best fitting models were found to contain the quadratic form of the Kessler Psychological Distress Scale (both 6 item and 10 item versions). Age was found to be significant in the model predicting mood, anxiety, and substance use with serious impairment using the 6 item version whilst age and gender was found to be significant in the model for the 10 item version. The concordance between the predicted probabilities of mood, anxiety, and substance use with serious impairment generated from the best models and DSM-IV mood, anxiety, and substance use with serious impairment was within an acceptable level for both versions. Results were similar when predicting DSM-IV mood, anxiety, and substance use without seriousness indicators and DSM-IV anxiety and depression. The performance of predicted probabilities was then examined in various subpopulations of the Australian population. Conclusions: Using a logistic regression model, the Kessler Psychological Distress Scale can be used to generate predicted probabilities of mental illness with an acceptable level of agreement in Australian-based population studies where it is not feasible to conduct a comprehensive assessment.
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(2010)Journal ArticleBackground: Large community based epidemiological surveys have consistently identified high co-morbidity between major depressive episode (MDE) and generalized anxiety disorder (GAD). Some have suggested that this co-morbidity may be artificial and the product of the current diagnostic system. Due to the added direct and indirect costs associated with co-morbidity it is important to investigate if methods of diagnostic classification are artificially increasing the level of observed co-morbidity. Methods: The item response theory log-likelihood ratio procedure was used to test for differential item functioning of MDE symptoms between respondents with and without a diagnosis of GAD in the 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions. Results: The presence of GAD significantly increased the chances of reporting any symptom of MDE with odds ratios ranging from 2.54 to 3.60. However, there was no indication of significant differential item functioning of MDE symptoms in respondents with and without GAD. Conclusions: The lack of any significant differential item functioning indicates that cases with GAD do not present with a distinct MDE symptom profile, one that is consistent with the endorsement of symptoms that are conceptually similar in nature between the two disorders, compared to cases without GAD. This does not support the hypothesis that co-morbidity between MDE and GAD is artificially inflated due to similar symptom criteria required by the current diagnostic system. Instead, MDE and GAD may be thought of as two distinct diagnostic entities that frequently co-occur due to a shared underlying trait.
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(2008)Journal ArticleObjectives: It has been previously argued that the methodology employed by the Composite International Diagnostic Interview version 2.1 to assess the substance induced and general medical condition exclusion criteria are inadequate. As a result prevalence estimates generated from epidemiological studies using this interview may be underestimated. The purpose of the current study was to examine the substance induced and general medical condition exclusion criteria in the Australian National Survey for Mental Health and Well-being and determine the impact they have on prevalence estimates of the common mental disorders. Method: Data from the 1997 Australian National Survey of Mental Health and Wellbeing were analyzed. Frequencies were generated as an indication of how many respondents believed their psychiatric symptoms were always due to a substance or general medical condition. New DSM-IV prevalence estimates were calculated ignoring the application of the substance induced and general medical condition exclusion criteria and compared to standard DSM-IV prevalence estimates. Results: The effect of the substance induced and general medical condition exclusion criteria on final prevalence rates were minimal with around a 0.1% increase when the exclusions were ignored. This equates to a relative difference ranging from no difference for Generalized Anxiety Disorder to an increase of 12% of the base prevalence estimate for Agoraphobia. Conclusions: In surveys that use the Composite International Diagnostic Interview version 2.1 the substance induced and general medical condition exclusion criteria have a minor impact on determining final case definition in the majority of mental disorders.
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(2013)Journal ArticleBackground: Health anxiety is associated with high distress, disability, and increased health service utilisation. However, there are relatively few epidemiological studies examining the extent of health anxiety or the associated socio-demographic and health risk factors in the general population. Aims: The current study aims to provide epidemiological data on health anxiety in the Australian population. Methods: Lifetime and current prevalence estimates, associations between comorbid disorders, psychological distress, impairment, disability, and mental health service utilisation were generated using the Australian 2007 National Survey of Mental Health and Wellbeing. Results: Health anxiety affects approximately 5.7% of the Australian population across the lifespan and 3.4% currently met criteria for health anxiety at the time of the interview. Age, employment status, smoking status, and comorbid physical conditions were significantly related to health anxiety symptoms. Health anxiety was associated with significantly more distress, impairment, disability, and health service utilisation than respondents without health anxiety. Conclusions: Health anxiety is non-trivial; it affects a significant proportion of the population and further research and clinical investigation of health anxiety is required.
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(2012)Journal ArticleObjectives: To examine reductions in suicidal ideation among a sample of patients who were prescribed an internet cognitive behavior therapy (iCBT) course for depression. Design: Effectiveness study within a quality assurance framework. Setting: Primary care. Participants: 299 patients who were prescribed an iCBT course for depression by primary care clinicians. Intervention: Six lesson, fully automated cognitive behaviour therapy course delivered over the internet. Primary outcome: suicidal ideation as measured by question 9 on the Patient Health Questionnaire (PHQ-9). Results: Suicidal ideation was common (54%) among primary care patients prescribed iCBT treatment for depression but dropped to 30% post-treatment despite minimal clinician contact and the absence of an intervention focused on suicidal ideation. This reduction in suicidal ideation was evident regardless of sex and age. Conclusions: The findings do not support the exclusion of patients with significant suicidal ideation.
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(2013)Journal ArticleBackground: Major Depressive Disorder (MDD) and Generalised Anxiety Disorder (GAD) have the highest comorbidity rates within the internalising disorders cluster, yet no internet-based Cognitive Behavioural Treatment (iCBT) exists for their combined treatment. Methods: We designed a 6-lesson therapist-assisted iCBT program for mixed anxiety and depression. Study 1 was a Randomised Controlled Trial (RCT) comparing the iCBT program (n=46) versus Wait-List Control (WLC, n=53) for patients diagnosed by structured clinical interview with MDD, GAD or co-morbid GAD/MDD. Primary outcome measures were the PHQ-9 (depression), GAD-7 (generalised anxiety), K-10 (distress) and WHODAS-II (disability). The iCBT group was followed-up at 3-months post-treatment. In Study 2, we investigated the adherence to, and efficacy of the same program in a primary care setting, where patients (n=136) completed the program under the supervision of primary care clinicians. Results: The RCT showed that the iCBT program was more effective than WLC, with large within- and between-groups effect sizes found (>.8). Adherence was also high (89%), and gains were maintained at 3 month-follow-up. In Study 2 in primary care, adherence to the iCBT program was low (41%), yet effect sizes were large (>.8). Thirty per cent of non-completers experienced benefit. Conclusions: Together the results show that iCBT is effective and adherence is high in research settings, but there is a problem of adherence when translated into the ‘real world.’ Future efforts need to be placed on developing improved adherence to iCBT in primary care settings.