Gaynor Heading

Bio: Gaynor Heading is an academic researcher from University of Sydney. The author has contributed to research in topics: Acne & Psoriasis. The author has an hindex of 15, co-authored 17 publications receiving 978 citations. Previous affiliations of Gaynor Heading include University of Newcastle.

A review and recommendations for optimal outcome measures of anxiety, depression and general distress in studies evaluating psychosocial interventions for English-speaking adults with heterogeneous cancer diagnoses

Abstract: Objective The objective of this paper is to inform choice of optimal patient-reported outcome measures (PROMs) of anxiety, depression and general distress for studies evaluating psychosocial interventions for English-speaking adults with heterogenous cancer diagnoses.

Psychological sequelae of acne vulgaris: results of a qualitative study.

Abstract: OBJECTIVE: To investigate the psychological sequelae of acne vulgaris. DESIGN: Qualitative study using a grounded-theory approach. SETTING: General practices and specialty dermatology practices in Newcastle, Australia. PARTICIPANTS: Patients with current acne recruited from the practices. METHOD: We used semistructured interviews and recorded participants' comments verbatim. Data analysis was cumulative and concurrent throughout the data-collection period. Coding and analysis was done in the inductive tradition. MAIN FINDINGS: Interviews were conducted with 26 subjects who represented a range of ages and acne severity. Psychological morbidity was considerable. Though participants had mood and anxiety symptoms, these symptoms tended to be subsyndromal and evanescent. More prominent symptoms were embarrassment, impaired self-image, low self-esteem, self-consciousness, frustration, and anger. Some subjects thought that acne had affected their personalities permanently and adversely. Psychological sequelae were attributed to the effects of facial acne on appearance. CONCLUSION: The psychological effects of acne can be considerable. The psychological morbidity is complex and often does not conform to standard psychiatric disease criteria. Recognition and management of the psychological sequelae of acne by general practitioners is of considerable importance.

Experiences of appearance-related teasing and bullying in skin diseases and their psychological sequelae: Results of a qualitative study

Abstract: Acne, psoriasis and atopic eczema are common diseases and have been consistently associated with adverse psychological sequelae including stigmatization. Being teased on the basis of appearance has been associated with psychiatric morbidity in children and adolescents. The objective of this qualitative study was to explore the experiences of teasing and bullying in patients with acne, psoriasis and eczema, and the role of appearance-related teasing and bullying as mediators of psychological morbidity in these patients. Data collection consisted of 62 in-depth semi-structured interviews with patients with acne, psoriasis or atopic eczema recruited from both specialist dermatology and general practices. Data analysis was cumulative and concurrent throughout the data collection period reflecting a grounded theory approach. Analysis followed the analytic induction method, allowing themes to emerge from the data. Teasing, taunting or bullying was a considerable problem for a significant minority of acne, psoriasis and atopic eczema participants. Themes that emerged were the universally negative nature of the teasing, the use of teasing as an instrument of social exclusion, and as a means of establishing or enforcing power relationships, teasing related to contagion and fear, the emotional and psychological sequelae of teasing and the theme of 'insensate' teasing. For those who had suffered teasing or bullying, this was causally linked in respondents' accounts with psychological sequelae, especially self-consciousness and effects on self-image and self-esteem. Experiences of teasing and bullying were found to have principally occurred during the adolescence of participants and the perpetrators were other adolescents, but there were findings of respondents with psoriasis also having been subjected to ridicule or derogatory remarks by health professionals. Teasing, taunting and bullying may represent an underappreciated source of psychological morbidity in children and adolescents with these common skin diseases.

Patients with skin disease and their relationships with their doctors: a qualitative study of patients with acne, psoriasis and eczema.

Abstract: Objective: To explore the experiences of patients with acne, psoriasis or atopic eczema in their relationships with their treating doctors. Design: Qualitative study, using semi-structured interviews conducted between January 2004 and April 2005, thematic analysis and modified grounded theory methodology. Setting and participants: Participants were patients with acne, psoriasis or atopic eczema recruited from urban general practices and urban dermatology practices. Results: 62 semi-structured interviews were conducted. Reports of negative experiences with doctors treating participants' skin conditions were common. Both general practitioners and dermatologists were reported as having poor comprehension of the psychological implications of skin diseases, being insensitive to their patients' emotional suffering, and trivialising participants' disease. Participants acknowledged that time considerations and other pressures may explain these apparent deficiencies. Some participants perceived their doctors as medical technicians and sought treatment for their physical skin disease, not for its emotional or social aspects. Conclusion: We recommend education for GPs about the psychological effects of skin diseases, and education for dermatologists and GPs on how to elicit and manage, or appropriately refer, these problems.

Qualitative research for education: An introduction to theories and methods

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Theorising Interventions as Events in Systems

Abstract: Conventional thinking about preventive interventions focuses over simplistically on the “package” of activities and/or their educational messages. An alternative is to focus on the dynamic properties of the context into which the intervention is introduced. Schools, communities and worksites can be thought of as complex ecological systems. They can be theorised on three dimensions: (1) their constituent activity settings (e.g., clubs, festivals, assemblies, classrooms); (2) the social networks that connect the people and the settings; and (3) time. An intervention may then be seen as a critical event in the history of a system, leading to the evolution of new structures of interaction and new shared meanings. Interventions impact on evolving networks of person-time-place interaction, changing relationships, displacing existing activities and redistributing and transforming resources. This alternative view has significant implications for how interventions should be evaluated and how they could be made more effective. We explore this idea, drawing on social network analysis and complex systems theory.

Epidemiology of acne vulgaris

Abstract: Summary Despite acne being an almost universal condition in younger people, relatively little is known about its epidemiology. We sought to review what is known about the distribution and causes of acne by conducting a systematic review of relevant epidemiological studies. We searched Medline and Embase to the end of November 2011. The role of Propionibacterium acnes in pathogenesis is unclear: antibiotics have a direct antimicrobial as well as an anti-inflammatory effect. Moderate-to-severe acne affects around 20% of young people and severity correlates with pubertal maturity. Acne may be presenting at a younger age because of earlier puberty. It is unclear if ethnicity is truly associated with acne. Black individuals are more prone to postinflammatory hyperpigmentation and specific subtypes such as ‘pomade acne’. Acne persists into the 20s and 30s in around 64% and 43% of individuals, respectively. The heritability of acne is almost 80% in first-degree relatives. Acne occurs earlier and is more severe in those with a positive family history. Suicidal ideation is more common in those with severe compared with mild acne. In the U.S.A., the cost of acne is over 3 billion dollars per year in terms of treatment and loss of productivity. A systematic review in 2005 found no clear evidence of dietary components increasing acne risk. One small randomized controlled trial showed that low glycaemic index (GI) diets can lower acne severity. A possible association between dairy food intake and acne requires closer scrutiny. Natural sunlight or poor hygiene are not associated. The association between smoking and acne is probably due to confounding. Validated core outcomes in future studies will help in combining future evidence.