Showing papers by "Helen Christensen published in 1997"

"Mental health literacy": a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment.

Abstract: Objectives To assess the public's recognition of mental disorders and their beliefs about the effectiveness of various treatments ("mental health literacy") Design A cross-sectional survey, in 1995, with structured interviews using vignettes of a person with either depression or schizophrenia Participants A representative national sample of 2031 individuals aged 18-74 years; 1010 participants were questioned about the depression vignette and 1021 about the schizophrenia vignette Results Most of the participants recognised the presence of some sort of mental disorder: 72% for the depression vignette (correctly labelled as depression by 39%) and 84% for the schizophrenia vignette (correctly labelled by 27%) When various people were rated as likely to be helpful or harmful for the person described in the vignette for depression, general practitioners (83%) and counsellors (74%) were most often rated as helpful, with psychiatrists (51%) and psychologists (49%) less so Corresponding data for the schizophrenia vignette were: counsellors (81%), GPs (74%), psychiatrists (71%) and psychologists (62%) Many standard psychiatric treatments (antidepressants, antipsychotics, electroconvulsive therapy, admission to a psychiatric ward) were more often rated as harmful than helpful, and some nonstandard treatments were rated highly (increased physical or social activity, relaxation and stress management, reading about people with similar problems) Vitamins and special diets were more often rated as helpful than were antidepressants and antipsychotics Conclusion If mental disorders are to be recognised early in the community and appropriate intervention sought, the level of mental health literacy needs to be raised Further, public understanding of psychiatric treatments can be considerably improved

A quantitative review of cognitive deficits in depression and Alzheimer-type dementia.

Abstract: Meta-analysis was used to examine the performance of depressed and Alzheimer-type dementia (DAT) patients on standard and experimental clinical tests of cognitive function. Deficits were found for depression on almost every psychological test. Relative to nondepressed controls, the average deficit was 0.63 of a standard deviation, but the magnitude of the effect varied with the type of test. DAT patients performed worse than depressed patients, with an average effect size of 1.21 standard deviations, but the size of the effect depended on the clinical test. Effect sizes for the comparison between depressives and controls were significantly affected by age, treatment setting, ECT use, severity of depression, and the source of diagnostic criteria, but not by the type of depression. Effect sizes in the comparison of depressives to DAT patients were influenced by age, the severity of depression, and ECT. Depressives performed proportionately worse than controls on tasks with pleasant or neutral, compared with unpleasant content, on speeded compared with nonspeeded tasks, and on vigilance tasks. However, there were no differences in the magnitude of effect size for tests using recall compared with recognition, using categorical compared with noncategorical word lists, on story compared with word comprehension, and using verbal compared with visual material. Relative to DAT patients, depressives performed no better on recall compared to recognition tasks, or verbal compared to visual material. The findings of the review are not consistent with the hypothesis that depression is associated with deficits in effortful processing. A model of psychological deficit in depression as a deficit in speed or attention has more promise.

Helpfulness of interventions for mental disorders : beliefs of health professionals compared with the general public

Abstract: BACKGROUND The study aimed to compare the beliefs of health professionals about the potential helpfulness of various mental health interventions with those of the general public. METHOD Surveys were carried out in Australia of 872 general practitioners, 1128 psychiatrists, 454 clinical psychologists and 2031 members of the public. Respondents were presented with a case vignette describing either a person with depression or one with schizophrenia. Respondents were asked to rate the likely helpfulness of various types of professional and non-professional help and of pharmacological and non-pharmacological interventions. RESULTS The professionals gave much high ratings than the public to the helpfulness of antidepressants for depression, and of antipsychotics and admission to a psychiatric ward for schizophrenia. Conversely, the public tended to give much more favourable ratings to vitamins and minerals and special diets for both depression and schizophrenia, and to reading self-help books for schizophrenia. CONCLUSION The beliefs that health practitioners hold about mental disorders differ greatly from those of the general public. There is a need for mental health education campaigns to help close the gap between professional and public beliefs.

Public beliefs about causes and risk factors for depression and schizophrenia.

Abstract: The objective of this study was to carry out a national survey to assess the Australian public's beliefs about causes and risk factors for mental disorders. A national household survey of 2,031 Australian adults was carried out. Half the respondents were presented with a vignette describing a person with major depression and the other half with a vignette describing schizophrenia. Respondents were asked to rate whether various factors are likely causes of problems such as that described in the vignette and to rate whether various groups are at higher or lower risk. For depression, social environmental factors were often seen as likely causes, which is consistent with the epidemiological evidence. However, genetic factors were considered as a likely cause by only half the population. For schizophrenia, social environmental factors were also often seen as causes, which is in contrast to the weak epidemiological evidence for such a role. Genetic factors attracted more support as a cause of schizophrenia than of depression. These finding point to areas where the mental health literacy of the population could be improved, particularly the over-emphasis on social environmental factors in schizophrenia. Of some concern was the belief of half the population that weakness of character is a likely cause of both depression and schizophrenia. This belief implies a negative evaluation of the sufferer as a person.

Education and decline in cognitive performance: compensatory but not protective

Abstract: The association between education and cognitive change was investigated in a large community sample of elderly people followed up after 3.6 years. Lower education was predictive of decline on the Mini-Mental State Examination (MMSE) and on tests of language and knowledge, but not on tests of cognitive speed, memory or reaction time. The effects of education were not attenuated when adjusted for health, disability or activity level. The findings suggest that education slows the rate of decline on crystallized intelligence, but not other cognitive abilities. Education may compensate for neurodegenerative changes rather than protect against them.

Belief systems of the general public concerning the appropriate treatments for mental disorders

Abstract: A study was conducted to assess the belief systems of the general public concerning the appropriate treatments for mental disorders and correlates of these belief systems. The study was based on the results of a household survey of the general public in Australia, using a national random sample of 2,031 adults aged 18–74 years. Respondents were given a vignette describing either a person with depression or one with schizophrenia, and were asked for their opinions about the helpfulness of various professional and non-professional treatments for the person described. A principal components analysis of the helpfulness ratings gave three factors: a Medical factor with high loadings on all drug treatments (exceptVitamins) and onPsychiatric ward andECT; a Psychological factor with high loadings onCounsellor, Social worker, Phone counselling, Psychiatrist, Psychologist, Psychotherapy andHypnosis; and a Lifestyle factor with high loadings onClose family, Close friends, Naturopath, Vitamins, Physical activity andGet out more. The same factors emerged from ratings of the two vignettes. Mean scores on scales constructed from the items with high loadings showed that the public tend to have a negative view of medical treatments and a positive view of psychological and lifestyle ones. However, medical treatments were rated more negatively for depression than for schizophrenia, psychological treatments were rated more positively for schizophrenia, and lifestyle treatments more positively for depression. Age, sex and education of respondents showed few associations with scores on the scales, although the better educated were more in favour of psychological treatments for both depression and schizophrenia and were less opposed to medical treatments for schizophrenia. Respondents who had suffered from the symptoms described in the schizophrenia vignette were more negative towards medical treatments. These findings about public belief systems could have implications for the provision of treatment: where there is a discrepancy in belief system between the patient and the clinician there may be poor adherence to treatment.

A prospective study of cognitive function in the elderly.

Abstract: Background. We report on the change in cognitive function in a population sample of elderly people who have been examined on two occasions more than 3 years apart.Methods. A sample of 1135 persons aged 70–102 years was interviewed at base-line then reinterviewed 3·6 years later with the Canberra Interview for the Elderly, which included tests of episodic memory and cognitive speed as well as the Mini-Mental State Examination and the National Adult Reading Test (NART).Results. Mortality and loss to follow-up reduced the sample to 736, of whom 614 completed at least one test of cognitive performance on both occasions. Cognitive performance decreased with age, except on the NART. Decline over the follow-up period increased as a function of age in all cognitive measures, except the NART. Change in cognitive scores was close to normal distribution. Incident dementia was associated strongly with age and current level of cognitive performance, but not with rate of decline. Cognitive decline and the risk of incident dementia did not differ by gender.Conclusions. A score indicating possible impairment in the very elderly carries a worse prognosis than for the younger elderly. Decline is almost universal in at least one cognitive area among those over the age of 85.

Aspirin, anti-inflammatory drugs and risk of dementia.

Abstract: Objective. To test the hypothesis that aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) may prevent dementia or cognitive impairment. Design. A two-wave longitudinal study over 3.6 years. Setting. A community survey of elderly persons living in Canberra, Australia. Participants. There were 1045 elderly persons aged 70 at the start of the study; cognitive assessment was obtained at both waves on 588. Main outcome measures. Cognitive functioning was measured using the Mini-Mental State Examination, an episodic memory test, a test of mental speed and the National Adult Reading Test. Dementia was assessed using the Canberra Interview for the Elderly. Results. On cross-sectional data, those who had been taking NSAIDs or aspirin performed no better on the cognitive tests after account had been taken of other confounding variables. There was no interaction with apolipoprotein E genotype. On longitudinal data, no difference was found between NSAID or aspirin users and controls, either in cognitive decline or incidence of dementia. Conclusions. The results do not support the hypothesis that aspirin or NSAIDs have a protective effect, but it remains possible that various sources of measurement error may have attenuated an effect of clinical significance from either type of drug. Conclusive evidence can be obtained only by a prospective trial. © 1997 John Wiley & Sons, Ltd.

Impact of pet ownership on elderly Australians' use of medical services: an analysis using Medicare data

Abstract: Objectives To determine whether pet ownership by elderly people is associated with lower use of health services. Design Survey of physical and mental health, and retrospective 12-month review of Medicare records of the number of general practitioner and specialist services. Participants and setting Elderly people living in Canberra (Australian Capital Territory) and Queanbeyan (New South Wales), surveyed in 1994 for the second stage of a larger longitudinal study. Results Elderly pet owners did not differ from non-owners on any of the physical or mental health measures or in use of health services. Conclusion Given the high use of health services by older people, our findings suggest that the claim that pet ownership leads to savings in health services should be viewed with caution.

GP attendance by elderly Australians: Evidence for unmet need in elderly men

Abstract: OBJECTIVES To examine GP service use by elderly people and, in particular, to compare those who had not consulted a GP in one year with those who were low attenders and those who were high attenders. DESIGN Medicare data on GP service use were matched to data collected by interview in 1990-1991 and reinterview in 1994 as part of a community study on health and well-being. SETTING Canberra and Queanbeyan in the Australian Capital Territory. PARTICIPANTS People aged 70 years and over, living in the community. MAIN OUTCOME MEASURES The number of visits made to a GP in 12 months. RESULTS Medicare data were available for 624 of the 897 participants interviewed (70%). While the women non-attenders reported similar levels of physical illness and symptoms to the low attenders, men non-attenders reported significantly higher levels of illness (P < 0.01) than the low-attender group. The health of men who were non-attenders was very similar to men who were high attenders of GP services. Men who had not seen a GP in one year reported significantly more pain (P = 0.002) and less social support than both low attenders and high attenders (P = 0.012 and P = 0.049, respectively). CONCLUSION We identified a group of men who had not attended a GP in one year, despite significant levels of morbidity. Such a group may benefit from consultation with a GP and could be targeted in any attempt to improve elderly men's health.

Pet ownership and future health

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