Publications by authors named "Anna Chur-Hansen"

83 Publications

People Living with Inflammatory Bowel Disease Want Multidisciplinary Healthcare: A Qualitative Content Analysis.

J Clin Psychol Med Settings 2021 Jun 29. Epub 2021 Jun 29.

School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, North Tce, SA, 5005, Australia.

This study reports on the preferences of people with inflammatory bowel disease (IBD) for their healthcare. Overall, 477 people with IBD responded to an open-ended survey question within a larger study. We qualitatively content-analysed these responses with open coding using NVivo. Respondents expressed a desire for (1) better communication, (2) multidisciplinary care, (3) better treatment, services and specialist care, (4) whole person care, (5) health promotion, (6) proactive healthcare, (7) fewer administrative issues and (8) improved hospital experience. Patients with IBD want patient-centred, multidisciplinary care. Healthcare professionals should facilitate patients' access to proactive care.
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http://dx.doi.org/10.1007/s10880-021-09801-4DOI Listing
June 2021

The prevalence and evidence-based management of needle fear in adults with chronic disease: A scoping review.

PLoS One 2021 10;16(6):e0253048. Epub 2021 Jun 10.

Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Background: Little is known about the prevalence and best management of needle fear in adults with chronic disease, who may experience frequent and long-term exposure to needles for lifesaving therapies such as renal dialysis and cancer treatment. Identifying interventions that assist in management of needle fear and associated distress is essential to support these patients with repeated needle and cannula exposure.

Method: We followed the PRISMA methodology for scoping reviews and systematically searched PsychINFO, PubMed (MEDLINE), ProQuest, Embase and grey literature and reference lists between 1989 and October 2020 for articles related to needle discomfort, distress, anxiety, fear or phobia. The following chronic diseases were included: arthritis, asthma, chronic back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, and mental illness, or kidney failure. Literature concerning dentistry, vaccination, intravenous drug users and paediatric populations were excluded.

Results: We identified 32 papers reporting prevalence (n = 24), management (n = 5) or both (n = 3). Needle fear prevalence varied in disease cohorts: 17-52% (cancer), 25-47% (chronic kidney disease) and 0.2-80% (diabetes). Assessment methods varied across studies. Management strategies had poor evidence-base, but included needle-specific education, decorated devices, cognitive-behavioural stress management techniques, distraction, and changing the therapy environment or modality.

Conclusion: Although needle fear is common there is a paucity of evidence regarding interventions to address it among adults living with chronic disease. This scoping review has highlighted the need for improved identification of needle fear in adults and development of interventions are required for these cohorts.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253048PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192004PMC
June 2021

Facilitators and barriers to employment for persons with chronic spinal cord injury or disorder: A qualitative study framed by the person-environment-occupation model.

J Spinal Cord Med 2021 May 26:1-10. Epub 2021 May 26.

Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Kolling Institute of Medical Research, RNSH, St Leonards, Australia.

Context/objective: Prolonged unemployment is common for people living with a spinal cord injury or disorder (SCI/D) and can impact negatively on quality of life. The present study examines stakeholder perspectives and experiences with the job search process in order to identify service gaps and return-to-work solutions.

Design: In-depth semi-structured interviews were thematically analysed, with questions focused on factors that can help or hinder efforts to gain employment. Generated themes were then applied to the Person-Environment-Occupation (PEO) systems model of participation.

Setting: Community-based disability service provider in South Australia.

Participants: Purposive sample of persons with SCI/D ( = 8) and rehabilitation professionals ( = 4).

Results: Person-centred themes were strongly endorsed by both groups and focused on incentives of, and motivation for, employment. Equally important to the job search process were individual expectations and attitudes, particularly job readiness. Environmental facilitators included employers' positive attitude, although workplace discrimination remained a concern. Occupation-based barriers, rather than opportunities, were identified - namely, difficulties in SCI/D self-management, the need for timely functional assessments, and more opportunities for education, upskilling and retraining.

Conclusions: The PEO model provides a broad framework to better understand the complex return-to-work process for people with a SCI/D and, potentially, uncover tangible solutions. The suggestion is that vocational rehabilitation should go beyond skills training and include motivational support to enhance job readiness. This must be done on a case-by-case basis. There is also a need for active and covert discrimination to be addressed through employment policies. The findings will be used to develop intervention targets for a newly established vocational rehabilitation service.
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http://dx.doi.org/10.1080/10790268.2021.1922231DOI Listing
May 2021

Emotion as Motivator: Parents, Professionals and Diagnosing Childhood Deafness.

Med Anthropol 2021 04 31;40(3):254-266. Epub 2020 Jul 31.

School of Psychology, University of Adelaide, Adelaide, Australia.

Diagnosing deafness is a culturally situated practice generating considerable research in health sciences but limited work in anthropology. Diagnosis fast-tracks parents into a medical and education pathway but can also create tension for parents and professionals. Drawing on ethnographic fieldwork, we argue that in this biomedical context, emotions are often understood by professionals as impairing for parents, and hence problematic for the treatment process. In contrast emotions are characterized by parents as motivational and tools for decision making on a pathway that is experienced as a source of stress.
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http://dx.doi.org/10.1080/01459740.2020.1796659DOI Listing
April 2021

Adult separation anxiety disorder: The human-animal bond.

J Affect Disord 2020 06 5;270:90-96. Epub 2020 Apr 5.

School of Psychology, University of Adelaide, Adelaide, SA, 5005, Australia.

Background: The introduction of an adult onset Separation Anxiety Disorder in the DSM-V recognises that separation anxiety can occur at any stage across the lifespan. In this paper, we examine whether adult separation anxiety, which is known to occur when people are apart from other people close to them, can also develop when people are separated from animal companions. The social and individual psychological correlates of this reported phenomenon are examined.

Methods: Participants (N = 313, aged 18-76, M = 41.89 years), completed demographic information and questionnaires measuring separation anxiety from companion animals and humans, attachment towards companion animals and humans, and social support.

Results: Significant positive relationships were observed between separation anxiety from humans, people substitution and separation anxiety from animals. Participants with greater separation anxiety from animals also reported less social support and greater attachment anxiety involving humans. People substitution was also positively related to greater animal-related separation anxiety. Associations were generally weaker when cats were identified as the principal companion animal. Participants without children reported significantly less attachment-related avoidance (human); less perceived social support; greater people substitution; and, greater separation anxiety towards companion animals. Separation anxiety from humans, attachment avoidance, and attachment anxiety accounted for 41% of variance in separation anxiety from animals.

Limitations: The correlational design does not allow the investigation of causal associations.

Conclusions: A strong, positive relationship was observed between human-related separation anxiety and animal-related separation anxiety, which was significantly stronger for people with lower levels of social support.
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http://dx.doi.org/10.1016/j.jad.2020.03.147DOI Listing
June 2020

First-time mothers' perceptions of social support: Recommendations for best practice.

Health Psychol Open 2020 Jan-Jun;7(1):2055102919898611. Epub 2020 Feb 7.

The University of Adelaide, Australia.

Research indicates social support is imperative for postpartum well-being. The types of social support and access to preferred supports are less understood. This article considers first-time mothers' perceptions of the effectiveness of social supports and perceived barriers to accessing support and provides recommendations for best practice. A search of the literature for terms related to postpartum social support was conducted. Major themes were identified and synthesised. A critique and analysis of the literature is presented with recommendations for best practice. Much of the research around postnatal support fails to distinguish the specific type of support, meaning creating support solutions for the postpartum period may not be effectively targeted. Recommendations for individualised support are made.
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http://dx.doi.org/10.1177/2055102919898611DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008558PMC
February 2020

Integrated Psychological Care Reduces Health Care Costs at a Hospital-Based Inflammatory Bowel Disease Service.

Clin Gastroenterol Hepatol 2021 01 31;19(1):96-103.e3. Epub 2020 Jan 31.

Inflammatory Bowel Disease Service, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; School of Medicine, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.

Background & Aims: Inflammatory bowel diseases (IBD) are associated with high psychosocial burden and economic cost. Integrating psychological care into routine management might lead to savings. We performed a 2-year investigation of the effects of integrated psychological care in reducing healthcare use and costs.

Methods: We performed a prospective study of 335 adult patients treated at a hospital-based IBD service in Australia. Participants were recruited between September 2015 and August 2016 and completed screening instruments to evaluate mental health and quality of life. Data on healthcare use and costs for the previous 12 months were also collected. Patients found to be at risk for mental health issues were offered psychological intervention. Patients were followed up 12 months after screening (between September 2016 and August 2017).

Results: A significantly higher proportion of subjects at risk for mental health issues had presented to an emergency department in the 12 months before screening (51/182; 28%) compared to psychologically healthy subjects (28/152; 18%; X(1) = 4.23; P = .040). Higher levels of depression and general distress (but not anxiety) were related to increased odds of hospital admission (adjusted odds ratios, 1.07 and 1.05, respectively). Among the patients who accepted psychological intervention, the number who presented to emergency departments was reduced significantly in the 12 months after screening (follow-up) compared to the 12 months before screening (P = .047), resulting in a cost saving of AU$30,140 ($20,816 USD). A cost-benefit analysis of the integrated psychological care model revealed a net saving of AU$84,905 ($58,647 USD) over a 2-year period.

Conclusions: Risk for mental health issues is associated with higher healthcare costs in people with IBD. Providing integrated psychological care to individuals at risk for mental health issues can reduce costs, particularly by decreasing visits to emergency departments. Further studies are required to determine the best care to provide to reduce costs.
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http://dx.doi.org/10.1016/j.cgh.2020.01.030DOI Listing
January 2021

'It's just a peripheral issue': A qualitative analysis of mental health clinicians' accounts of (not) addressing sexuality in their work.

Int J Ment Health Nurs 2019 Dec 28;28(6):1278-1287. Epub 2019 Jul 28.

Adelaide Sexual Health Centre, Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Sexuality, relationships, and intimacy are integral parts of many peoples' lives, not negated by mental distress and illness. Yet typically, these needs are not addressed adequately in mental health settings. In-depth interviews were conducted with mental health clinicians with an aim of exploring their perceptions and understandings of sexuality and sexual concerns within mental health settings. Participants were 22 mental health nurses, psychologists, and psychiatrists working with people across a range of settings in four Australian cities. Sexuality or aspects of this were often not addressed in clinical practice, and this was common across participants' accounts. A critical thematic analysis was conducted to explore how participants made sense of or explained this silence in relation to sexuality. Two key themes were 'Sexuality is hard to talk about' and 'Sexuality is a "peripheral issue"'. In positioning sexuality as a peripheral issue, participants drew on three key explanations (sub-themes): that sexuality rarely 'comes up', that it is not pragmatic to address sexuality, and that addressing sexuality is not part of participants' roles or skill sets. A third theme captured the contrasting perception that 'Sexuality could be better addressed' in mental health settings. This analysis indicates that, beyond anticipated embarrassment, mental health clinicians from three disciplines account for omissions of sexuality from clinical practice in similar ways. Moreover, these accounts serve to peripheralize sexuality in mental health settings. We consider these results within the context of espoused holistic and recovery-oriented principles in mental health settings.
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http://dx.doi.org/10.1111/inm.12633DOI Listing
December 2019

Knowledge, skills, and attitudes of psychologists working with persons with vision impairment.

Disabil Rehabil 2021 03 11;43(5):621-631. Epub 2019 Jul 11.

School of Psychology, University of Adelaide, Adelaide, Australia.

Purpose: Psychologists working with persons with vision impairment face unique challenges in providing psychological services, including mental health care and cognitive assessments. While existing competency guidelines for general disability and rehabilitation psychology are relevant to working with persons with vision impairment in many ways, specific competencies are needed. Previous psychological research into the provision of therapy for persons with vision impairment has focused mainly on communication and intervention strategies and lacks input from the vision-impaired community.

Materials And Methods: This qualitative study, grounded in disability, rehabilitation psychology, and competency frameworks aimed to identify the knowledge, skills, and attitudes necessary for psychologists working with persons with vision impairment.

Results: Through triangulating responses from both registered psychologists ( = 10) and persons with vision impairment ( = 5), a thematic analysis identified 29 competencies under six major themes, including: Expertise, Impact, Approach, Collaboration, Assessment, and Flexibility. Competencies were discretely categorized as knowledge, skills, or attitudes.

Conclusions: This study provides data that may be used as the basis for more rigorous research into identifying areas for vision impaired-specific competency-based training in undergraduate, postgraduate, and professional psychology curricula.Implications for rehabilitationWhilst competencies for disability and rehabilitation psychology already exist, the competencies for psychologists working with persons with vision impairment require updating, informed by both practitioners and clients with vision impairment.These competencies include: knowledge of eye conditions and pathologies; knowledge of the variation in impact of vision loss; general knowledge about vision loss and normal lifespan development; and, the ability to assess the specific impact of vision loss on the individual.Other skills and attitudes, such as oral communication skills and relaying hope and optimism, whilst necessary for all therapeutic encounters, may require particular modification when working with vision-impaired persons.Educators responsible for professional postgraduate courses in psychology should ensure that training incorporates an understanding of the need to modify approaches for particular groups of clients, such as those with vision impairment.
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http://dx.doi.org/10.1080/09638288.2019.1634155DOI Listing
March 2021

Integrated Psychological Care is Needed, Welcomed and Effective in Ambulatory Inflammatory Bowel Disease Management: Evaluation of a New Initiative.

J Crohns Colitis 2019 Jul;13(7):819-827

IBD Service, Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Adelaide, Australia.

Background And Aims: Inflammatory bowel disease is associated with psychosocial issues which reduce quality of life and impair medical management. However, these issues are rarely addressed in routine care. A model of integrated psychological screening and intervention was trialled to measure prevalence, patient participation, and potential benefits to mental health and/or quality of life.

Methods: During a 12-month period, 490 adult patients at an established hospital-based service were approached to complete screening instruments for anxiety, depression, general distress, quality of life and medication adherence. Disease-specific and demographic data were also collected. Patients who scored highly on screening questionnaires were offered psychological intervention (in-service or externally referred). Participants were reassessed after 12 months.

Results: Psychological screening was well accepted with 68% (N = 335) participating. Psychological care was 'needed', with 55% (N = 183) scoring highly for anxiety, depression and/or general distress. Half of those 'in need' (N = 91) accepted intervention. In those who accepted, levels of anxiety (mean at intake [M1] = 12.11 vs mean at follow-up [M2] = 9.59, p < 0.001), depression (M1 = 8.38 vs M2 = 6.42, p < 0.001), general distress (M1 = 17.99 vs M2 = 13.96, p < 0.001), mental health quality of life (M1 = 54.64 vs M2 = 59.70, p < 0.001) and overall quality of life (M1 = 57.60 vs M2 = 64.10, p < 0.001) each improved between intake and follow-up. Engagement in psychological intervention was six times greater for those treated in-service vs externally referred (χ2[1] = 13.06, p < 0.001, odds ratio = 6.47).

Conclusions: Mental health issues are highly prevalent in people with inflammatory bowel disease. Patients are open to psychological screening and treatment. Psychological care can improve patient mental health and quality of life, and works best when integrated into routine management.
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http://dx.doi.org/10.1093/ecco-jcc/jjz026DOI Listing
July 2019

Psychosocial consequences of gastrointestinal symptoms and dietary changes in people receiving automated peritoneal dialysis.

J Ren Care 2019 Mar 25;45(1):41-50. Epub 2018 Dec 25.

Central and Northern Adelaide Renal and Transplantation Service (CNARTS), Royal Adelaide Hospital, South Australia, 5000, Australia.

Background: Gastrointestinal (GI) symptoms are associated with poor psychosocial wellbeing among people receiving peritoneal dialysis (PD). The mind-gut axis represents one possible explanatory mechanism for this relationship. Despite existing evidence, the individual's experience of GI symptoms and their potential psychosocial consequences have not been explored.

Objective: To understand the experiences of people receiving peritoneal dialysis regarding their gastrointestinal health and psychosocial wellbeing.

Method: Ten people undergoing automated PD (five females, five males) aged 31-77 years (Mean = 59.3, SD = 15.67) participated in a single one-on-one qualitative interview. Interviews ceased at thematic saturation. Transcripts were analysed using the framework approach.

Results: A central theme of Autonomy emerged from the data representing participants' experiences of the psychosocial consequences of dialysis, GI symptoms, and dietary changes. This overarched two main themes: 1) Loss of Autonomy [Sub-themes: Interference to Daily Life (Dialysis process and sleep, Impacts on relationships), Powerlessness, Frustration, Food Aversion, and Restriction (Friendships and social life, Impacts on partner)] and 2) Attempts to Gain Autonomy (Sub-themes: Coping Well, Pragmatism, and Maintaining Normality). A related sub-theme of Partner as a Carer emerged as part of Loss of Autonomy.

Conclusion: GI symptoms and diet and fluid restrictions have psychosocial consequences resulting in multiple losses of autonomy for people receiving PD, who employ strategies to attempt to regain autonomy in the face of these issues. Dietary and GI symptom management advice should aim to enhance patient autonomy within the confines of PD therapy and thus reduce its psychosocial impacts.
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http://dx.doi.org/10.1111/jorc.12265DOI Listing
March 2019

Beyond Right or Wrong: Attitudes and Practices of Physicians, Nurses, Psychologists, and Social Workers Regarding Attendance at Patient Funerals.

J Palliat Med 2019 Apr 9;22(4):400-407. Epub 2018 Nov 9.

3 Northern Adelaide Palliative Service, Northern Adelaide Local Health Network , Adelaide, Australia .

Background: Health professionals' bereavement practices, including funeral attendance, have attracted relatively little attention from researchers. There may be a number of motivations and perceived benefits for health professionals to attend patient funerals. There are no published data comparing different groups of health professionals' perceptions of and practices in attending the funerals of their patients.

Objective: To understand the attitudes and practices of health professionals toward attendance at patient funerals.

Design: Cross-sectional nationwide online survey of attitudes and practices toward attendance at patient funerals based upon data from interviews with health professionals.

Participants: Australian health practitioners from medicine, nursing, psychology, social work, and other allied health professions (n = 1098).

Results: Attendance at patient funerals was predicted by age, telling colleagues about own funeral attendance practices, having discussions with colleagues about funeral attendance, having long relationships with patients, and having a majority of patients at the end of life. Nonattendance was predicted by believing that if they cannot attend all funerals, they prefer not to attend any, feeling that colleagues disapprove of funeral attendance, believing that attending funerals is crossing the line between the personal and the professional, and being a psychologist.

Conclusions: Our findings emphasize the need for more open discussions and reflection among individuals and groups of health practitioners regarding attendance at funerals. Understanding the motivations of physicians, nurses, social workers, and other allied health practitioners to attend or not attend patient funerals is an important first step in working toward policies, protocols, and guidelines to support best practice.
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http://dx.doi.org/10.1089/jpm.2018.0234DOI Listing
April 2019

Work and SCI: a pilot randomized controlled study of an online resource for job-seekers with spinal cord dysfunction.

Spinal Cord 2019 Mar 27;57(3):221-228. Epub 2018 Sep 27.

Department of Occupational Therapy, School of Primary Health Care, Monash University, Frankston, VIC, Australia.

Study Design: A prospective, parallel randomized controlled trial (RCT).

Objectives: To test the preliminary effects of an online resource targeted to job-seekers with spinal cord injury or disorder (SCI/D), and to determine the feasibility of proceeding to a full-scale RCT.

Setting: A community cohort in Australia.

Methods: Forty-eight adults (M = 42 years, SD = 10.95, 27 males) were randomized to receive 4-weeks access to the Work and SCI resource (n = 25) or to a wait-list control group (n = 23). The Work and SCI intervention involved six stand-alone learning modules which provided job-searching and career-planning information through text, videos, and interactive activities. Self-report measures were administered at baseline and after 4 weeks: Job Procurement Self-Efficacy Scale (JSES), Life Orientation Test-Revised (LOT-R), and Patient Health Questionnaire-9 (PHQ-9).

Results: Online usage data identified high uptake of the Work and SCI resource, although study attrition was problematic. Intention-to-treat analyses failed to reach statistical significance, whereas complete data revealed a significant interaction effect for optimism (LOT-R).

Conclusion: Further research to develop and enhance Work and SCI is indicated. Remediable strategies to optimize recruitment and statistical power in a future definitive RCT are discussed.

Sponsorship: This project was funded by the auDA Foundation (project 16019).
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http://dx.doi.org/10.1038/s41393-018-0200-1DOI Listing
March 2019

Who decides when people can have sex? Australian mental health clinicians' perceptions of sexuality and autonomy.

J Health Psychol 2020 Nov-Dec;25(13-14):2188-2199. Epub 2018 Jul 23.

The University of Adelaide, Australia.

Sexuality is a central aspect of human experience but there is evidence that this is largely constrained, pathologised or ignored in mental health settings. We conducted in-depth interviews with 22 psychologists, psychiatrists and mental health nurses working across a variety of settings in four Australian cities. Sexuality was most often perceived as relevant in the mental health setting when it was simultaneously constructed as dangerous. Participants located this danger in sexual expression itself or within individuals who, because of mental illness, lacked the autonomy required to successfully engage in 'safe' sex. We discuss these findings and their implications for research and professional practice.
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http://dx.doi.org/10.1177/1359105318790026DOI Listing
April 2021

Neutralising the meat paradox: Cognitive dissonance, gender, and eating animals.

Appetite 2018 04 4;123:280-288. Epub 2018 Jan 4.

University of Adelaide, Australia.

Meat eating is a common behaviour, despite many people claiming to like, love, and care about animals. The apparent disconnection between not wanting animals to suffer, yet killing them for food, has been termed the 'meat paradox.' In this experimental study (N = 460), participants completed pre-affect, post-affect, meat attachment, and attitude towards animals questionnaires, under two conditions: exposure to the life of an Australian meat lamb, and information about the nutritional benefits of meat. A factorial MANOVA revealed that negative affect was significantly greater when participants were exposed to the meat-animal connection; however, more entrenched attitudes towards animals and attachment to meat remained unaffected. Significant gender effects were found across all variables: most notably, meat attachment differed according to gender, decreasing in women and increasing in men when exposed to the meat-animal condition. Open-ended responses were subjected to content analysis to understand participants' future meat-consumption preferences and accompanying reasoning strategies. Findings from the present study contribute to understanding how cognitive dissonance and inconsistencies are rationalised by meat consumers.
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http://dx.doi.org/10.1016/j.appet.2018.01.005DOI Listing
April 2018

Patients' reasons for and against undergoing Roux-en-Y gastric bypass, adjustable gastric banding, and vertical sleeve gastrectomy.

Surg Obes Relat Dis 2017 Nov 15;13(11):1887-1896. Epub 2017 Jul 15.

School of Psychology, University of Adelaide, Adelaide, Australia.

Background: The most common bariatric procedures, Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (LAGB), and sleeve gastrectomy (SG), generally induce significant weight loss and health improvements. However, little is known about how patients decide which procedure to undergo.

Objective: Investigate patients' reasons for and against undergoing RYGB, LAGB, and SG.

Setting: Online questionnaire.

Methods: Data were analyzed from 236 Australian adults with current RYGB (15.7%), LAGB (22.0%), or SG (62.3%) who completed a questionnaire including an open-ended question about why they underwent their procedure. Data were coded for content and analyzed.

Results: Patients most often underwent RYGB because of its evidence base and success rate and the patient's characteristics, whereas the most common reason for SG was a medical practitioner's recommendation, preference, or choice, followed by the patients' evaluation of information gathered from their own research and observations of others' success. The most common reasons for undergoing LAGB related to characteristics of the procedure, including its reversibility and a perception of LAGB as less invasive. The most common reason against undergoing both RYGB and SG was a desire to avoid postsurgical complications and risks such as leaks or malabsorption, whereas the most common reason against LAGB was information and evidence from other people's unsuccessful experiences and failure rates.

Conclusions: Patients' reasons for and against procedures differed by procedure. In addition to the surgeon's influence, patients demonstrated clear procedure preferences based on their own research, knowledge, and experiences. Preferences should be understood to assist patients to select the most appropriate procedure for their circumstances.
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http://dx.doi.org/10.1016/j.soard.2017.07.013DOI Listing
November 2017

Attachment, Mothering and Mental Illness: Mother-Infant Therapy in an Institutional Context.

Cult Med Psychiatry 2018 Mar;42(1):112-130

School of Psychology, University of Adelaide, Adelaide, SA, 5005, Australia.

This paper is an ethnographic exploration of how attachment theory underpins therapeutic practices in an Australian institutional context where mothers of infants have been diagnosed and are undergoing treatment for mental illness. We argue that attachment theory in this particular context rests on a series of principles or assumptions: that attachment theory is universally applicable; that attachment is dyadic and gendered; that there is an attachment template formed which can be transferred across generations and shapes future social interactions; that there is understood to be a mental health risk to the infant when attachment is characterised as problematic; and that this risk can be mitigated through the therapeutic practices advocated by the institution. Through an in-depth case study, this paper demonstrates how these assumptions cohere in practice and are used to assess mothering as deficient, to choose therapeutic options, to shape women's behaviour, and to formulate decisions about child placement.
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http://dx.doi.org/10.1007/s11013-017-9544-9DOI Listing
March 2018

Can targeted job-information for adults with spinal cord dysfunction be effectively delivered online? A pilot study.

J Spinal Cord Med 2019 01 3;42(1):94-101. Epub 2017 May 3.

g Paraplegic and Quadriplegic Association of South Australia (PQSA) , South Australia , Australia.

Objective: To pilot a novel email-based information package (Work and SCI) for job-seekers with an acquired spinal cord injury (SCI) or spinal cord dysfunction (SCI/D).

Study Design: Prospective, non-randomized, repeated measures trial.

Setting: Community dwelling cohort in Australia.

Participants: Five people with SCI (mean age 46.4 years, SD = 10.2; 4 female) initially reviewed Work and SCI. Twenty-four with SCI/D subsequently enrolled, of whom 16 (mean age 46.4 years, SD = 11.1; 7 female), completed the intervention.

Intervention: Intervention participants accessed Work and SCI over a 4-week period.

Outcome Measures: Individual changes in pre-post scores for the My Vocational Situation Scale, Job Procurement Self-Efficacy Scale, Patient Health Questionnaire-9 and Life Orientation Test-Revised were examined.

Results: Reliable change in pre-post scores across outcomes were reported by 38% (n = 6) of participants. Favorable comments on the Work and SCI resource were provided in addition to suggestions for improvement.

Conclusions: Preliminary data suggest that Work and SCI may help to establish vocational interests among job-seekers with a SCI/D, however further work is needed to enhance participant compliance. This might include moderator support to promote and maintain participation. A controlled design will also help to identify factors that influence engagement with the Work and SCI resource.
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http://dx.doi.org/10.1080/10790268.2017.1321821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340270PMC
January 2019

Attending patient funerals: Practices and attitudes of Australian medical practitioners.

Death Stud 2017 02 9;41(2):78-86. Epub 2016 Sep 9.

b School of Medicine , The University of Adelaide , Adelaide , Australia.

The appropriateness of attending a patient's funeral is a medical dilemma. This article focuses on 437 doctors who participated in an online survey. Seventy-one percent of general practitioners, 67% of oncologists, 67% of psychiatrists, 63% of palliative medicine specialists, 52% of surgeons, and 22% of intensive care specialists had attended patient funerals. Significant differences in demographics and between specialties were identified in terms of barriers and benefits associated with attendance. Although attendance is a personal decision, there is a need for open discussions in medical education and professional development concerning death and the role of doctors after a patient dies.
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http://dx.doi.org/10.1080/07481187.2016.1214631DOI Listing
February 2017

Attitudes Toward Combining Psychological, Mind-Body Therapies and Nutritional Approaches for the Enhancement of Mood.

Adv Mind Body Med 2016 ;30(3):19-25

Context • Interest has been rising in the use of complementary and alternative medicine (CAM) for the promotion of health and treatment of disease. To date, the majority of CAM research has focused on exploring the demographic characteristics, attitudes, and motivations of CAM users and on the efficacy of different therapies and products. Less is known with respect to the psychological characteristics of people who use CAM. Previous research has not investigated the usefulness of integrating mind-body therapies with natural products in a combined mood intervention. Objective • The study intended to investigate attitudes toward a proposed new approach to the treatment of mood, one that integrates psychological mind-body therapies and natural nutritional products. Design • Participants completed an online survey covering demographics, personality traits, locus of control, use of CAM, attitudes toward the proposed psychonutritional approach, and mood. Setting • This study was conducted at the University of Adelaide School of Psychology (Adelaide, SA, Australia). Participants • Participants were 333 members of the Australian general public, who were recruited online via the social-media platform Facebook. The majority were women (83.2%), aged between 18 and 81 y. Outcome Measures • Measures included the Multidimensional Health Locus of Control Scale Form B, the Ten-Item Personality Inventory, and the Depression, Anxiety and Stress Scale. Results • Participants were positive about the proposed approach and were likely to try it to enhance their moods. The likeliness of use of the combined approach was significantly higher in the female participants and was associated with higher levels of the personality trait openness and an internal health locus of control, after controlling for all other variables. Conclusions • Interest exists for an intervention for mood that incorporates both psychological and nutritional approaches. Further research into the development of targeted treatment programs for mood is warranted.
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February 2017

Uncertain Diagnostic Language Affects Further Studies, Endoscopies, and Repeat Consultations for Patients With Functional Gastrointestinal Disorders.

Clin Gastroenterol Hepatol 2016 12 9;14(12):1735-1741.e1. Epub 2016 Jul 9.

University of Adelaide, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Background & Aims: Although guidelines state that functional gastrointestinal disorders (FGIDs) can be diagnosed with minimal investigation, consultations and investigations still have high costs. We investigated whether these are due to specific behaviors of specialist clinicians by examining differences in clinician approaches to organic gastrointestinal diseases vs FGIDs.

Methods: We performed a retrospective review of 207 outpatient department letters written from the gastroenterology unit at a tertiary hospital after patient consultations from 2008 through 2011. We collected data from diagnostic letters and case notes relating to patients with organic (n = 108) or functional GI disorders (n = 119). We analyzed the content of each letter by using content analysis and reviewed case files to determine which investigations were subsequently performed. Our primary outcome was the type of diagnostic language used and other aspects of the clinical approach.

Results: We found gastroenterologists to use 2 distinct types of language, clear vs qualified, which was consistent with their level of certainty (or lack thereof), for example, "the patient is diagnosed with…." vs "it is possible that this patient might have….". Qualified diagnostic language was used in a significantly higher proportion of letters about patients with FGIDs (63%) than organic gastrointestinal diseases (13%) (P < .001). In addition, a higher proportion of patients with FGIDs underwent endoscopic evaluation than patients with organic gastrointestinal diseases (79% vs 63%; P < .05).

Conclusions: In an analysis of diagnoses of patients with FGIDs vs organic disorders, we found that gastroenterologists used more qualified (uncertain) language in diagnosing patients with FGIDs. This may contribute to patient discard of diagnoses and lead to additional, unwarranted endoscopic investigations.
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http://dx.doi.org/10.1016/j.cgh.2016.06.030DOI Listing
December 2016

Not appropriate dinner table conversation? Talking to children about meat production.

Appetite 2016 May 22;100:1-9. Epub 2016 Jan 22.

School of Humanities, University of Adelaide, Adelaide, South Australia, Australia.

Although Australians on average consume large quantities of meat, their attitudes to farm animal welfare are poorly understood. We know little about how farm animal production is discussed in Australian households or how children learn about the origins of meat. This study consisted of an online survey completed by 225 primary carers throughout Australia recruited through social media. Findings include that conversations about the origin of meat were generally stimulated by meal preparation within the home rather than visits to agricultural shows or similar activities. Parents preferred to initiate conversations with children about meat production before they were 5 years of age. Urban parents were more likely than rural parents to reveal that they were conflicted about eating meat and would be more empathetic to children who chose to stop eating meat. Rural parents were more likely than urban parents to feel that children should eat what they are given and that talking about meat is not a major issue. Both groups felt that it was important that children should know where their food comes from. The findings of this study suggest that parental attitudes to meat production and consumption influence conversations about meat origins with children.
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http://dx.doi.org/10.1016/j.appet.2016.01.029DOI Listing
May 2016

'We don't have to go and see a special person to solve this problem': Trauma, mental health beliefs and processes for addressing 'mental health issues' among Sudanese refugees in Australia.

Int J Soc Psychiatry 2016 Feb 26;62(1):76-83. Epub 2015 Jul 26.

School of Public Health, University of Adelaide, Adelaide, SA, Australia.

Background: The impact of trauma on refugee mental health has been a particular focal point for research and treatment in Western contexts, despite uncertainty about the degree to which this corresponds with refugees' needs, mental health beliefs and healing mechanisms.

Aims: This study explored the mental health beliefs of resettling Sudanese refugees in Australia.

Methods: In-depth qualitative interviews were conducted with Sudanese community representatives and with a range of health and social work professionals who were not necessarily Sudanese.

Results: The concept of trauma was not universally considered to be salient for Sudanese refugees. Key informants, especially those in refugee-oriented services, emphasised stoicism and a desire to move forward and questioned the appropriateness of Western psychological therapies. Processes that exist within the family and the Sudanese community to deal with stressors like loss, grief and social isolation were explained.

Conclusion: Dialogue between services and community members is needed to ensure responses to refugee mental health are sensitive to the diversity of needs and mental health beliefs of refugees. This will enable workers to ascertain how individual refugees understand their experiences of distress or sadness and to determine whether community strategies and/or professional responses are appropriate.
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http://dx.doi.org/10.1177/0020764015595664DOI Listing
February 2016

'I don't want to be here but I feel safe': Referral and admission to a child and adolescent psychiatric inpatient unit: The young person's perspective.

Int J Ment Health Nurs 2015 Dec 2;24(6):569-76. Epub 2015 Sep 2.

School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia.

Early and appropriate intervention can assist children and young people manage their mental illness and prevent it becoming a long-term condition. However, satisfaction with mental health services can influence the level of engagement individuals are willing to participate in beyond the time of the initial contact or hospitalization. A qualitative design was used to identify and understand the experiences of the admission process for young people referred to the sole psychiatric inpatient unit in one Australian state for children up to the age of 18 years. Eleven young people participated in semistructured interviews that were audiotaped, transcribed, and coded. Interview data were examined through thematic analysis. Satisfaction with the inpatient experience was influenced by whether or not young people experienced a sense of connection with staff or other patients on the ward. The ability of nursing staff in identifying and catering to the individual needs of young people in their care facilitated feelings of safety, security, and acceptance, and contributed to the young person's desire to remain engaged in treatment post-discharge. This research supports the shift towards perceiving patient satisfaction as a separate entity from service delivery and quality, with some participants able to voice dissatisfaction about the lack of services, while reporting overall satisfaction with the inpatient experience.
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http://dx.doi.org/10.1111/inm.12163DOI Listing
December 2015

The assessment of parental stress and support in the neonatal intensive care unit using the Parent Stress Scale - Neonatal Intensive Care Unit.

Women Birth 2015 Sep 6;28(3):252-8. Epub 2015 May 6.

School of Psychology, Hughes Building, North Terrace Campus, University of Adelaide, SA 5000, Australia.

Problem: Parental stress in the neonatal intensive care unit (NICU) has been reported, however identifying modifiable stress factors and looking for demographic parent factors related to stress has not been well researched.

Aim: This study aims to identify the most stressful elements for parents in the neonatal intensive care unit.

Methods: Parents of babies in an Australian neonatal intensive care unit (N=73) completed both the Parent Stress Scale - Neonatal Intensive Care Unit and a survey of parent and baby demographic and support experience variables (Parent Survey) over an 18-month period.

Findings: Older parental age, very premature birth and twin birth were significantly associated with a higher Parent Stress Scale - Neonatal Intensive Care Unit score. Having a high score in the Relationship and Parental Role scale was strongly associated with attendance at the parent support group.

Conclusion: These results indicate the variables associated with stress and this knowledge can be used by teams within hospitals to provide better supportive emotional care for parents.
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http://dx.doi.org/10.1016/j.wombi.2015.04.001DOI Listing
September 2015

Is death our business? Philosophical conflicts over the end-of-life in old age psychiatry.

Aging Ment Health 2016 14;20(6):583-93. Epub 2015 Apr 14.

c School of Psychology , The University of Adelaide , Adelaide , South Australia.

Objectives: Old age psychiatrists work with end-of-life (EOL) issues and encounter patient deaths, but death and dying have received limited focus in old age psychiatry training and research. This qualitative study explores old age psychiatrists' experience of and approach to working with patients at the EOL.

Method: Australian old age psychiatrists were purposively sampled and interviewed in-depth. Data saturation was achieved after nine participant interviews. Verbatim transcripts were analysed for themes, which were independently verified.

Results: Two dichotomous overarching themes were identified. Death is not our business reflected participants' experience of working in a mental health framework and incorporated four themes: death should not occur in psychiatry; working in a psychiatric treatment model; keeping a distance from death and unexpected death is a negative experience. Death is our business reflected participants' experience of working in an aged care context and incorporated four themes: death is part of life; encountering the EOL through dementia care; doing EOL work and expected death is a positive experience.

Conclusion: Participants reported conflict because of the contradictory domains in which they work. They were comfortable working with patients at the EOL when death was expected, particularly in dementia. By contrast, they struggled with death as an adverse outcome in circumstances influenced by mental health culture, which was characterised by risk management, suicide prevention and a focus on recovery. This study has implications for models of care underpinning old age psychiatry. An integrated person-centred model of care may provide a contextually appropriate approach for practice.
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http://dx.doi.org/10.1080/13607863.2015.1031636DOI Listing
January 2017

Treatment approaches of palliative medicine specialists for depression in the palliative care setting: findings from a qualitative, in-depth interview study.

BMJ Support Palliat Care 2016 Jun 8;6(2):186-93. Epub 2015 Jan 8.

School of Psychology, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia.

Background: Treatment of depression in the palliative care setting is complicated by varied treatment preferences, a small body of research, and unique challenges associated with the end-of-life. Little is known about the treatment practices of medical practitioners in this setting.

Objective: This study aimed to investigate and characterise the treatment approaches of palliative medicine specialists for depression.

Design: Semistructured, in-depth interviews were conducted to explore explanatory models of depression from palliative medicine specialists, including a focus on treatment. Verbatim interview transcripts were analysed for themes.

Setting/participants: Palliative medicine specialists practising in Australia were recruited and purposively sampled. Nine participants were interviewed to reach data saturation.

Results: Five themes were identified in relation to treatment of depression: (1) guiding principles of treatment; (2) treatment approaches; (3) factors underpinning treatment decisions; (4) difficulties arising in treatment; and (5) interdisciplinary roles. Participants described five distinct treatment approaches, consisting of biological orientation, psychosocial orientation, combination approach, undifferentiated approach and ambivalence. Treatment decisions were contingent on patient, depression, clinician and sociocultural factors. Difficulties included discomfort with treating depression, being inadequately equipped and confronting therapeutic limitations. Treating depression was considered to require multidisciplinary team effort.

Conclusions: Palliative medicine specialists' treatment approaches are linked to their concepts of and causal explanations for depression. Future treatment guidelines could aim to consider specific varieties of depression, be more differentiated in treatment modality and type, and consider decision-shaping factors. Continuing mental health education and the incorporation of psychiatry and psychology into palliative care services may have enduring benefits.
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http://dx.doi.org/10.1136/bmjspcare-2014-000719DOI Listing
June 2016

Knowledge, skills and attitudes of rural and remote psychologists.

Aust J Rural Health 2014 Dec;22(6):273-9

School of Psychology, University of Adelaide, Adelaide, South Australia, Australia.

Objective: To develop a list of knowledge, skills and attitudes (KSAs, components of competencies) considered required or desirable by rural and remote psychologists for rural and remote psychology practice.

Design: Semi-structured qualitative telephone interviews. Data were analysed thematically.

Setting: Rural and remote regions of South Australia.

Participants: Nine registered psychologists living and working in rural and remote South Australia (as defined by ARIA++ classification categories excluding Highly Accessible communities). All participants were women.

Results: Seven competencies were identified, relating to two broad themes: 'Professional Isolation' (competencies arising from being the sole psychologist or one of few in the community); and 'rural life' (competencies relating to the need to manage features of the rural context). The seven competencies (managing professional development, supervision, the lack of other services, dual relationships, visibility, confidentiality and appreciation of the rural context) encompassed a number of corresponding and overlapping KSAs. Personality characteristics, including autonomy, resilience and confidence were also identified as important for working in rural areas.

Conclusions: Competencies and KSAs identified were consistent with issues identified in previous research for rural and remote psychologists and other health professionals. The present study contributes by providing a comprehensive checklist of KSAs for rural practice identified by rural psychologists. With further development, the competencies outlined could be used in conjunction with rural placements as part of competency-based training.
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http://dx.doi.org/10.1111/ajr.12152DOI Listing
December 2014

A qualitative study to explore communication skills in veterinary medical education.

Int J Med Educ 2014 Oct 11;5:193-8. Epub 2014 Oct 11.

School of Animal and Veterinary Science, University of Adelaide, Roseworthy Campus, Roseworthy, South Australia.

Objective: To explore and gain an understanding of what "clinical communication skills" mean to veterinarians working in private practice and what implications this might have for veterinary medical education.

Methods: Qualitative research methods were used to purposefully sample a range of veterinary practitioners from a pool of South Australian veterinary practices who were interviewed to determine their understanding of what communication skills mean in the context of veterinary practice. Interviews were conducted with fourteen veterinary practitioners. Participants were sampled from a range of ages, veterinary schools of graduation plus urban and rural locations. Interview transcripts were analysed for themes, definitions and contexts.

Results: Participants' accounts included a number of skills which they considered to be "communication". Some of the definitions of these skills parallel communication skills and competencies for human medicine on which communication skills training incorporated into veterinary curricula to date have largely been based. However, the veterinarians in this study also raised interesting contextual differences unique to the veterinary profession, such as communication with the animal, selling service, discussing money in relation to decisions for care, and communicating about euthanasia.

Conclusions: Veterinary practitioners require high level communication skills. Education and training in veterinary medicine may be better tailored to reflect the unique context of the veterinary profession.
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http://dx.doi.org/10.5116/ijme.542a.975dDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216729PMC
October 2014

Depression means different things: A qualitative study of psychiatrists' conceptualization of depression in the palliative care setting.

Palliat Support Care 2015 Oct 21;13(5):1223-30. Epub 2014 Oct 21.

School of Psychology,Faculty of Health Sciences,The University of Adelaide,South Australia,Australia.

Objective: Medical practitioners conceptualize depression in different ways, which adds to the challenges of its diagnosis and treatment, as well as research in the palliative care setting. Psychiatric assessment is often considered the "gold standard" for diagnosis, therefore how psychiatrists conceptualize depression in this setting is pertinent. Our study aimed to investigate this issue.

Method: Psychiatrists working in palliative care in Australia were individually interviewed using a semistructured approach. Nine participants were interviewed to reach data saturation. Interview transcripts were analyzed for themes.

Results: Three overarching themes were identified: (1) depression means different things; (2) depression is conceptualized using different models; and (3) depression is the same concept within and outside of the palliative care setting. Participants explicitly articulated the heterogeneous nature of depression and described a different breadths of concepts, ranging from a narrow construct of a depressive illness to a broader one that encompassed depressive symptoms and emotions. However, depressive illness was a consistent concept, and participants considered this in terms of phenotypic subtypes. Participants used three models (spectral, dichotomous, and mixed) to relate various depressive presentations.

Significance Of Results: Psychiatrists did not subscribe to a unitary model of depression but understood it as a heterogeneous concept comprised of depressive illness and other less clearly defined depressive presentations. Given the influence of psychiatric opinion in the area of depression, these findings may serve as a platform for further discussions to refine the concepts of depression in the palliative care setting, which in turn may improve diagnostic and treatment outcomes.
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http://dx.doi.org/10.1017/S1478951514001187DOI Listing
October 2015
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