Smoking prevalence among Indigenous Australians far exceeds that of non-Indigenous Australians and is considered the greatest contributor to burden of disease for Indigenous Australians. The Quitline is a primary intervention for facilitating smoking cessation and, given the health implications of tobacco use, maximising its effectiveness for Indigenous Australians is imperative. However, the utilisation and effectiveness of this service within the Indigenous Australian population has not been examined. This study explores the utilisation of the South Australian Quitline by smokers identifying as Indigenous Australian. Quitline counsellors collected data regarding demographic characteristics, and smoking and quitting behaviour from Quitline callers in 2010. Results indicated that the proportion of Indigenous and non-Indigenous smokers who registered for the service was comparable. Demographic variables and smoking addiction at time of registration with the Quitline were similar for Indigenous and non-Indigenous callers. However, results indicated that Indigenous callers received significantly fewer callbacks than non-Indigenous callers and were significantly less likely to set a quit date. Significantly fewer Indigenous callers reported that they were still successfully quit at 3 months. Thus, Indigenous Australian callers may be less engaged with the Quitline and further research is required exploring whether the service could be tailored to make it more engaging for Indigenous Australians who smoke.

Objective: To (1) report the prognostic association between anxiety disorder subtypes and major adverse cardiac events (MACE), (2) report anxiety disorder prevalence in coronary heart disease (CHD), and (3) report the efficacy of anxiety disorder treatments in CHD. Methods: A comprehensive electronic database search was performed in November 2013 for studies reporting anxiety disorder prevalence according to structured interview in CHD samples or MACE, and randomized controlled trials (RCTs) comparing anxiety disorder treatment with placebo or usual care. From 4041 articles 42 samples were selected for extraction (8 for MACE prognosis, 39 for prevalence, no RCTs were eligible). Results: Five generalized anxiety disorder (GAD) studies reported 883 MACE events (combined n = 2851). There was a non-significant association between GAD and MACE (risk ratio = 1.20, 95% CI .86-1.68, P = .28) however the effect size was highly significant in outpatient samples (adjusted hazard ratio = 1.94, 95% CI 1.45-2.60, P < .001). No other anxiety disorder subtype was associated with MACE. Prevalence data showed high comorbidity with depression (49.06%; 95% CI 34.28-64.01) and substantial heterogeneity between studies. Panic disorder prevalence was higher in psychiatrist/psychologist raters (9.92% vs. 4.74%) as was GAD (18.45% vs. 13.01%). Panic and GAD estimates were also heterogeneous according to DSM-III-R versus DSM-IV taxonomies. Conclusions: The paucity of extant anxiety disorder RCTs, alongside MACE risk for GAD outpatients, should stimulate further anxiety disorder intervention in CHD populations. Research should focus on depression and anxiety, thereby unraveling disorder specific and more generic pathways.

Motherhood and participation in elite sport have traditionally been viewed as at odds with each other. However, mothers competing at the pinnacle of sport are becoming more common. Despite such trends, motherhood often remains invisible and taboo within the sphere of elite sport and little research has addressed athletes who are mothers. In order to explore popular accounts of motherhood and elite sport, we examined 326 media reports of the case of Keli Lane, an Australian water polo player who was convicted of murdering her infant in order to pursue her sporting goals. We draw on a social constructionist and critical approach to discursive analysis in order to explore repeated patterns of constructions of athlete identity and motherhood. We argue that within these media accounts, the identities of ‘elite athlete’ and ‘mother’ were depicted as mutually exclusive. Moreover, the role of the broader context of elite sporting culture and organisations in influencing the combination of motherhood and elite sport participation was rendered invisible within these accounts. The implications for female athletes, especially mothers, are discussed.

Hearing loss (HL) is highly common in older adulthood, constituting the third most prevalent chronic health condition in this population. In addition to posing a substantial burden to disease and negatively impacting quality of life, an emerging literature highlights that HL is associated with unipolar depression including among older adults. This review outlines evidence examining the HL and depression relationship as well as clinical implications for assessment and treatment of comorbid depression and HL. Although prevalence estimates of comorbid depression in HL vary, as many as 1 in 5 experience clinically relevant depression symptoms. Both cross-sectional and longitudinal studies indicate that HL is related to increased unipolar depression symptoms, although the strength of the association varies between studies. A range of methodological variations, such as inclusion age, severity of HL and assessment of depression, likely underpin this heterogeneity. Overall, however, the evidence clearly points to an association of HL with clinically relevant depression symptoms. The association with the diagnosis of major depression disorder remains less clear and under-researched. HL is also associated with a range of other poor mental health outcomes in older adults, including anxiety and suicidal ideation, and predicts poorer cognitive functioning. Accordingly, assessment and treatment of comorbid depression in HL is pertinent to promote mental well-being among older adults. Currently, evidence regarding best practice for treating depression in HL remains scant. Preliminary evidence indicates that audiological rehabilitation, including use of hearing aids, as well as community-based hearing interventions can also improve mental health. Psychological intervention that enhances communication skills and addresses coping strategies might also be beneficial for this population. Additionally, evidence suggests that online interventions are feasible and may circumvent communication difficulties in therapy associated with HL. Due to poor help-seeking among this population, an enhanced focus on specific and targeted assessment and treatment is likely necessary to ensure reduced mental health burden among older adults with HL.

Extensive work has been conducted on constructions of the female body as risky, particularly in relation to reproduction (Martin, 1987; Rich, 1976; Ussher, 2006). In contrast, the male reproductive body generally remains invisible (Oudshoorn, 2004). The analysis presented in this paper explores debate in 285 online responses to an article about gender-based differential pricing of health insurance. One of the discursive strategies drawn upon to defend this differential pricing is through familiar constructions of women's bodies as at risk' due to reproductive potential. However, this justification for inequality is resisted within the corpus through explicitly rendering the male body as similarly 'at risk' of reproduction. By examining how both women's and men's reproductive bodies are made visible, this paper explores discursive practices around how gender inequality is (re)produced and resisted. In particular, we can see how rendering the male reproductive body visible works in this context to resist practices that disadvantage women relative to men, and expand the responsibility for reproduction beyond women and individual, to society as a whole.

Objective: The study explored relationships between preferences for and experiences of clinical decision making (CDM) with service use among persons with severe mental illness. Methods: Data from a prospective observational study in six European countries were examined. Associations of baseline staff-rated (N=213) and patient-rated (N=588) preferred and experienced decision making with service use were examined at baseline by using binomial regressions and at 12-month follow-up by using multilevel models. Results: A preference by patients and staff for active patient involvement in decision making, rather than shared or passive decision making, was associated with longer hospital admissions and higher costs at baseline and with increases in admissions over 12 months (p=.043). Low patient-rated satisfaction with an experienced clinical decision was also related to increased costs over the study period (p=.005). Conclusions: A preference for shared decision making may reduce health care costs by reducing inpatient admissions. Patient satisfaction with decisions was a predictor of costs, and clinicians should maximize patient satisfaction with CDM.

Objectives: Increasingly, athletes are expected to undertake tertiary education contemporaneously with their sporting careers. However, to do so may prove difficult and stressful. Exploration of the stressors encountered by student-athletes in combining the two pursuits is limited. There is also limited research examining whether combining the two pursuits impacts upon sporting or educational success. Design and method: A discursive psychological approach was employed, examining twenty interviews conducted with Australian athletes enrolled in tertiary education, exploring how athletes integrated sport and education. Results: Within the interviews, athletes constructed their primary academic goal as to ‘just pass’. Athletes repeatedly presented themselves as sacrificing educational success to integrate the two pursuits. Moreover, athletes constructed accounts of themselves as prioritising sport, but as passive in decision-making around priorities. In doing so, athletes produced accounts that removed their own agency for their sacrificed academic success. The interviewees also constructed time as a barrier to the successful integration of sport and education. In the dataset time was constructed either as fixed, limited and externally controlled, or as flexible and controllable. Conclusions: These alternate constructions allowed athletes to remove agency for poor educational outcomes, or conversely, enabled them to present themselves as successfully able to integrate sport and education. Thus, differing constructions of time were used to achieve different rhetorical ends. Implications and interventions for supporting student athletes successfully to combine sport and education are discussed.

Background: Previous psychological and pharmacological interventions have primarily focused on depression disorders in populations with cardiovascular diseases (CVDs) and the efficacy of anxiety disorder interventions is only more recently being explored. Transdiagnostic interventions address common emotional processes and the full range of anxiety and depression disorders often observed in populations with CVDs. The aim of CHAMPS is to evaluate the feasibility of a unified protocol (UP) for the transdiagnostic treatment of emotional disorders intervention in patients recently hospitalized for CVDs. The current study reports the protocol of a feasibility randomized controlled trial to inform a future trial.

Methods/Design: This is a feasibility randomized, controlled trial with a single-center design. A total of 50 participants will be block-randomized to either a UP intervention or enhanced usual care. Both groups will receive standard CVD care. The UP intervention consists of 1) enhancing motivation, readiness for change, and treatment engagement; (2) psychoeducation about emotions; (3) increasing present focused emotion awareness; (4) increasing cognitive flexibility; (5) identifying and preventing patterns of emotion avoidance and maladaptive emotion-driven behaviors (EDBs, including tobacco smoking, and alcohol use); (6) increasing tolerance of emotion-related physical sensations; (7) interoceptive and situation-based emotion-focused exposure; and (8) relapse prevention strategies. Treatment duration is 12 to 18 weeks. Relevant outcomes include the standard deviation of self-rated anxiety, depression and quality of life symptoms. Other outcomes include intervention acceptability, satisfaction with care, rates of EDBs, patient adherence, physical activity, cardiac and psychiatric readmissions. Parallel to the main trial, a nonrandomized comparator cohort will be recruited comprising 150 persons scoring below the predetermined depression and anxiety severity thresholds.

Discussion: CHAMPS is designed to evaluate the UP for the transdiagnostic treatment of emotional disorders targeting emotional disorder processes in a CVD population. The design will provide preliminary evidence of feasibility, attrition, and satisfaction with treatment to design a definitive trial. If the trial is feasible, it opens up the possibility for interventions to target broader emotional processes in the precarious population with CVD and emotional distress.

Background: The established relationship between vision impairment and depression is limited by the examination of depression only as a unidimensional construct. The present study explores the vision-depression relationship using a dimensional approach. Methods: 9036 participants aged 65 years and above enrolled in the Three-City study were included. Relationships between baseline near Vision Impairment (VI) or self-reported distance Visual Function (VF) loss with trajectory of four dimensions of depression – depressed affect, positive affect, somatic symptoms and interpersonal problems - over 12 years were examined using mixed-effects models. Depression dimensions were determined using the four-factor structure of the Centre for Epidemiology Studies-Depression Scale (CESD). Results: In the fully adjustment models, mild near VI predicted poorer depressed affect (b = 0.04, p = .002) and positive affect (b = −0.06, p < 0.001) over time, with evidence of longer term adjustment. Distance VF loss was associated with poorer depressed affect (b = 0.27, p ≤ .001), positive affect (b = −0.15, p = .002), and somatic symptoms (b = 0.18, p ≤ .001) at baseline, although only the association with depressed affect was significant longitudinally (b = 0.01, p = .001). Neither near VI nor distance VF loss was associated with interpersonal problems. Limitations: This paper uses a well-supported model of depression dimensions, however, there remains no definite depression dimension model. Distance VF loss was self-reported, which can be influenced by depression symptoms. Conclusions: Vision impairment in older adults is primarily associated with affective dimensions of depression. A reduction in social connectedness and ability to engage in pleasurable activities may underlie the depression-vision relationship. Older adults with vision impairment may benefit from targeted treatment of affective symptoms, and pleasant event scheduling.

Generalized anxiety disorder prevalence and comorbidity with depression in coronary heart disease patients remain unquantified. Systematic searching of Medline, Embase, SCOPUS and PsycINFO databases revealed 1025 unique citations. Aggregate generalized anxiety disorder prevalence (12 studies, N = 3485) was 10.94 per cent (95% confidence interval: 7.8-13.99) and 13.52 per cent (95% confidence interval: 8.39-18.66) employing Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria (random effects). Lifetime generalized anxiety disorder prevalence was 25.80 per cent (95% confidence interval: 20.84-30.77). In seven studies, modest correlation was evident between generalized anxiety disorder and depression, Fisher’s Z = .30 (95% confidence interval: .19-.42), suggesting that each psychiatric disorder is best conceptualized as contributing unique variance to coronary heart disease prognosis.