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Tully, Phillip
- PublicationThe anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity risk in coronary heart diseaseObjective: 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.
- PublicationTreating Depression and Anxiety Disorders Simultaneously in Patients With Cardiovascular Diseases Utilizing the Unified Protocol
This chapter elaborates on the treatment of depression and anxiety disorders simultaneously in patients with cardiovascular diseases (CVDs) using the Unified Protocol (UP). Persons with CVDs alongside depression or anxiety have a heightened risk for death and disability, poor quality of life, and significantly higher costs for medical care. The UP provides a coherent conceptual and pragmatic approach to treating emotional disorders that are highly prevalent in CVD populations. Anxiety disorders remain largely neglected by randomized control trials due to procedural challenges in applying traditional cognitive–behavioral therapy (CBT) exposure therapies to CVD patients. Thus, the UP delivers immense benefits and a novel approach to patients with CVDs and comorbid emotional disorders.
- PublicationReintegrating young offenders into the community through discharge planning: a review of interventions and needs of youth in secure care
The health status of young offenders is often poorer than similar aged non-offenders. Addressing young offender needs is a key priority for their rehabilitation and reintegration into the community. The objectives were to identify programs and interventions that assist detained youth through focussed discharge planning by a systematic review of the literature. In addition, this review examined the identified health needs of young offenders in secure care. Our systematic review searched electronic databases using the keyword terms youth, secure care, health assessment and primary health care. Keyword browser terms were also entered as search strings, and only literature from 1997 onwards was retained. Twenty-two pieces of published literature were retained, and these documented the needs and service utilisation of young offenders. Mental health problems and trauma exposure were commonly identified in the literature, as was general physical health deficits and social and familial problems. Retrieved articles also made recommendations for health assessments and discharge planning, and some provided discharge planning models. Young offenders have diverse needs that can be ascertained from quality assessment measures. Effective discharge planning is important to attend to ongoing health issues and aid rehabilitation and reintegration into the community. By administering a comprehensive multidimensional screening measure upon admission to secure care, individualised care plans can be formulated with discharge planning measures. Recommendations for further study include the development and implementation of a needs assessment tool in youth secure-care facilities that complements the existing assessments and helps reintegrate young offenders to primary health care and community services.
- PublicationHoarding to the heart's content: a case series and detailed case report of hoarding treatment in heart failureHoarding disorder (HD) is characterized by an accumulation of possessions due to excessive acquisition of, or difficulty discarding possessions. Evidence demonstrates an increased cardiovascular response in patients with HD. Cognitive-behavioral therapy modifications are described for HD patients with heart failure to compensate for fatigability, syncope and falls risk.
- PublicationA Community Mental Health Integrated Disaster Preparedness Intervention for Bushfire Recovery in Rural Australian Communities: Protocol for a Multimethods Feasibility and Acceptability Pilot Study(JMIR Publications, Inc, 2024-06-04)
; ; ; ; ;Welton-Mitchell, Courtney; ; ; Background: Natural hazards are increasing in frequency and intensity due to climate change. Many of these natural disasters cannot be prevented; what may be reduced is the extent of the risk and negative impact on people and property. Research indicates that the 2019-2020 bushfires in Australia (also known as the “Black Summer Bushfires”) resulted in significant psychological distress among Australians both directly and indirectly exposed to the fires. Previous intervention research suggests that communities impacted by natural hazards (eg, earthquakes, hurricanes, and floods) can benefit from interventions that integrate mental health and social support components within disaster preparedness frameworks. Research suggests that disaster-affected communities often prefer the support of community leaders, local services, and preexisting relationships over external supports, highlighting that community-based interventions, where knowledge stays within the local community, are highly beneficial. The Community-Based Disaster Mental Health Intervention (CBDMHI) is an evidence-based approach that aims to increase disaster preparedness, resilience, social cohesion, and social support (disaster-related help-seeking), and decrease mental health symptoms, such as depression and anxiety.
Objective: This research aims to gain insight into rural Australian’s recovery needs post natural hazards, and to enhance community resilience in advance of future fires. Specifically, this research aims to adapt the CBDMHI for the rural Australian context and for bushfires and second, to assess the acceptability and feasibility of the adapted CBDMHI in a rural Australian community.
Methods: Phase 1 consists of qualitative interviews (individual or dyads) with members of the target bushfire-affected rural community. Analysis of these data will include identifying themes related to disaster preparedness, social cohesion, and mental health, which will inform the adaptation. An initial consultation phase is a key component of the adaptation process and, therefore, phase 2 will involve additional discussion with key stakeholders and members of the community to further guide adaptation of the CBDMHI to specific community needs, building on phase 1 inputs. Phase 3 includes identifying and training local community leaders in the adapted intervention. Following this, leaders will co-deliver the intervention. The acceptability and feasibility of the adapted CBDMHI within the community will be evaluated by questionnaires and semistructured interviews. Effectiveness will be evaluated by quantifying psychological distress, resilience, community cohesion, psychological preparedness, and help-seeking intentions.
Results: This study has received institutional review board approval and commenced phase 1 recruitment in October 2022.
Conclusions: The study will identify if the adapted CBDMHI is viable and acceptable within a village in the Northern Tablelands of New South Wales, Australia. These findings will inform future scale-up in the broader rural Australian context. If this intervention is well received, the CBDMHI may be valuable for future disaster recovery and preparedness efforts in rural Australia. These findings may inform future scale-up in the broader rural Australian context.
- PublicationDepression in elderly patients with hearing loss: current perspectives(Dove Medical Press Ltd, 2019-08-14)
; ;Helmer, Catherine ;Delcourt, Cecile ;Robins, Tamara GHearing 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. - PublicationLive long and PROSPERO: A comment on Chiu and coworkers
The a priori registration of systematic reviews provides a way to describe the methods for a meta-analysis before Review Paper selection commences. Chiu and coworkers report a systematic review of blood pressure variability, deviating from the protocol registered on PROSPERO (CRD42020190429).
- PublicationPsychosocial perspectives in cardiovascular disease(SAGE Publications Inc, 2017-06-01)
;Pedersen, Susanne S ;von Känel, Roland; Denollet, JohanAdaptation to living with cardiovascular disease may differ from patient to patient and is influenced not only by disease severity and limitations incurred by the disease but also by socioeconomic factors (e.g. health literacy), the patients' psychological make-up and susceptibility to distress. Co-morbid depression and/or anxiety is prevalent in 20% of patients with cardiovascular disease, which may be either transient or chronic. Distress, such as depression, reduces adherence, serves as a barrier to behaviour change and the adoption of a healthy lifestyle, and increases the risk that patients drop out of cardiac rehabilitation, impacting on patients' quality of life, risk of hospitalisation and mortality. Hence it is paramount to identify this subset of high-risk patients in clinical practice. This review provides a general overview of the prevalence of selected psychosocial risk factors, their impact on patient-reported and clinical outcomes, and biological and behavioural mechanisms that may explain the association between psychosocial factors and health outcomes. The review also provides recommendations on which self-report screening measures to use to identify patients at high risk due to their psychosocial profile, and the effectiveness of available trials that target these risk factors. Despite challenges and barriers associated with screening of patients combined with appropriate treatment, it is paramount that we treat not only the heart but also the mind in order to improve the quality of care and patient and clinical outcomes. - Publication“All I have to do is pass”: A discursive analysis of student athletes' talk about prioritising sport to the detriment of education to overcome stressors encountered in combining elite sport and tertiary educationObjectives: 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.
- PublicationA dynamic view of comorbid depression and generalized anxiety disorder symptom change in chronic heart failure: The discrete effects of cognitive behavioral therapy, exercise, and psychotropic medication
Purpose: No previous study has reported upon comorbid depression and anxiety disorders and their treatment in heart failure (HF), which the current study has sought to document. Materials and methods: Total 29 HF patients under psychiatric management underwent primary depression cognitive behavioral therapy (CBT; n = 15) or primary generalized anxiety disorder (GAD) CBT (n = 14), and participated in a community exercise program and standard physician care. Repeated measures analysis of variance assessed Patient Health Questionnaire (PHQ-9) and GAD-7 symptom change pre- and post-CBT treatment, and assessed the interaction effects of treatment type, exercise, anti-depressant and anxiolytic. Results: There was a significant time and treatment interaction effect that favored the primary GAD CBT group for reduction in PHQ symptoms (F(1, 24) = 4.52, p = 0.04). Analysis of PHQ-somatic symptoms also showed a significant main effect for participation in the exercise program (F(1, 24) = 4.21, p = 0.05) and a significant time and anxiolytic interaction (F(1, 24) = 3.98, p = 0.05). The average number of cardiac hospital readmissions favored the primary GAD CBT group (p = 0.05). Conclusion: The findings support the use of multifaceted interventions in the rehabilitation of HF patients with comorbid psychiatric needs.