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The prevalence of common mental disorders has not declined in high-income countries despite substantial increases in service provision. A possible reason for this lack of improvement is that greater willingness to disclose mental disorders might have led to increased reporting of psychiatric symptoms, thus masking reductions in prevalence. This masking hypothesis was tested using data from two trials of interventions that increased willingness to disclose and that also measured symptoms. Both interventions involved Mental Health First Aid (MHFA) training, which is known to reduce stigma, including unwillingness to disclose a mental health problem.
A cross-lagged panel analysis was carried out on data from two large Australian randomised controlled trials of MHFA training. The first trial involved 1643 high school students in Year 10 (mean age 15.87 years), who were randomised to receive either teen MHFA training or physical first aid training as the control. The second trial involved 608 Australia public servants who were randomised to receive either eLearning MHFA, blended eLearning MHFA or eLearning physical first aid as the control. In both trials, willingness to disclose a mental disorder as described in vignettes and psychiatric symptoms (K6 scale) were measured pre-training, post-training and at 12-month follow-up.
Both trials found that MHFA training increased willingness to disclose. However, a cross-lagged panel analysis showed no effect of this change on psychiatric symptom scores.
Greater willingness to disclose did not affect psychiatric symptom scores. Because the trials increased willingness to disclose through a randomly assigned intervention, they provide a strong causal test of the masking hypothesis. It is therefore unlikely that changes in willingness to disclose are masking reductions in prevalence in the population.
Introduction: September 2017 saw the launch of the British Columbia (BC) Emergency Medicine Network (EM Network), an innovative clinical network established to improve emergency care across the province. The intent of the EM Network is to support the delivery of evidence-informed, patient-centered care in all 108 Emergency Departments and Diagnostic & Treatment Centres in BC. After one year, the Network undertook a formative evaluation to guide its growth. Our objective is to describe the evaluation approach and early findings. Methods: The EM Network was evaluated on three levels: member demographics, online engagement and member perceptions of value and progress. For member demographics and online engagement, data were captured from member registration information on the Network's website, Google Analytics and Twitter Analytics. Membership feedback was sought through an online survey using a social network analysis tool, PARTNER (Program to Analyze, Record, and Track Networks to Enhance Relationships), and semi-structured individual interviews. This framework was developed based on literature recommendations in collaboration with Network members, including patient representatives. Results: There are currently 622 EM Network members from an eligible denominator of approximately 1400 physicians (44%). Seventy-three percent of the Emergency Departments and Diagnostic and Treatment Centres in BC currently have Network members, and since launch, the EM Network website has been accessed by 11,154 unique IP addresses. Online discussion forum use is low but growing, and Twitter following is high. There are currently 550 Twitter followers and an average of 27 ‘mentions’ of the Network by Twitter users per month. Member feedback through the survey and individual interviews indicates that the Network is respected and credible, but many remain unaware of its purpose and offerings. Conclusion: Our findings underscore that early evaluation is useful to identify development needs, and for the Network this includes increasing awareness and online dialogue. However, our results must be interpreted cautiously in such a young Network, and thus, we intend to re-evaluate regularly. Specific action recommendations from this baseline evaluation include: increasing face-to-face visits of targeted communities; maintaining or accelerating communication strategies to increase engagement; and providing new techniques that encourage member contributions in order to grow and improve content.
Invasive rodents detrimentally affect native bird species on many islands worldwide, and rodent eradication is a useful tool to safeguard endemic and threatened species. However, especially on tropical islands, rodent eradications can fail for various reasons, and it is unclear whether the temporary reduction of a rodent population during an unsuccessful eradication operation has beneficial effects on native birds. Here we examine the response of four endemic land bird species on subtropical Henderson Island in the Pitcairn Island Group, South Pacific Ocean, following an unsuccessful rodent eradication in 2011. We conducted point counts at 25 sampling locations in 14 survey periods between 2011 and 2015, and modelled the abundance trends of all species using binomial mixture models accounting for observer and environmental variation in detection probability. Henderson Reed Warbler Acrocephalus taiti more than doubled in abundance (2015 population estimate: 7,194-28,776), and Henderson Fruit Dove Ptilinopus insularis increased slightly between 2011 and 2015 (2015 population estimate: 4,476–10,072), while we detected no change in abundance of the Henderson Lorikeet Vini stepheni (2015 population estimate: 554–3014). Henderson Crake Zapornia atra increased to pre-eradication levels following anticipated mortality during the operation (2015 population estimate: 4,960–20,783). A temporary reduction of rat predation pressure and rat competition for fruit may have benefitted the reed warbler and the fruit dove, respectively. However, a long drought may have naturally suppressed bird populations prior to the rat eradication operation in 2011, potentially confounding the effects of temporary rat reduction and natural recovery. We therefore cannot unequivocally ascribe the population recovery to the temporary reduction of the rat population. We encourage robust monitoring of island biodiversity both before and after any management operation to better understand responses of endemic species to failed or successful operations.
Little is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration.
Randomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates.
Thirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p < 0.001) compared with control conditions. None of the examined participant- and study-level moderators were significantly associated with deterioration rates.
Self-guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.
Insomnia treatment using an internet-based cognitive–behavioural therapy
for insomnia (CBT-I) program reduces depression symptoms, anxiety
symptoms and suicidal ideation. However, the speed, longevity and
consistency of these effects are unknown.
To test the following: whether the efficacy of online CBT-I was sustained
over 18 months; how rapidly the effects of CBT-I emerged; evidence for
distinct trajectories of change in depressive symptoms; and predictors of
A randomised controlled trial compared the 6-week Sleep Healthy Using the
Internet (SHUTi) CBT-I program to an attention control program. Adults
(N=1149) with clinical insomnia and subclinical
depression symptoms were recruited online from the Australian
Depression, anxiety and insomnia decreased significantly by week 4 of the
intervention period and remained significantly lower relative to control
for >18 months (between-group Cohen's d=0.63, 0.47,
0.55, respectively, at 18 months). Effects on suicidal ideation were only
short term. Two depression trajectories were identified using growth
mixture models: improving (95%) and stable/deteriorating (5%) symptoms.
More severe baseline depression, younger age and limited comfort with the
internet were associated with reduced odds of improvement.
Online CBT-I produced rapid and long-term symptom reduction in people
with subclinical depressive symptoms, although the initial effect on
suicidal ideation was not sustained.
The interaction of the barotropic tide with a tall, two-dimensional ridge is examined analytically and numerically at latitudes where the tide is subinertial, and contrasted to when the tide is superinertial. When the tide is subinertial, the energy density associated with the response grows with latitude as both the oscillatory along-ridge flow and near-ridge isopycnal displacement become large. Where
, nonlinear processes lead to the formation of along-ridge jets, which become faster at high latitudes. Dissipation and mixing is larger, and peaks later in the tidal cycle when the tide is subinertial compared with when the tide is superinertial. Mixing occurs mainly on the flanks of the topography in both cases, though a superinertial tide may additionally generate mixing above topography arising from convective breaking of radiating waves.
We locate the micro-foundations of social order in the cultural meanings of institutional identities and roles, the daily enactment of which ensures social order through the continual reproduction and legitimation of social institutions. Following discussion of a general conceptual model, we discuss two complementary, micro-level explanations of social order: a cognitive approach combining a classic micro-sociological theory of institutions with a recent method for analyzing the causal structures of social actions in institutional settings; and an affective approach based on affect control theory. We then present two analyses illustrating specific sectors of our conceptual model. The first deals with cognitive meanings, showing how social institutions are present as associative structures within individuals’ minds, enabling them to define situations in institutional contexts. The second demonstrates how the evaluation, potency, and activity dimensions of affective meaning employed by affect control theory correspond to the structure of interdependence relations as represented in game matrices.
In the augmented symbolic interactionist perspective that we present here, human activities are stimulated and maintained by cognitive and affective meanings, and change emerges as new human activities evolve or are consciously designed in ways that instigate new meanings. This symbolic interactionism is “augmented” in that it incorporates affective meanings along with cognitive meanings, and it allows for multiple kinds of human activities, from various kinds of thought to individual behavior to coordinated group actions.
In this framework, cognitive experiences of successive generations accumulate as practical knowledge (Berger and Luckmann 1966), while emotional experiences accumulate as cultural sentiments (Heise 2007; MacKinnon and Heise 2010). Through socialization, individuals internalize both kinds of cultural meaning; and by employing practical knowledge and cultural sentiments to guide and motivate their interpersonal activities, they ensure the continual reproduction of the organized activities that embody society.
Social order is the outcome of complex, reciprocal relations among cultural and social processes at different levels of analysis, as portrayed in Figure 9.1, from MacKinnon and Heise's 2010 book. MacKinnon and Heise used this figure to explain the construction and interplay of selves and social institutions, but a lot of conceptual territory was left unanalyzed in their presentation. In this chapter, we employ Figure 9.1 as a theoretical scaffold for explaining selected aspects of social order.
Children and youth have tended to be under-reported in the historical scholarship. This collection of essays recasts the historical narrative by populating premodern Scottish communities from the thirteenth to the late eighteenth centuries with their lively experiences and voices. By examining medieval and early modern Scottish communities through the lens of age, the collection counters traditional assumptions that young people are peripheral to our understanding of the political, economic, and social contexts of the premodern era. The topics addressed fall into three main sections: theexperience of being a child/adolescent; representations of the young; and the construction of the next generation. The individual essays examine the experience of the young at all levels of society, including princes and princesses, aristocratic and gentry youth, urban young people, rural children, and those who came to Scotland as slaves; they draw on evidence from art, personal correspondence, material culture, song, legal and government records, work and marriage contracts, and literature.
Janay Nugent is an Associate Professor of History and a founding member of the Institute for Child and Youth Studies at the University of Lethbridge, Alberta, Canada; Elizabeth Ewan is University Research Chair and Professor of History and Scottish Studies at the Centre for Scottish Studies, University of Guelph, Ontario, Canada.
Contributors: Katie Barclay, Stuart Campbell, Mairi Cowan, Sarah Dunnigan, Elizabeth Ewan, Anne Frater, Dolly MacKinnon, Cynthia J. Neville, Janay Nugent, Heather Parker, Jamie Reid Baxter, Cathryn R. Spence, Laura E. Walkling, Nel Whiting.
It is well known that web-based interventions can be effective treatments for depression. However, dropout rates in web-based interventions are typically high, especially in self-guided web-based interventions. Rigorous empirical evidence regarding factors influencing dropout in self-guided web-based interventions is lacking due to small study sample sizes. In this paper we examined predictors of dropout in an individual patient data meta-analysis to gain a better understanding of who may benefit from these interventions.
A comprehensive literature search for all randomized controlled trials (RCTs) of psychotherapy for adults with depression from 2006 to January 2013 was conducted. Next, we approached authors to collect the primary data of the selected studies. Predictors of dropout, such as socio-demographic, clinical, and intervention characteristics were examined.
Data from 2705 participants across ten RCTs of self-guided web-based interventions for depression were analysed. The multivariate analysis indicated that male gender [relative risk (RR) 1.08], lower educational level (primary education, RR 1.26) and co-morbid anxiety symptoms (RR 1.18) significantly increased the risk of dropping out, while for every additional 4 years of age, the risk of dropping out significantly decreased (RR 0.94).
Dropout can be predicted by several variables and is not randomly distributed. This knowledge may inform tailoring of online self-help interventions to prevent dropout in identified groups at risk.
Distinguishing bipolar disorder (BP) from major depressive disorder (MDD) has important relevance for prognosis and treatment. Prior studies have identified clinical features that differ between these two diseases but have been limited by heterogeneity and lack of replication. We sought to identify depression-related features that distinguish BP from MDD in large samples with replication.
Using a large, opportunistically ascertained collection of subjects with BP and MDD we selected 34 depression-related clinical features to test across the diagnostic categories in an initial discovery dataset consisting of 1228 subjects (386 BPI, 158 BPII and 684 MDD). Features significantly associated with BP were tested in an independent sample of 1000 BPI cases and 1000 MDD cases for classifying ability in receiver operating characteristic (ROC) analysis.
Seven clinical features showed significant association with BPI compared with MDD: delusions, psychomotor retardation, incapacitation, greater number of mixed symptoms, greater number of episodes, shorter episode length, and a history of experiencing a high after depression treatment. ROC analyses of a model including these seven factors showed significant evidence for discrimination between BPI and MDD in an independent dataset (area under the curve = 0.83). Only two features (number of mixed symptoms, and feeling high after an antidepressant) showed an association with BPII versus MDD.
Our study suggests that clinical features distinguishing depression in BPI versus MDD have important classification potential for clinical practice, and should also be incorporated as ‘baseline’ features in the evaluation of novel diagnostic biomarkers.