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Existing studies on language learner emotions mainly focus on Foreign Language Anxiety (FLA) and Foreign Language Enjoyment (FLE). They are primarily conducted in offline learning settings. This paper reports the empirical findings of an exploratory investigation conducted in a fully synchronous online learning environment for "ab initio" Korean. Through an Achievement Emotions Questionnaire administered to 117 students in an Australian university, this study measures learners' pride as well as their enjoyment and anxiety during four teaching weeks. In addition, this paper examines how learner emotions correlate with academic achievement as well as crucial learner and teacher variables. The study confirms many patterns of learner emotions in offline teaching environments, such as the association of positive emotions with positive outcomes and with some teacher characteristics, and the association of anxiety with negative outcomes. However, it also reveals patterns that appear to be new, warranting further empirical studies. The pedagogical implications of results for L2 teaching and learning are also discussed.

This quasi-experimental research design surveyed 688 students through a self-administered online survey to specifically explore relations between student self-assessed capabilities (Lizzio Five Senses, 2006), overall program satisfaction, withdrawal behaviours, demographics and year of study in their university courses during an emergency COVID-19 lockdown experience. Importantly, this research offers a more nuanced view of the "Five Senses" and confirms their importance as a university strategy for student success. These findings offer further granularity into the complex set of relations that impact decisions around satisfaction, persistence, and capability in higher education and support previous research by Lizzio and Wilson (2008) indicating students' perceptions of "purpose" is the strongest predictor of satisfaction, lower anxiety and lower course withdrawal. Ultimately, the paper suggests as higher education looks towards future possible disruptions due to climate, health or political realities, equipping and fostering a strong sense of purpose, connectedness, and resourcefulness as well as sense of capability and academic culture will buffer and support students to persevere. In addition, this research suggests that those students who may have weak associations with these senses merit additional attention.

This paper reports on a study that replaced marks with digital badges in an undergraduate Initial Teacher Education course. The aim was to examine the impact of badging on students, and on the quality of university provision. Data collection consisted of surveys and focus groups. The study found that while digital badges had considerable potential to improve the student experience in terms of engagement with feedback, motivation and reducing 'grade anxiety', delaying the awarding of marks caused significant student anxiety. The effect on university provision was more positive, and digital badges promoted constructive alignment between university-based assessment tasks and external professional standards frameworks. The student findings pointed to an underlying tension associated with implementing student-centred, outcomes-based assessment methods in contexts designed to accommodate traditional high-stakes assessment. Five recommendations for future practice were made: (1) Remove marks altogether where digital badges are used; (2) Do not substitute written feedback with digital badges; (3) Developing a badge framework is important for both students and staff; (4) Inform students about what to expect; (5) Develop a 'Badge Tree'.

Purpose: Work-integrated learning (WIL) is an integral part of hospitality curriculums in Australia. Experiencing stress during WIL is expected, as students try to balance work and other responsibilities. Previous studies have usually examined the negative impact of stress on individuals. By referring to relevant theories, this paper argues the positive impact of stress and reports on a study which aimed to investigate whether stress -- experienced by students during WIL -- leads to resilience and well-being. Design/methodology/approach: Hospitality students from different backgrounds enrolled at a tertiary institution completed an online survey. This study uses structural equation modelling (SEM), to test the proposed links between stress, resilience and well-being. Findings: The study results show that "academic pressure" (mean score = 3.57) is the most common stressor identified by hospitality students. This was followed by stress caused by "time pressure" (mean score = 3.01). Model testing reveals that experiencing "career development concerns" has a statistically significant association with resilience. Moreover, there is a strong link ([Beta] = 0.624) between resilience and well-being. Originality/value: This study makes a contribution by proposing positive outcomes related to stress during WIL. A handful of studies have looked at similar concepts. However, this paper uses statistical techniques to measure and analyse relationships between different variables. By running an SEM, the authors were able to test a linear causal relationship which identifies stressors leading to a significant impact on resilience. Similarly, the strength of relationship between resilience and well-being is also empirically tested.

Purpose: From 2018, the Schools Up North (SUN) programme worked with three remote Australian schools to enhance their capability and resilience to support the wellbeing and mental health of Aboriginal and Torres Strait Islander students and staff. This paper explores the implementation of SUN during the first two years of COVID-19 (2020-2021). Method: Using grounded theory methods, school staff, other service providers and SUN facilitators were interviewed, with transcripts and programme documents coded and interrelationships between codes identified. An implementation model was developed. Results: The SUN approach was place-based, locally informed and relational, fostering school resilience through staff reflection on and response to emerging contextual challenges. Challenges were the: community lockdowns and school closures; (un)availability of other services; community uncertainty and anxiety; school staff capability and wellbeing; and risk of educational slippage. SUN strategies were: enhancing teachers' capabilities and resources, facilitating public health discussions, and advocating at regional level. Outcomes were: enhanced capability of school staff; greater school-community engagement; student belonging and engagement; a voice for advocacy; and continuity of SUN's momentum. Conclusions: The resilience approach (rather than specific strategies) was critical for building schools' capabilities for promoting students and staff wellbeing and provides an exemplar for remote schools globally.

Inclusive policies in early childhood classrooms have in recent decades become mainstream [UNESCO. 1994. "The UNESCO Salamanca statement and framework for action on special educational needs." Paris: UNESCO]. Inclusive practices however are far from ideal [Slee, R. 2013. "How do we make inclusive education happen when exclusion is a political predisposition?" "International Journal of Inclusive Education" 17 (8): 895-907; Grace, R, G. Llewellyn, N. Wedgwood, M. Fenech, and D. McConnell. 2008. "Far From Ideal: Everyday Experiences of Mothers and Early Childhood Professionals Negotiating an Inclusive Early Childhood Experience in the Australian Context." "Topics in Early Childhood Special Education" 28 (1): 18-31] and although children with disabilities are often welcomed into early childhood classrooms, the dominant discourses that circulate continue to position them as different and as Other [Watson, K. 2017. "Inside the 'inclusive' early childhood classroom: The power of the 'normal'." New York: Peter Lang]. To build on our understanding of contemporary inclusive practices, an awareness of the complexities of the knowledge that informs practice is central. Some appreciation of the contribution made by historical discourses to the contemporary construction of disability in the classroom is necessary [Barnes, C. 2014. "A brief history of discrimination and disabled people." http://repositoriocdpd.net:8080/bitstream/handle/123456789/495/CL_BarnesC_BriefHistoryDiscrimination_1991.pdf?sequence = 1]. This ethnographic research, employing observation and conversations among children, brings into focus how remnants from the past affect everyday encounters in the classroom as deeply embedded fears and anxieties continue to circulate around disability. Seldom made visible, rarely talked about or openly challenged, bygone relics permeate the way educators and children position children with a disability as a comparison to the norm, hindering inclusivity. This paper aims to bring into focus how fear affects the way disability is positioned in our early childhood classrooms, fear that leads to exclusions, separation, and Othering. Recognition of the past and scrutiny of the fear that lingers provides some promise for inclusive practice.

In December 2019, the Organisation for Economic Co-operation and Development released the latest results of its triennial Programme for International Student Assessment (PISA) testing. What followed was a flurry of media reports in the participant countries about the 2018 PISA results that were interpretive rather than descriptive. Whilst there is a considerable body of literature describing PISA's impact on education policies, there are fewer studies that examine how PISA data is presented to the public by the media and how this contributes to the construction of policy truths. As part of a broader study of policy landscapes in the Asia Pacific region, this paper provides a critical analysis of the mediatisation of the 2018 PISA results in Australia and Singapore. It will be demonstrated that in Australia, much of the reporting was characterised by panic, whereas in Singapore the reporting was much more measured, exhibiting a stoicism. Drawing on a corpus of articles published in Australian and Singaporean newspapers in December 2019, and informed by the work of Michel Foucault, the analysis will make visible how dominant discourses used by the media operated as regimes of truth to advance neoliberal imperatives.

This paper explores existing evidence on indicators of risk to the mental health status of Chinese students studying in Australian universities prior to the COVID-19 pandemic. Studies published from January 1999 to January 2020 were considered. Findings indicated that Chinese students routinely report increased levels of fear, stress, anxiety, depression and social problems, as well as decreased levels of general well-being, while studying in Australia. Numerous factors may exacerbate the issues confronted by Chinese university students studying in Australia, including language barriers; social, academic and financial difficulties; challenges associated with the different education systems of the two countries; and their own underuse of available mental health services. Recommendations for further practice and research are presented based on these findings.

Anonymous student evaluation of teaching (SET) is a universal practice in higher education. We conducted a mixed-methods approach to investigate the nature and impact of anonymous SET commentary in the Australian higher education sector. Respondents shared a range of detailed SET exemplars, which revealed the extent of hurtful, defamatory and abusive commentary made by students. This paper reports the self-perceived impact of these on the health and wellbeing of academics. The majority of respondents reported that anonymous narrative comments contributed to workplace stress. There were no significant differences for gender. Younger academics were more likely to report the process of SET as stressful. Four themes were identified from the narrative responses: stress, distress, disorder and coping. These themes highlight the mental distress and impacts on well-being from repeated exposure to uncivil commentary made in SET by students. This distress was exacerbated by the failure of many employing universities to take substantial action to remedy or limit exposure to uncivil behaviour. The current system of anonymous SET has little validity and instead may operate as a vehicle for unfettered incivility directed towards teaching staff. The mental health impacts are significant for some and may impact the recruitment, retention and renewal of academic teaching staff into the future.

Background: Anxiety and depressive disorders typically emerge in adolescence and can be chronic and disabling if not identified and treated early. School-based universal mental health screening may identify young people in need of mental health support and facilitate access to treatment. However, few studies have assessed the potential harms of this approach. This paper examines some of the potential mental health-related harms associated with the universal screening of anxiety and depression administered in Australian secondary schools. Methods: A total of 1802 adolescent students from 22 secondary schools in New South Wales, Australia, were cluster randomised (at the school level) to receive either an intensive screening procedure (intervention) or a light touch screening procedure (control). Participants in the intensive screening condition received supervised self-report web-based screening questionnaires for anxiety, depression and suicidality with the follow-up care matched to their symptom severity. Participants in the light touch condition received unsupervised web-based screening for anxiety and depression only, followed by generalised advice on help-seeking. No other care was provided in this condition. Study outcomes included the increased risk of anxiety, depression, psychological distress, decreased risk of help-seeking, increased risk of mental health stigma, determined from measures assessed at baseline, 6 weeks post-baseline, and 12 weeks post-baseline. Differences between groups were analysed using mixed effect models. Results: Participants in the intensive screening group were not adversely affected when compared to the light touch screening condition across a range of potential harms. Rather, participants in the intensive screening group were found to have a decreased risk of inhibited help-seeking behaviour compared to the light touch screening condition. Conclusions: The intensive screening procedure did not appear to adversely impact adolescents' mental health relative to the light touch procedure. Future studies should examine other school-based approaches that may be more effective and efficient than universal screening for reducing mental health burden among students. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12618001539224) https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375821. [ABSTRACT FROM AUTHOR]

Skydivers are required to interpret person-context characteristics to overcome inherent internal challenges (i.e., fear and anxiety) and external challenges (i.e., equipment malfunctions) to successfully perform. Research suggests that as skydiving experience increases, skydivers' self-confidence in their actions increases, while their perception of risk and anxiety decreases. However, there is a lack of research investigating the influence of experience and considerations of performance in extreme sports. This study examined the influence of skydiving experience on the interpretation of risk perception, anxiety and self-confidence. Participants comprised 503 experienced Australian skydivers (M age  = 40.10, SD age  = 12.40; 79.5 % male). Using a mixed methods approach, skydivers completed measures of risk perceptions, anxiety, and self-confidence related to skydiving, as well as open-ended questions on their skydiving experiences. The findings indicated that increases in jumping experience led to greater self-confidence, and self-confidence mediated the relationship between all elements of jumping experience and cognitive and somatic anxiety associated with skydiving. Thematic analysis reinforced that skydivers understood the inherent risks associated with skydiving, and that skydivers adopted positive strategies that promoted self-confidence and mastery to perform successfully, while also managing their interpretations of risk and associated anxiety that potentially exists. Further research is needed to better understand the interpretation of person-context situations in extreme sports and recognize the important affordances for performance., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This case study evaluated the effects of a health package (HP) of a light intensity individualised exercise program and advice on anxiety management and nutrition, on the physical and mental health of people with or without COVID-19, who were quarantined in hotels used as Special Health Accommodation and admitted to the Royal Prince Alfred Virtual Hospital, Sydney during the COVID-19 pandemic. After initial screening and consenting, participants completed three surveys: Depression, Anxiety, Stress Scale; Brief Fatigue Inventory; and the European Quality of Life 5-Dimensions 5-Levels, and were provided with the HP for the duration of their quarantine. The three surveys and a participant reported experience measure were completed prior to discharge. The HP for people in quarantine demonstrated stability of health outcomes and reduction in fatigue. Most participants reported that the HP helped them cope with isolation. Provision of a HP during quarantine could be useful to support physical and mental health. What is known about the topic? Quarantine during the COVID-19 pandemic could negatively impact physical and mental health. What does this paper add? A health package of light intensity exercise, advice on anxiety management and nutritional information demonstrated maintenance of physical and mental health and reduced fatigue in people with and without mild COVID-19 in hotel quarantine. What are the implications for practitioners? Practitioners should consider providing a health package of exercise, anxiety management and nutritional information to help people in quarantine to cope with the physical and mental isolation. Adequate staffing is required to enable implementation. [ABSTRACT FROM AUTHOR]

Summary: The quality of the helping relationship is experienced when theories and principles are enacted in practice. Here, the people social workers seek to serve are able to decide whether the practice they experience is useful. One way that social workers can enhance the quality of the relationships they develop is to 'start where the person is at'. In order to explore what this phrase means in and for effective social work practice, this paper revisits Martin Buber's articulation of the I/thou relationship seeking to shed light on the notion of personhood in this value-based profession. Two participants, within a larger research project exploring the experiences of social workers in the Australian child welfare field, independently used the language of personhood to refer to the way they conceptualised the process of engaging with people. Both were referring to enacting the transcendent value of each person in terms of a practice philosophy. These personal narratives inspired the authors to move away from the usual professional discourse about the skills involved in relationship building and instead reflect on their own practice in order to capture something philosophical about caring relational processes. Revisiting humanistic conceptualisations of the helping relationship such as the I/thou has the potential to discourage practitioners from seeing relationships as transactional. This has particular significance in practice contexts characterised as risk-averse, austere or involuntary, and/or where people may be feeling anxious, stressed and/or simply unheard. Contemporary implications for social work practice are discussed. [ABSTRACT FROM AUTHOR]

Objectives: To identify and synthesize existing research on the effectiveness and feasibility of multiform humor therapy on people suffering from depression or anxiety, with the hope of benefiting future research., Methods: An integrative literature review of quantitative, qualitative, and mixed studies was performed. The PubMed, Cochrane Library, Web of Science, Embase, and CINAHL databases were searched up to March 2022. Two independent reviewers conducted each stage of the review process, by assessing eligibility using preferred reporting items for systematic review and meta-analyses (PRISMA) and quality appraisal using the Mixed Methods Appraisal Tool, and data extraction., Results: In this integrative review, 29 papers were included, containing 2964 participants across a diverse range of studies, including quantitative, qualitative, and mixed methods. The articles were from the United States, Australia, Italy, Turkey, South Korea, Iran, Israel, China, and Germany. The findings indicated that most of the subjects thought humor therapy was effective in improving depression and anxiety while a few participants considered the effect insignificant. However, more high-quality studies will be needed to confirm these conclusions., Discussion: This review collated and summarized findings from studies examining the impact of humor therapy (medical clowns, laughter therapy/yoga) on people with depression or anxiety, including children undergoing surgery or anesthesia, older people in nursing homes, patients with Parkinson's disease, cancer, mental illness, and undergoing dialysis, retired women, and college students. The results from this review may help inform future research, policy, and practice in humor therapy to improve people's symptoms of depression and anxiety., Impact: This systematic review objectively evaluated the effect of humor therapy on depression and anxiety. As a simple and feasible complementary alternative therapy, humor therapy may provide a favorable alternative for clinicians, nurses, and patients in the future., (© 2023 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Despite an increasing number of studies demonstrating the potential mental health benefits of greenspace, few longitudinal studies have been reported. We aimed to assess associations between two metrics of residential greenspace exposure and anxiety symptoms in a cohort of Australian women living in major cities. Our study comprised 3,938 women, born between 1973 and 78. Anxiety symptoms in the previous month were assessed at follow-up every three years during 2003-2018, using the anxiety subscale of the Goldberg Anxiety and Depression Scale. The three-month seasonal average normalized difference vegetation index (NDVI) was estimated from 30 m Landsat satellite images in a 500 m buffer (NDVI 500m ) around participants' address at each survey (higher NDVI indicates more green vegetation). The annual fractional cover of non-photosynthesising vegetation was estimated (fNPV 500m , with higher values indicating greater levels of dead leaf litter or dry grass). A generalised estimating equation assessed associations between greenspace measures and anxiety symptoms (as odds ratios [ORs]), adjusting for repeated outcomes and individual-level covariates. Additional analyses focused on women experiencing substantial changes in between-survey exposure due to moving, and adjusting for nitrogen dioxide (NO 2 ) and fine particulate matter (PM 2.5 ) exposure, among others. A standard deviation (SD) (0.12 units) increase in NDVI 500m was significantly associated with lower odds of anxiety symptoms (OR: 0.96, 95% CI: 0.93-0.99) in the adjusted model. An SD (5.2%) increase in annual fNPV 500m was consistent with the direction expected for that exposure, but not significant in the adjusted model (OR: 1.03, 95% CI: 0.99-1.07). NDVI 500m was modestly attenuated when air pollutants were adjusted for, while fNPV 500m only became significant when PM 2.5 was adjusted for. Between-survey contrasts had no clear effect for NDVI 500m . Moving to a higher fNPV 500m area, compared with a similar fNPV 500m area, was consistently associated with anxiety symptoms (OR: 1.15, 95% CI: 1.02-1.31). NDVI 500m was generally associated with lower odds of anxiety symptoms, while fNPV 500m was generally associated with higher odds of anxiety, depending on the covariates considered., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Historically, once the baby was born, the mother and baby were separated shortly after birth into a postnatal ward and a baby nursery. Overtime, with advances in neonatology led to an increasing number of neonates being separated from their mothers at birth for specialised neonatal care if they required additional needs. As more research has been undertaken there is an increasing focus that mothers and babies should be kept together from birth, termed couplet care. Couplet care refers to keeping the mother and baby together. Despite this evidence, in practice, this is not happening. Aim: to examine the barriers to nurses and midwives providing couplet care of the infant requiring additional needs in postnatal and nursery. Methods: A thorough literature review relies on a well-developed search strategy. This resulted in a total of 20 papers that were included in this review. Results: This review revealed five main themes or barriers to nurses and midwives providing couplet care: models of care, systems and other barriers, safety, resistance, and education. Discussion: Resistance to couplet care was discussed as being caused by feelings of lack of confidence and competence, concerns around maternal and infant safety and an under-recognition of the benefits of couplet care. Conclusion: The conclusion is that there is still a paucity of research in relation to nursing and midwifery barriers to couplet care. Although this review discusses barriers to couplet care, more specific original research on what nurses and midwives themselves perceive to be the barriers to couplet care in Australia is needed. The recommendation is therefore to undertake research into this area and interview nurses and midwives to ascertain their perspectives. [ABSTRACT FROM AUTHOR]

Many countries, including Australia, have laws that enable criminal prosecution of an individual based on reckless or intentional transmission of HIV to another person. Previous research has suggested that criminalisation of HIV may serve to hamper public health efforts by inhibiting HIV status disclosure or testing. Limited research to date has sought to examine the broader impact of criminalisation on the health and wellbeing of people living with HIV, which this paper aims to address. Drawing on cross-sectional data from 895 people living with HIV in Australia, this paper describes associations between standard measures of mental health and resilience with a newly devised scale measuring anxiety about HIV criminalisation. Findings suggest that laws criminalising HIV transmission have a broadly negative impact on wellbeing of people living with HIV, a situation that is exacerbated for gay and bisexual men, and other people living with HIV who may face intersecting forms of marginalisation based on race, gender or class. There is little justification for these laws being applied in Australia and the findings add weight to advocacy seeking to overturn criminalisation across the world. [ABSTRACT FROM AUTHOR]

Background: The United Kingdom IAPT (Improving Access to Psychological Therapies) approach of delivering low intensity therapies for symptoms of depression and anxiety was adapted for Australia and named NewAccess. Clinical outcomes of the service were evaluated in three sites between October 2013 and 2016., Aims: This paper describes the clinical outcomes in the Australian health setting., Methods: Prospective cohort study with repeated measures. Both intent-to-treat and per protocol analyses were conducted for primary outcomes measures Patient Health Questionnaire-9 (nine item), and Generalised Anxiety Disorder (seven item). Secondary measures were Phobia Scale and Work and Social Adjustment Scale., Results: Three thousand nine hundred and forty-six individuals were assessed, and 3269 attended at least two treatment sessions. Forty percent were males. There was a clinically meaningful reduction (improvement) shown by reliable recovery rates in both depression and anxiety symptoms at post-treatment assessment (68%; 95% CI: 66-70%) with large effect sizes (1.23 for depression and 1.25 for anxiety). Outcomes in PHQ-9 and GAD-7 were not influenced by age or sex, but recovery rates were significantly reduced by relationship status (single or separated). Unemployment reduced PHQ-9 outcomes but not GAD-7 outcomes., Conclusion: NewAccess demonstrated positive clinical outcomes in Australia, that compared favourably with international studies with the same methodology.

Background: Implementation strategies are crucial to facilitate implementation success. To prepare and support implementation of a clinical pathway for screening, assessment and management of anxiety and depression in cancer patients (the ADAPT CP), six broad categories of implementation strategies; (1) Awareness campaigns, (2) Champions, (3) Education, (4) Academic Detailing and Support, (5) Reporting, (6) Technological Support, were developed. The aim of this paper is to describe the fidelity and acceptability of six categories of implementation strategies and any subsequent changes/adaptations made to those strategies. Methods: The ADAPT CP was implemented in twelve cancer services in NSW, Australia, as part of a cluster randomised controlled trial of core versus enhanced implementation strategies. Fidelity to and any subsequent changes to the delivery of the planned six categories of implementation strategies were captured using the ADAPT contact log, which recorded the contacts made between the ADAPT research team and services, engagement meetings and monthly meetings. To explore acceptability and awareness/engagement with the implementation strategies, interviews with a purposively selected staff sample across both study arms were held prior to implementation (T0), six months into implementation (T1) and at the end of the 12-month implementation period (T2). Interviews were thematically analysed across the six categories of strategies. Results: Delivery of all six categories of implementation strategies as planned was moderated by service context and resources and staff engagement. As such, for some implementation strategies, subsequent changes or adaptations to the content, mode of delivery, frequency and duration such as abbreviated training sessions, were made to optimise fidelity to and engagement with the strategies. Most strategies were perceived to be acceptable by service staff. Use of strategies prior to implementation of the ADAPT CP such as the engagement meetings and training sessions, positively impacted on ownership and preparedness to implement the ADAPT CP. Furthermore, ongoing support such as provision of additional training or monthly meetings facilitated increased awareness and engagement with the ADAPT program. Conclusion: Flexibility in delivering implementation strategies, and ensuring staff engagement with, and acceptability of those strategies, can support implementation of interventions within healthcare settings. Trial registration: The ADAPT CRCT was registered prospectively with the ANZCTR on 22/3/2017. Trial ID ACTRN12617000411347. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372486&isReview=true [ABSTRACT FROM AUTHOR]

Purpose: From 2018, the Schools Up North (SUN) programme worked with three remote Australian schools to enhance their capability and resilience to support the wellbeing and mental health of Aboriginal and Torres Strait Islander students and staff. This paper explores the implementation of SUN during the first two years of COVID-19 (2020–2021). Method: Using grounded theory methods, school staff, other service providers and SUN facilitators were interviewed, with transcripts and programme documents coded and interrelationships between codes identified. An implementation model was developed. Results: The SUN approach was place-based, locally informed and relational, fostering school resilience through staff reflection on and response to emerging contextual challenges. Challenges were the: community lockdowns and school closures; (un)availability of other services; community uncertainty and anxiety; school staff capability and wellbeing; and risk of educational slippage. SUN strategies were: enhancing teachers' capabilities and resources, facilitating public health discussions, and advocating at regional level. Outcomes were: enhanced capability of school staff; greater school-community engagement; student belonging and engagement; a voice for advocacy; and continuity of SUN's momentum. Conclusions: The resilience approach (rather than specific strategies) was critical for building schools' capabilities for promoting students and staff wellbeing and provides an exemplar for remote schools globally. [ABSTRACT FROM AUTHOR]

Background: Research suggests that some speech–language pathologists are uncomfortable treating people who stutter. Accessing quality clinical education experiences in stuttering is difficult given the ongoing rise in students enrolled in speech–language pathology programmes and the limited number of stuttering‐specific placements available. Simulation‐based learning is a viable option for providing speech–language pathology students with practical experience in a safe learning environment. Whilst research has found that simulation‐based learning experiences in stuttering assist in the development of students' clinical skills, students' perceptions of participating in stuttering simulation‐based learning are yet to be explored. Aims: To investigate speech–language pathology students' comfort, anxiety, knowledge and confidence in the management of stuttering at the commencement of an academic stuttering course and before and following participation in a stuttering simulation‐based learning programme. Methods & Procedures: This study used a cross‐sectional survey design. Participants were 105 undergraduate and graduate entry masters speech–language pathology students enrolled at an Australian university. Students engaged in a stuttering simulation‐based learning programme embedded within an existing academic course on the management of stuttering. A purposefully developed survey was administered at three time points: pre‐course (T1), pre‐simulation (T2) and post‐simulation (T3) in order to explore students' comfort and anxiety levels, and perceptions of their knowledge and confidence in stuttering management. Descriptive statistics were used to report the medians and range of students' responses. Changes across all time points and between each of the time points were determined using the Friedman test and the Wilcoxon signed rank test, respectively. Outcomes & Results: Statistically significant differences (p < 0.001) were observed on all matched survey items (n = 96) across all time points. Between each time point, a significant difference in students' perceived knowledge levels was found with small to large effect sizes. However, there was no difference in students' perceived comfort and anxiety levels between the time points of pre‐course and pre‐simulation. Open‐ended responses on the post‐simulation survey revealed that students valued learning about stuttering within a simulation‐based learning environment. Conclusions & Implications: Simulation‐based learning experience in stuttering management was valued by students. When accompanied by theoretical content, participation in a stuttering simulation‐based learning programme supported students to feel more comfortable and less anxious about working with people who stutter. This finding has implications for the development of clinical skills in the assessment and treatment of adults who stutter. WHAT THIS PAPER ADDS: What is already known on this subject: Simulation is a teaching approach used within speech–language pathology to support the development of students' clinical skills. Simulation provides a safe learning environment for students, an opportunity for repeated practice and is valued by students. What this paper adds to existing knowledge: This study explored students' perceptions of their comfort, anxiety, knowledge and confidence in working with people who stutter before and following participation in a simulation‐based learning programme. It describes a stuttering simulation‐based learning programme that can be embedded into speech–language pathology programme curricula. What are the potential or actual clinical implications of this work?: The stuttering simulation‐based learning programme detailed in this study can be applied and embedded in speech–language pathology curricula. It can be used to support the development of students' confidence in the assessment and management of stuttering. [ABSTRACT FROM AUTHOR]

Objective: To describe self-reported general and psychological health for allied health practitioners at an Australian acute public health service over three time points within the coronavirus disease 2019 (COVID-19) pandemic. Methods: This study collected data from cross-sectional online surveys at three time points: May–June 2020 (T 1), October–November 2020 (T 2) and November–December 2021 (T 3). The self-report questionnaire consisted of demographic questions, a general health question and the 21-item version of the Depression Anxiety Stress Scales (DASS-21). Results: A total of 308 responses were received (T 1 n = 135, T 2 n = 78, T 3 n = 95) from representatives of eight allied health professions. The proportion of allied health practitioners reporting poor general health significantly increased over time, as did mean scores on all DASS-21 sub-scales. General health status was also significantly associated with DASS-21 subscale scores. Anxiety scores increased significantly between T 1 and T 2, while depression scores increased significantly between T 2 and T 3. Significant increases in stress scores were recorded across all time intervals. Between T 1 and T 3, the proportion of allied health practitioners reporting moderate, severe, or extremely severe symptoms increased for depression (10.3–30.9%), anxiety (5.2–18.2%) and stress (13.3–36.3%). Conclusion: The general and psychological health of allied health practitioners appears to be worsening as the COVID-19 pandemic continues. Organisational strategies to support the health of the allied health workforce in acute care settings must address the cumulative effects of prolonged pressure on their general and psychosocial health. Support strategies need to be responsive to changes in psychological wellbeing at different phases of the pandemic. What is known about the topic? Many cross-sectional studies report poor psychosocial wellbeing during the COVID-19 pandemic. What does this paper add? Here we provide evidence about the long-term and declining general and psychological health status of Australian allied health practitioners during the COVID-19 pandemic. What are the implications for practitioners? The psychological wellbeing of allied health practitioners has declined as the COVID-19 pandemic continues. There is an urgent need for initiatives targeting allied health practitioners that support their wellbeing and ongoing ability to provide high quality patient care. [ABSTRACT FROM AUTHOR]

Background: The prevalence of language disorder in youth offenders far exceeds rates reported in community samples. Youth involved in the justice system are also at increased risk of a range of psychiatric disorders, including internalizing mental health problems (i.e., anxiety, depression). However, the frequency with which these co‐occur in this population is not known. Understanding the co‐occurrence of language disorder with anxiety and depression in youth offenders may contribute to more coordinated and targeted support for these vulnerable youth. Aims: To explore the co‐occurrence of language disorder and anxiety and depression in youth offenders. Methods & Procedures: A systematic literature search of six databases (CINAHL, ERIC, Medline, PyscINFO, PubMED, Scopus) was conducted (September 2021) using key search terms relevant to the systematic review question. Study inclusion criteria were: (1) original research published in English; (2) youth up to 21 years of age involved in the justice system; and (3) reported outcomes on language and anxiety and/or depression. All included studies were appraised using the Joanna Briggs Critical Appraisal tool checklist relevant to study design. Due to the heterogeneity of included studies, data synthesis was narrative. Main Contribution: Eight studies met the eligibility criteria. A range of measures was used to assess language abilities across samples. Only two studies directly addressed the relationship between language disorder and internalizing mental health problems; both found no significant correlation. Conclusions & Implications: Although the results did not support a significant relationship between language disorder and internalizing mental health problems in youth offenders, the two appear to occur comorbidly as evidenced by heightened rates of both in the included samples. This review highlights the need for more robust studies aimed to better understand this relationship. Stronger evidence may contribute to increased collaborative speech pathology and psychology services which might increase youth offenders' accessibility and engagement in intervention programmes (e.g., cognitive–behaviour therapy; interpersonal skills training; individual counselling). WHAT THIS PAPER ADDS: What is already known on this subject: The markedly high rates of language disorder in youth involved in the justice system have been widely reported. It is also known that externalizing mental health problems often bring youth in contact with the justice system. Though there is some information about the prevalence of internalizing mental health problems in this population, the co‐occurrence of language disorder and internalizing mental health problems has not been examined as widely. What this study adds to existing knowledge: This study aimed to identify the frequency of co‐occurrence of language disorder and anxiety and/or depression in youth offenders. Although the results did not support a significant relationship between language disorder and internalizing mental health problems in this population, results of the review provide evidence of heightened rates of both. This study also provides a summary of the various measures used to assess language and internalizing mental health in youth offenders across the eight studies included in this review. What are the potential or actual clinical implications of this work?: It is possible that the tests and sub‐tests used to identify language disorders and internalizing mental health problems were not sensitive enough to identify the full extent of youth offenders' needs. Identifying the presence of language disorders and internalizing mental health problems and recognizing the impact these may have on the communication and behaviours of an individual can better inform staff and therapists as they engage and interact with youth in the justice system. [ABSTRACT FROM AUTHOR]

Introduction: Quality of life (QoL), mental wellbeing, and physical function are often diminished among people with chronic disease. Tai Chi is a moderate form of exercise that may be effective in improving chronic disease management. This protocol paper outlines a trial to determine the therapeutic effects of a Tai Chi program on chronic disease management. Methods and analysis: This study will be a pilot, interventional, single-blind, two-armed, randomised, parallel, and controlled trial involving a 12-week Tai Chi program for Australian adults. Forty people aged 18 years and older, diagnosed with one or more chronic disease from general community will be recruited. All participants will be randomised to either a 12-week Tai Chi program or a waiting list control group. The Tai Chi program will involve 12 weeks of group Tai Chi sessions, with 45 minutes per session, twice a week. The primary outcome will be QoL as measured by mean scores on the 12-item Short Form Health Survey (SF-12v2) and the EuroQoL (EQ-5D). The secondary outcomes will include anxiety as measured by mean score on the generalised anxiety disorder 7 (GAD-7) survey; depression as measured by mean score on the patient health questionnaire (PHQ-9); work productivity and activity assessment (WPAI:SHP); pain (if any) as measured by mean scores on the visual analogue scale (VAS) and the McGill pain questionnaire (MPQ). These primary and secondary outcomes will be self-administered via two online assessments prior to (T0) and post-intervention (T1). Objective measures as additional secondary outcomes, will also be carried out by the research team including flexibility as measured by the finger to floor distance (FFD); obesity as measured by mean scores on body mass index (BMI); vital signs (blood pressure, heart rate, respiratory rate, temperate, and oxygen saturation) as measured by a blood pressure monitor, tympanic, and pulse oximetry device, and these outcomes will be measured at T0 and T1 in the ECU Holistic Health Research Clinic. People diagnosed with pre-diabetes or diabetes, their glycosylated haemoglobin (HbA1C) and fasting (before breakfast) blood glucose level (BGL) will also be measured via test kits at T0 and T1 in the clinic. Linear mixed modelling will be conducted to assess changes in outcomes. Statistical significance will be set at an alpha level of 0.05 with a medium effect size. All analyses will be conducted using R version 4.1. Qualitative data will be analysed using template thematic analysis. Ethics and dissemination: Ethical approval has been obtained from the Edith Cowan University (ECU) Human Research Ethics Committee (2021-03042-WANG). Research findings will be disseminated to the public, health professionals, researchers, and healthcare providers through conference presentations, lay summaries, and peer-reviewed publications. This study will provide an updated evidence on a safe, sustainable, and inexpensive non-pharmacological approach in the management of chronic disease, the number one burden of disease in Australia. Trial registration: Trial registration number:ACTRN12622000042741p. [ABSTRACT FROM AUTHOR]

This paper examines whether adolescents can be reliably categorized into subgroups based on their patterns of anxiety levels over time and whether low levels of social support from parents, peers, and their school, and high levels of peer victimization, predict a pattern of increasing anxiety. Participants were 3392 youth from the Longitudinal Study of Australia's Children (LSAC). Youth-reported anxiety was measured at three occasions at ages 12/13 years, 14/15 years, and 16/17 years, with social support and victimization assessed at age 12/13 years. Anxiety trajectories were identified using latent class growth mixture modelling, and predictors of class membership were examined using multinomial logistic regression analyses. Three discrete classes of anxiety trajectories were identified. Most youth fell within a stable-low anxiety symptom class (89.5% males; 78.2% females), with smaller percentages in low-increasing (5.6% males; 14.4% females) or high-decreasing (4.9% males; 7.4% females) classes. Low support from parents and teachers, low sense of school belonging, and high peer victimization predicted membership of the low-increasing anxiety trajectory class, irrespective of gender. Social support did not moderate the effect of peer victimization upon the risk of developing anxiety, with peer victimization remaining a risk factor even when adolescents experienced good social support from parents, peers, and school. The findings highlight the need for screening in early adolescence to identify those who are experiencing low social support and high peer victimization and are thus at increased risk of developing anxiety problems. These youth could then be offered targeted intervention to reduce the likelihood of anxiety development. [ABSTRACT FROM AUTHOR]

Australians were subject to a series of COVID-19 lockdown restrictions throughout 2020. Although accessing medical care was allowable, concerns were raised that people were avoiding healthcare services. We explored young Australians' reasons for delaying seeking sexual and reproductive health (SRH) care during the pandemic, using data from two cross-sectional surveys. The surveys included a question asking whether respondents had delayed accessing care during the pandemic. Free-text responses from young Australians (aged 18–29 years) were analysed using conventional content analysis. In all, 1058 under-30s completed a survey, with 262 (24.8%) reporting they had delayed seeking SRH care. Of these, 228 (87.0%) respondents provided a free-text comment. Participants who commented were predominantly female (86.4%) and had a median age of 23 years (interquartile range 20–26 years). Most commonly, respondents delayed testing for sexually transmissible infections, cervical cancer screening, and contraceptive care. Some delayed accessing care despite experiencing symptoms. Participants avoided seeking care due to concerns about contracting COVID-19, uncertainty about accessing care during restrictions and anxiety relating to accessing SRH care. Although some reported a reduced need for SRH care, others required but did not access care. Young people should be reassured that SRH issues are a valid reason to access services, especially when experiencing symptoms. Concerns about people delaying accessing healthcare services were raised early in the COVID-19 pandemic. This paper explores young people's perspectives on decisions to delay accessing care for their sexual and reproductive health, finding that although decreased sexual activity resulted in reduced need for care for some, others avoided seeking care despite experiencing symptoms or concerns about their health. Young people should be assured that their sexual and reproductive health remains a priority, even during a pandemic. [ABSTRACT FROM AUTHOR]

This paper will explore the clinical application of tracking sequences in family therapy with a particular focus on Bowen family systems theory. It considers how sequences can be used to track the emotional process occurring in relationship interactions, and the similarities and differences of a Bowen theory‐informed approach compared with dialectical behaviour therapy and both classic and contemporary family therapy models. Case examples are utilised from the author's clinical practice to raise ideas about the therapist joining the client as a co‐researcher in this exercise and facilitating a process that helps assist the client develop their own self‐awareness and problem‐solving resources in the context of their relationships. [ABSTRACT FROM AUTHOR]

Background: Optimal strategies to facilitate implementation of evidence-based clinical pathways are unclear. We evaluated two implementation strategies (Core versus Enhanced) to facilitate implementation of a clinical pathway for the management of anxiety and depression in cancer patients (the ADAPT CP). Methods: Twelve cancer services in NSW Australia were cluster randomised, stratified by service size, to the Core versus Enhanced implementation strategy. Each strategy was in place for 12 months, facilitating uptake of the ADAPT CP (the intervention being implemented). The Core strategy included a lead team with champions, staff training and awareness campaigns prior to implementation, plus access to feedback reports and telephone or online support during implementation. The Enhanced strategy included all Core supports plus monthly lead team meetings, and proactive, ongoing advice on managing barriers, staff training and awareness campaigns throughout implementation. All patients at participating sites were offered the ADAPT CP as part of routine care, and if agreeable, completed screening measures. They were allocated a severity step for anxiety/depression from one (minimal) to five (severe) and recommended management appropriate to their severity step. Multi-level mixed-effect regression analyses examined the effect of Core versus Enhanced implementation strategy on adherence to the ADAPT CP (binary primary outcome: adherent ≥ 70% of key ADAPT CP components achieved versus non-adherent < 70%), with continuous adherence as a secondary outcome. Interaction between study arm and anxiety/depression severity step was also explored. Results: Of 1280 registered patients, 696 (54%) completed at least one screening. As patients were encouraged to re-screen, there were in total 1323 screening events (883 in Core and 440 in Enhanced services). The main effect of implementation strategy on adherence was non-significant in both binary and continuous analyses. Anxiety/depression step was significant, with adherence being higher for step 1 than for other steps (p = 0.001, OR = 0.05, 95% CI 0.02–0.10). The interaction between study arm and anxiety/depression step was significant (p = 0.02) in the continuous adherence analysis only: adherence was significantly higher (by 7.6% points (95% CI 0.08–15.1%) for step 3 in the Enhanced arm (p =.048) and trending to significance for step 4. Discussion: These results support ongoing implementation effort for the first year of implementation to ensure successful uptake of new clinical pathways in over-burdened clinical services. Trial registration: ANZCTR Registration: ACTRN12617000411347 (Trial registered 22/03/2017; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372486&isReview=true) [ABSTRACT FROM AUTHOR]

Objective: COVID-19 has led to disruptions to the lives of Australian families through social distancing, school closures, a temporary move to home-based online learning, and effective lockdown. Understanding the effects on child and adolescent mental health is important to inform policies to support communities as they continue to face the pandemic and future crises. This paper sought to report on mental health symptoms in Australian children and adolescents during the initial stages of the pandemic (May to November 2020) and to examine their association with child/family characteristics and exposure to the broad COVID-19 environment. Methods: An online baseline survey was completed by 1327 parents and carers of Australian children aged 4 to 17 years. Parents/carers reported on their child's mental health using five measures, including emotional symptoms, conduct problems, hyperactivity/inattention, anxiety symptoms and depressive symptoms. Child/family characteristics and COVID-related variables were measured. Results: Overall, 30.5%, 26.3% and 9.5% of our sample scored in the high to very high range for emotional symptoms, conduct problems and hyperactivity/inattention, respectively. Similarly, 20.2% and 20.4% of our sample scored in the clinical range for anxiety symptoms and depressive symptoms, respectively. A child's pre-existing mental health diagnosis, neurodevelopmental condition and chronic illness significantly predicted parent-reported child and adolescent mental health symptoms. Parental mental health symptoms, having a close contact with COVID-19 and applying for government financial assistance during COVID-19, were significantly associated with child and adolescent mental health symptoms. Conclusion: Our findings show that Australian children and adolescents experienced considerable levels of mental health symptoms during the initial phase of COVID-19. This highlights the need for targeted and effective support for affected youth, particularly for those with pre-existing vulnerabilities. [ABSTRACT FROM AUTHOR]

Written, invigilated examinations are valued for their reliability, economy and academic integrity. Nevertheless, examinations are problematic. Final, summative examinations can disadvantage students who experience assessment anxiety, and students may not receive useable feedback. An alternative is the two-stage examination, where a traditional examination is followed by a group examination with similar questions. Students gain peer feedback on their examination performance, and can meaningfully apply this feedback. Use of this format in tertiary STEM education in universities has indicated that students prefer the format, although it has been little studied in Australia. Furthermore, its effects on reducing stress and fostering deeper learning are not well understood. The COVID-19 pandemic and switch to online learning has provided us with an opportunity to review our assessment practices and has led to a new willingness to test different examination formats. Here we provide a narrative review of the results of previous studies on two-stage examinations and, based on this and our experience teaching in large-cohort introductory biology courses at an Australian university, we propose a formula for employing them in this context. [ABSTRACT FROM AUTHOR]

This paper examines the reasons why many people are reticent about travelling in a COVID-adapted world. It reports on a study of residents of Southeast Queensland, Australia conducted in mid-2022, up to six months after borders reopened after a prolonged COVID-19 shutdown. About one quarter of respondents were less interested in travel in a COVID-adapted world than they were before the pandemic struck. They were a diverse group whose reasons for their reticence could be categorised into four broad risk groups of: ongoing anxiety; fear of catching the disease; satisfaction risk, and; travel risk as reflected by an overall loss of interest in travel. Each group displayed different COVID-adapted travel patterns that reflect the operationalisation of different risk categories. A follow-up survey conducted in August 2023 confirmed that up to one in four people still have less desire to travel as a result of COVID-19. [ABSTRACT FROM AUTHOR]

This study aimed to assess differences in emotion and elaboration quality between clinical and community child cohorts in both past reminiscing and future worry conversations. We analyzed 54 Australian parents (46 mothers, 8 fathers) and their 8- to 12-year-old children (M = 9.63, SD = 1.29; 28 boys, 26 girls) in reminiscing interactions. Dyads were recruited from local schools (community cohort, n = 26) or a children's psychology clinic waitlist (clinical cohort, n = 28). Clinical cohort children engaged in less emotion exploration in both past and future conversations, as did parents for future conversations. Elaboration quality did not differ. Parent-son dyads differed in the clinical cohort, exhibiting significantly lower emotion resolution than the community cohort, or parent-daughter dyads when discussing past events. These findings suggest that discussing anticipated negative events may be a relevant point of family-based intervention for anxious children. Additionally, this study highlights the importance of parent-son emotional discussion. [ABSTRACT FROM AUTHOR]

Objective: To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion. Design: We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study. Setting: Economically disadvantaged areas in rural Australia. Participants: Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status. Main measures: A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28). Results: Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57–0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00–1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02–2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14–2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18–0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion. Conclusions: Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes. [ABSTRACT FROM AUTHOR]

Many autistic adults are likely to experience poor financial wellbeing and hardship due to unemployment and under-employment. Research in the general population demonstrates that subjective financial wellbeing—how people perceive their financial situation—influences quality of life. There is no research, however, examining the subjective financial wellbeing of autistic people. This study therefore aimed to (1) understand the subjective financial wellbeing of a sample of autistic adults living in Australia compared to a general Australian population sample and (2) identify the predictors of subjective financial wellbeing in this sample of autistic adults. To this end, 191 autistic adults aged 18–83 years (mean = 39.28, standard deviation = 11.74) completed an online survey about their economic status, financial wellbeing, financial behaviors, confidence in money management skills, and anxiety and depression symptoms. Almost half of our sample felt it was a struggle to make ends meet, whereas only one-third of the general Australian population felt this way. Similar to the general population, autistic people's income and their financial behaviors (specifically, saving and not borrowing for everyday expenses) predicted their sense of financial wellbeing. Our findings have implications for both research and practice. Researchers have found the way people feel about their financial situation is related to their quality of life. We know that many autistic people find it hard to find a job. And for those autistic people who have a job, they are often underpaid. Not having a job or being underpaid often means having low income. Having low income is likely to influence how autistic people feel about their financial situation. However, no research has looked at these issues for autistic people. This is the first study that helps us learn more about what autistic adults think about their financial situation. We looked at autistic people's thoughts on this issue compared to people from the general Australian population. We also looked at what things might impact how autistic people feel about their financial situation—which might be how much money they earn, what they do with that money, and their mental health. Many autistic adults felt they were struggling with financial wellbeing and this was connected both to the level of their income and how they said they managed their money. Those who were able to save and not borrow for everyday expenses reported feeling a greater sense of financial wellbeing. Concrete changes might help to improve autistic people's financial wellbeing. We need to investigate how we can help autistic people find and keep well-paying jobs. And we need to work out the best ways of equipping autistic people with the skills they need in financial matters. [ABSTRACT FROM AUTHOR]

As tobacco smoking prevalence is unacceptably high for the one in five Australians reporting a mental health condition in the past year, multiple cessation supports are needed to reduce tobacco-related disease. Nicotine vaping product (NVP)-facilitated smoking cessation is one option requiring a medical prescription in Australia. Yet, people easily obtain NVPs via nonprescription channels. As mental health impacts quitting intentions and health system engagement, this study examined how presence of anxiety and depression symptoms may be associated with perceived health risk of using NVPs from prescription or non-prescription sources for smoking cessation. We used cross-sectional South Australian (15 years +) 2022 survey data on vaping, smoking, anxiety, and depression. Robust linear regression was used to examine the association of anxiety and depression symptoms and nicotine addiction concern on perceived health risk of using NVPs from prescription or nonprescription sources. For prescription NVPs, vaping was associated with lower perceived health risk (b=−0.732). Higher perceived addiction risk was associated with higher perceived health risk from prescription NVPs (b=0.784). For nonprescription NVPs, vaping (b=−0.661) or smoking (b=−0.310) was associated with lower perceived health risk, and higher perceived addiction risk (b=0.733) was associated with a higher perceived health risk. Although anxiety and depression were not directly associated with NVP health risk perceptions, vaping while having depression symptoms was associated with higher perceived health risk ratings for prescription (b=0.700) but not non-prescription sources. People with depression who vape may see health risk barriers in NVP prescription access for smoking cessation, a smoking cessation support gap. [ABSTRACT FROM AUTHOR]

INTRODUCTION The present study aims to investigate whether mothers from Culturally and Linguistically Diverse (CALD) backgrounds present with higher levels of demoralization in comparison with their non-minority counterparts, and to explore potential correlations between demoralization and anxiety as well as depression in the same sample of mothers. METHODS Women admitted to a public tertiary care teaching hospital were invited to participate in the study within 24-48 hours following delivery. The study compared women who did not regard English as their main spoken language to native English-speaking women. Women were asked to complete the demographic Kissane Demoralization Scale (KDS) and Being a Mother Scale (BaM-13) questionnaires. Participants were contacted by phone, 6 to 8 weeks after they had completed the KDS and the BaM-13 questionnaires, to complete an Edinburgh Postnatal Depression Scale (EPDS) and State Trait Anxiety Scale (STAI) questionnaires. RESULTS Mothers of CALD background presented with significantly higher scores on the KDS (p<0.001), STAI (p<0.001) and EPDS (p<0.001) scales in comparison with their non- CALD counterparts. Furthermore, when mothers were reassessed after 6 to 8 weeks, higher KDS scores in the postnatal period predicted significantly higher anxiety and depression scores, according to STAI (p<0.001) and the EPDS (p<0.001), respectively. CONCLUSIONS The results of this study reveal that, mothers of CALD background manifest higher levels of demoralization as well as anxiety and depression in the postpartum period when compared with their non-CALD counterparts. [ABSTRACT FROM AUTHOR]

Background: The Family Community-based Assistance Resourcing and Education Program (FCP) is a nurse home visiting program that was introduced in Queensland two decades ago to redress health inequalities for infants from families experiencing specific social stressors. Locally adapted versions of this home visiting program are still in use, but have not been evaluated. This study examined child health nurse perceptions of the adapted FCP in one regional Queensland health service. Methods: A qualitative descriptive exploratory study using two focus groups (conducted May 2019) with Child Health Nurses who delivered the FCP was conducted. Transcripts of digital recordings were analysed using Braun and Clarke's (2006) six-step framework for guided thematic analysis. Results: A total of 16 Child Health Nurses participated in the study, with a mean of 10 years' experience with the program. Data analysis generated 12 themes organised under three domains: 'Establishing the relationship with families', 'What works in practice' and 'We could do it better'. Participants cited flexibility, expert input and in-home delivery as key program benefits. However, narrow eligibility criteria, poor screening for perinatal anxiety and resourcing constraints were identified as limitations. Conclusions: This study is the first to measure Child Health Nurses' perceptions of an adapted FCP. It sheds light on their 'practice wisdom', including the program's ability to meet the needs of families with social vulnerabilities. The study supports prior calls for home visiting programs to be evaluated against clearly stated program intentions. Participant insights have been shared to inform practice and program implementation both locally and as part of Queensland's First 2000 Days health service delivery reform agenda. Home visiting programs can improve outcomes for infants and families at risk of suboptimal health and developmental outcomes. However, there is limited evidence regarding the efficacy of current programs in use in Queensland. This study analyses Child Health Nurse perceptions of one such program, with findings confirming the need for active monitoring of program outcomes against their stated objectives. [ABSTRACT FROM AUTHOR]

Barriers to healthcare experienced by Australian autistic adults have not been previously explored. We conducted a cross-sectional investigation of barriers to healthcare and associated factors from a subtle realism perspective. Perceived barriers to healthcare were obtained from the Barriers to Healthcare Checklist Short-Form (BHC). A total of 263 autistic and 70 non-autistic individuals completed the BHC. On average, autistic adults reported more barriers to healthcare (4.58) than non-autistic adults (0.76). Gender diversity, higher levels of generalised anxiety, greater global disability and less satisfaction with social support contributed to the experience of barriers to healthcare in autistic participants in regression modelling. Australian autistic adults face substantial barriers to healthcare. Understanding these barriers provides an opportunity to develop approaches to improve access; such as co-designing a healthcare access roadmap for autistic adults, with co-designed policies and practices which advocate for the needs of autistic adults. This study looked at how Australian autistic and non-autistic adults experience barriers to healthcare. We asked autistic and non-autistic adults to complete the Barriers to Healthcare Checklist Short-Form (BHC). We analysed data from 263 autistic adults and 70 non-autistic adults. We found that autistic adults experienced more barriers to healthcare than non-autistic adults. Gender diversity, feeling more anxious, having greater disability and feeling unsatisfied with social support contributed to barriers to healthcare in autistic participants. We recommend interventions such as developing and implementing a national action plan, similar to the National Roadmap for Improving the Health of People with Intellectual Disability (2021) to reduce barriers and address unmet healthcare needs of Australian autistic adults. We also recommend working with autistic adults to develop new policies and strategies, implementing environmental adaptations to health care facilities, and increasing Autism education opportunities for health professionals to address gaps in knowledge. [ABSTRACT FROM AUTHOR]

In studies that contain repeated measures of variables, longitudinal analysis accounting for time-varying covariates is one of the options. We aimed to explore longitudinal association between diet quality (DQ) and non-communicable diseases (NCDs). Participants from the 1973–1978 cohort of the Australian Longitudinal Study on Women's Health (ALSWH) were included, if they; responded to survey 3 (S3, 2003, aged 25–30 years) and at least one survey between survey 4 (S4, 2006) and survey 8 (S8, 2018), were free of NCDs at or before S3, and provided dietary data at S3 or S5. Outcomes were coronary heart disease (CHD), hypertension (HT), asthma, cancer (except skin cancer), diabetes mellitus (DM), depression and/or anxiety, and multimorbidity (MM). Longitudinal modelling using generalised estimation equation (GEE) approach with time-invariant (S4), time-varying (S4–S8) and lagged (S3–S7) covariates were performed. The mean (± standard deviation) of Alternative Healthy Eating Index-2010 (AHEI-2010) of participants (n = 8022) was 51·6 ± 11·0 (range: 19–91). Compared to women with the lowest DQ (AHEI-2010 quintile 1), those in quintile 5 had reduced odds of NCDs in time-invariant model (asthma: OR (95 % CI): 0·77 (0·62–0·96), time-varying model (HT: 0·71 (0·50–0·99); asthma: 0·62 (0·51–0·76); and MM: 0·75 (0·58–0·97) and lagged model (HT: 0·67 (0·49–0·91); and asthma: 0·70 (0·57–0·85). Temporal associations between diet and some NCDs were more prominent in lagged GEE analyses. Evidence of diet as NCD prevention in women aged 25–45 years is evolving, and more studies that consider different longitudinal analyses are needed. [ABSTRACT FROM AUTHOR]

Background: Traditionally, general practitioners (GPs) have initiated the need for, and ordered, radiological tests. With the emergence of consumer-centred care, patients have started to request scans from doctors on their own initiative. Consumeristic health care has shifted the patient–doctor dyadic relationship, with GPs trending towards accommodating patients' requests. Methods: A mixed method analysis was conducted using a survey instrument with open ended questions and concurrent interviews to explore participants' responses from their requests for radiological studies from GPs. Themes emerging from both qualitative and quantitative methodologies were mapped onto the Andersen Newman Model (ANM). Results: Data were analysed for 'predisposing,' 'need' and 'enabling' elements of the ANM model and were correspondingly mapped to patient's requests for radiological referrals according to the elements of the ANM. Participants expressed anxiety about their health, were confident in the types of radiological scans they desired and typically indicated the need for evidence of good health. Their desire for such requested scans was often enabled through prior exposure to health information and the experience of specific symptoms. Requests came with the expectation of validation, and if these requests were denied, participants indicated that they would seek another doctor who would oblige. Conclusions: In our modest study of Australian patients, participants were well informed about their health. Exposure to information seems to create a sense of anxiousness prior to visiting the doctor. Individuals sought visual proof of wellness through imaging, and doctors in return often accommodated patient requests for radiological studies to appease patients' needs and to maintain workflow. With increased availability of online health information, individuals are more educated about managing their health care. Our study investigates patients requesting their own radiological scans rather than relying on their doctors' expertise. We explore participant responses to clinical encounters where they have initiated a radiological study from their general practitioner, and their self-reported responses and outcomes from such requests. [ABSTRACT FROM AUTHOR]

Describing neural connectivity between pre-frontal and parietal brain regions and anxiety in children and adolescents with Autism Spectrum Disorder (ASD) has the potential to inform diagnosis and treatment decisions. This study aimed to identify the neural connectivity patterns between the prefrontal cortex (PFC) and parietal regions in young autistic males, and to determine if Generalised Anxiety Disorder (GAD) was associated with these communication patterns. Forty-one males with ASD aged between 6 and 18 yr (M age = 10.76 yr, SD = 3.14 yr) and their mothers were recruited as volunteer participants from the Gold Coast region, Australia. After assessments, participants received 3 min of eyes-closed and 3 min of eyes-opened EEG data-collection under resting conditions. EEG data from the frontal and parietal regions were investigated for their connectivity via Granger Causality (GC). There were significant correlations between the PFC-to-parietal region GC connectivity indices and total GAD scores, and also for the core components of GAD, but these were restricted to the alpha-wave frequency with only minimal beta-wave significant results. No significant correlations between parietal-to-PFC regions and GAD were present. Communication from the decision-making region (PFC) to the spatial reasoning (parietal) regions appeared to be aimed at instigating increased motor activity associated with GAD. [ABSTRACT FROM AUTHOR]

Lockdowns were the major policy response to COVID-19 containment in many countries, and subsequently many people spent abnormal amounts of time at home. Research has found that housing conditions affected more peoples' mental health during the COVID-19 crisis than prior to it, and vulnerable groups were especially affected. One group that may be particularly vulnerable is private renters in shared housing. Using a socio-economic lens, our research examined to what extent mental well-being outcomes were associated with housing conditions in shared housing under COVID-19 restrictions in Australia. Data about private renters were obtained from the Australian Rental Housing Conditions Dataset (n = 1908), collected in mid-2020 during the easing of the first lockdown restrictions. Respondents living in shared arrangements reported higher levels of worry and anxiety (8.5–13.2%) and loneliness and isolation (3.7–18.3%) compared to other household types. Binary logistic regressions showed that COVID-19-related mental and financial well-being variables were the main contributors in COVID-19-related worry/anxiety and loneliness/isolation models. Accumulated housing problems were the only housing condition measure that was significant in the worry/anxiety model. Participants who had more than two people living in a household felt 1.4 times lonelier/isolated compared to those who lived with four or more people. Males and participants who reported good mental health were less likely to feel COVID-19-related worry/anxiety and loneliness/isolation. Our analysis demonstrates the importance of measures for mental health and income during a pandemic and concludes with recommendations of support for shared housing renters during and beyond crisis events. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) complicates ∼16% of pregnancies in Australia and has significant implications for health of both mother and baby. Antenatal anxiety and depression are also associated with adverse pregnancy outcomes. The interaction between GDM and mental health in pregnancy is poorly understood. With the aim of exploring the nuanced interaction between GDM and mental health further, we investigated whether GDM treatment modality (diet versus insulin) influenced psychological wellbeing in women with GDM. Psychological wellbeing was assessed in women with GDM treated with diet (GDM-Diet, n = 20) or insulin (GDM-Insulin, n = 15) and pregnant women without GDM (non-GDM, n = 20) using questionnaires [Edinburgh Depression Scale (EDS), State-Trait Anxiety Inventory (STAI-6), and in women with GDM, Problem Areas in Diabetes (PAID)] at 24–34 weeks gestation and again at ∼36 weeks gestation. Women in the GDM-insulin group had significantly higher levels of anxiety than the non-GDM group at both time points. Women in the GDM-Diet group had higher levels of anxiety at 24–34 weeks gestation than the non-GDM group but did not differ at ∼36 weeks gestation. Although depression scores tended to be higher in GDM-Insulin and GDM-Diet groups than in the non-GDM group at both time points, this was not statistically significant. Diabetes-related distress was similar in the GDM-Diet and GDM-Insulin groups at both time points and did not change during pregnancy. A high proportion of the GDM-Insulin group had past/current mental illness (60%). In this pilot study GDM was associated with differences in psychological wellbeing, specifically increased anxiety in women treated with insulin. Specialised interventions to support women with GDM should be considered, especially those requiring insulin. Trial registration: Not applicable as this was a purely observational study. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to assess and compare the psychological wellbeing of Australian hospital clinical staff at three timepoints during the coronavirus disease 2019 (COVID-19) pandemic. Methods. An anonymous, online, cross-sectional survey was conducted at three timepoints during the COVID-19 pandemic (T1: May–June 2020; T2: October–December 2020; T3: November 2021–January 2022). The surveys were completed by nurses, midwives, doctors and allied health staff employed at a large metropolitan tertiary health service located in Melbourne, Australia. The Depression, Anxiety and Stress Scale (DASS-21) assessed respondents’ psychological wellbeing in the past week. General linear models were used to measure the effects of survey timepoint on DASS-21 subscale scores, adjusting for selected sociodemographic and health characteristics. Results. A total of 1470 hospital clinical staff completed at least one survey (T1: 668 (14.7%), T2: 358 (7.9%) and T3: 444 (9.8%)). Respondents’ sociodemographic characteristics were similar across the three timepoints and within professional discipline groups. Respondents’ psychological wellbeing was worse at T3 compared to the earlier survey timepoints. Adjusting for respondent characteristics, depression, anxiety and stress scores were significantly higher for respondents of the third survey compared to the first (P < 0.001). Conclusions. There was a significant and persistent negative impact on the psychological wellbeing of hospital clinical staff in Australia across waves of the COVID-19 pandemic. Hospital clinical staff would benefit from ongoing and continued wellbeing support during and after pandemic waves. [ABSTRACT FROM AUTHOR]

Background: The utilisation of massed therapy for treating posttraumatic stress disorder (PTSD) is gaining strength, especially prolonged exposure. However, it is unknown whether massed prolonged exposure (MPE) is non-inferior to standard prolonged exposure (SPE) protocols in the long term. The current study aimed to assess whether MPE was non-inferior to SPE at 12 months post-treatment, and to ascertain changes in secondary measure outcomes. Methods: A multi-site non-inferiority randomised controlled trial (RCT) compared SPE with MPE in 12 clinics. The primary outcome was PTSD symptom severity (CAPS-5) at 12 months post-treatment commencement. Secondary outcome measures included symptoms of depression, anxiety, anger, disability, and quality of life at 12 weeks and 12 months post-treatment commencement. Outcome assessors were blinded to treatment allocation. The intention-to-treat sample included 138 Australian military members and veterans and data were analysed for 134 participants (SPE = 71, MPE = 63). Results: Reductions in PTSD severity were maintained at 12 months and MPE remained non-inferior to SPE. Both treatment groups experienced a reduction in depression, anxiety, anger, and improvements in quality of life at 12 weeks and 12 months post-treatment commencement. Treatment effects for self-reported disability in the SPE group at 12 weeks were not maintained, with neither group registering significant effects at 12 months. Conclusions: The emergence of massed protocols for PTSD is an important advancement. The current study provides RCT evidence for the longevity of MPE treatment gains at 12 months post-treatment commencement and demonstrated non-inferiority to SPE. Promisingly, both treatments also significantly reduced the severity of comorbid symptoms commonly occurring alongside PTSD. [ABSTRACT FROM AUTHOR]

Epidemiological evidence suggests that regular physical activity (PA) positively impacts individuals' mental health (MH). The PA-MH relationship may be critical among immigrants owing to psycho-social-cultural influences. This scoping review of 61 studies employed a holistic bio-psycho-socio-cultural framework to thoroughly investigate the complex relationship between PA (across life domains) and immigrants' MH in Western countries. A systematic search of five electronic databases (Medline, PubMed, Embase, PsycINFO and Anthropology Plus) was conducted to locate relevant articles. No limitations were applied to study design, age, gender, home country, MH condition or PA type. A bio-psycho-socio-cultural-informed conceptual model guided the analysis of the multi-domain PA-MH relationship. Immigrant PA-MH studies were conducted and reported most commonly in the USA (38%), Australia (18%), and Canada (11%). Overall, PA was positively related to MH. Each domain-specific PA appeared to be associated with unique MH-promoting pathways/mechanisms. Leisure-related PA may support MH by enhancing self-agency and minimizing risky behaviors, whilst travel- and domestic-related PA may promote self-accomplishment and physical engagement. Ethnic sports appeared to enhance resilience. Occupational-related PA was associated with either positive or negative MH, depending on the type of occupation. A bio-psycho-socio-cultural-informed model is required to gain an encompassing and integrated understanding of immigrants' health. The first iteration of such a model is presented here, along with an illustration of how the model may be used to deepen analysis and understanding of the multi-domain PA-MH relationship among immigrants and inform public health planners and practitioners. [ABSTRACT FROM AUTHOR]

Despite the Australian Government's attempts to reduce domestic violence (DV) incidences, impediments within the social and health systems and current interventions designed to identify DV victims may be contributing to female victims' reluctance to disclose DV experiences to their primary healthcare providers. This scoping review aimed to provide the state of evidence regarding reluctance to disclose DV incidents, symptoms and comorbidities that patients present to healthcare providers, current detection systems and interventions in clinical settings, and recommendations to generate more effective responses to DV. Findings revealed that female victims are reluctant to disclose DV because they do not trust or believe that general practitioners can help them to solve their issues, and they do not acknowledge that they are in an abusive relationship, and are unaware that they are in one, or have been victims of DV. The most common symptoms and comorbidities victims present with are sleep difficulties, substance use and anxiety. Not all GPs are equipped with knowledge about comorbidities signalling cases of DV. These DV screening programs are the most prominent intervention types within Australian primary health services and are currently not sufficiently nuanced nor sensitive to screen with accuracy. Finally, this scoping review provides formative evidence that in order for more accurate and reliable data regarding disclosure in healthcare settings to be collected, gender power imbalances in the health workforce should be redressed, and advocacy of gender equality and the change of social structures in both Australia and New Zealand remain the focus for reducing DV in these countries. [ABSTRACT FROM AUTHOR]

Using individual differences constructs, the current study used cross-sectional data to examine the mediating role of negative self-statements during public speaking on the relationship between fear of negative evaluation and public speaking anxiety (a type of performance anxiety), and how this relationship was moderated by positive self-statements during public performance. The sample comprised 319 adults (men = 105, women = 214) from the general Australian community, with ages ranging from 18 years to 65 years. All participants completed questionnaires covering the different study variables. The findings showed that there was partial mediation by negative self-statements on the relationship between fear of negative evaluation and performance anxiety. There were also moderation effects by positive self-statements for this relationship. Additionally, moderation by positive self-statements was evident at all levels of positive self-statements. The theoretical and clinical implications of the findings for public speaking anxiety are discussed. [ABSTRACT FROM AUTHOR]

Introduction. Patients with chronic pain (CP) are frequent users of general practitioners (GPs). Aim. This study aimed to assess factors associated with the rate of GP visits related to pain in patients with CP. Methods. This study used data collected by adult specialist pain management services (SPMS) that participated in the electronic Persistent Pain Outcomes Collaboration (ePPOC) in Australia. Adult patients (18 years or older) with CP (duration greater than 3 months) who were referred to SPMS from the calendar year 2015–2021 were included (N = 84 829). Results. Patients who reported severe anxiety, stress, pain, pain interference, pain catastrophising and severely impaired pain self-efficacy were more likely to seek help from a GP. Patients with longer pain duration had a lower rate of GP visits. The rate of GP visits was 1.22 (IRR = 1.22, 95% CI: 1.19, 1.26) times higher in patients with severe pain severity, compared to patients with mild pain severity. Patients who used opioids were more likely to visit a GP (IRR = 1.32, 95% CI: 1.30, 1.34) than those who were not using opioids. Discussions. More than half of the adult CP patients had greater than three GP visits in the 3 months before referral. This study would indicate that some patients may attend their GP to seek an opioid prescription. Given the rising use of opioids nationally, future study is required on opioid users’ GP visitation practices. Additionally, the inverse association between pain duration and the rate of GP visits warrants further exploration. [ABSTRACT FROM AUTHOR]