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As part of mental health reform in Australia, new policies were introduced to support recovery‐oriented practice; however, little has changed in hospital settings focused on managing risk and remediating acute symptoms. Previous studies have indicated that patients' experiences of personal recovery, during a hospital admission, may not mirror that of people living in the community, with patients being more likely to experience disconnection, hopelessness and disempowerment. Using a Participatory Health Research approach, eight mental health professionals, a patient advocate and an external researcher formed a research partnership to answer the question: How can staff enhance recovery‐oriented practice in a hospital‐based mental health service? The COREQ checklist was used for reporting the methods, analysis and findings. The methods comprised patient focus groups (n = 16 participants), interviews with managers (n = 7) and an online survey for staff (n = 17). Researchers analysed the feedback from the consultations using inductive thematic analysis, identifying two themes: relational recovery and recovery interventions. The findings indicate that relational recovery is key to recovery during a hospital admission and interventions that increase connectedness or reduce the impact of symptoms enhance personal recovery. [ABSTRACT FROM AUTHOR]

Background: Migration has challenged society. Most people who move do so for economic reasons, but others move for more tragic reasons. The proportion of female migrants was slightly higher than that of male migrants, partly due to the longer life expectancy of women and the higher demand for female migrants in care‐related Jobs. The process may affect migrants' health, particularly in countries where healthcare is associated with high economic costs or insurance availability. A global systematic review of qualitative studies with meta‐synthesis was conducted. The results can be used to support health policy and clinical practice. Objective: To describe how migrants perceive and experience the process of migrating and how it affects their health. Search strategy: Databases consulted were Medline, PsychInfo, Cuiden, Cinahl, WOS, Scopus, Social Science Database, and Epistemonikos. Thirty‐four articles were selected for final meta‐synthesis. Inclusion criteria: All qualitative primary studies were included that describe the experiences or perceptions of migrants and refugees over 18 years that talk about their migration process and the impact on their health; written in English or Spanish between 2016 and 2021. Articles referring to second generations and those dealing with pathologies that pre‐date the migration process were excluded. Data extraction and synthesis: The COREQ and JBI templates were used as quality criteria. Studies mostly used a phenomenological methodology and in‐depth interviews, both individual and group, were used for data collection and narrative synthesis. Main results: Uncertainty emerges as a main category. Three other interrelated themes have a direct impact on migrants' health: Language, Social Networks and Work. There are several conditions in each of these that have a positive or negative impact on health. The gender condition appears in both work and social networks, positively and negatively. Discussion and conclusions: Health would be improved by having a stable job, which would facilitate access to health resources. Social networks and language are facilitators of access to a better job, but not the only condition. From a gender perspective, social networks can become a source of health problems, especially for women. The process of migration places women in a position of vulnerability due to the difficulties of reconciling family and work life. Job insecurity, workload, loss of family life or social isolation increase hopelessness and anxiety, leading to health problems. Public or patient contribution: As an academic review study, no patient contribution was required, and this study serves as a theoretical framework for more in‐depth research that will work with migrant populations. As a public contribution, this work provides evidence of the need to improve access to health for some populations, in line with the Sustainable Development Goals (SDGs) set for 2030. [ABSTRACT FROM AUTHOR]

Background: Volunteering is a form of prosocial behaviour that has a been recognised as having positive benefits for medical students. However, there is a lack of research on what influences students to volunteer during and after weather‐related disasters. Our study (1) explores factors related to medical students' willingness and readiness to volunteer, and (2) describes mental health impacts of the flood events on students. Methods: We conducted a mixed‐methods study of medical students on rural clinical placements in a regional area of Australia, 2 to 6 weeks after two major flooding events in 2022. Data were collected through survey and focus groups. Summary statistics were generated from the survey data, and Fisher's exact test was used to determine associations between student experience of the flood and self‐rated well‐being. Qualitative data were deductively analysed using Byrne and colleagues' theory of prosocial behaviour during an emergency. Results: The 36 students who participated in focus groups (including the 34 who completed the survey) (response rates 84% and 79%, respectively) demonstrated high levels of prosocial behaviours and were willing to volunteer. A sense of moral obligation was the primary reason for volunteering, whereas concerns for their physical and psychological safety, and missing key aspects of their training, were the strongest reasons for not continuing to volunteer. Students reported personal stress, anxiety and trauma during this period, with significant associations between self‐rated impacts on their well‐being and feelings of being terrified, helpless and hopeless during the flooding events and of still being distressed weeks later (p <.05). Conclusions: This study expands on prosocial behaviour theory by applying Byrne and colleagues elaborated model in the context of medical student volunteering during the 2022 major flooding events in Australia. Modifiable barriers to prosocial behaviour are identified along with proposed strategies to address these barriers. As the climate warms, we can expect an increase in the intensity and frequency of weather‐related disasters. Here @JodieBailie1 et al. explore how medical students are well placed to support communities in their response to such events. [ABSTRACT FROM AUTHOR]

COVID-19 has caused unprecedented impact on the lives of Australians, with significant influence on the mental health and well-being of adults. Initial estimates predict that there will be a decline in birth rates from 1.7 to 1.59 children per woman in Australia over the course of 2021. This study aimed to explore change in fertility intentions as a result of COVID-19 in Australian young adults. Sixty-seven adults (82% women) between the ages of 18–35 years participated in the online survey. The study collected socio-demographic data including relationship status, employment, education, income, and gender as well as three measures of wellbeing including hopelessness, anxiety, and coping. Results of the study indicated that employment status is a significant indicator of change in fertility intention. There was a strong effect for hopelessness, indicating that increased hope for the future is associated with a change in fertility intention. Anxiety and coping did not appear to significantly influence change. The results of this study indicate that the immediate impact of COVID-19 on wellbeing does not cause people to change fertility intention, however, hope for the future has a significant influence. Through the lens of the Theory of Planned Behavior, this may be because people evaluate the consequences of their actions based on predictions of the future, and therefore hope for the future most significantly impacts their attitudes toward having children. Future research should investigate how supporting the wellbeing of young adults can influence choice in fertility intention. [ABSTRACT FROM AUTHOR]

Background: Many developed countries have introduced strict measures designed to deter people seeking asylum. Measures such as held detention, insecure visas, restrictions work and services all impact the mental health of asylum seekers. In 2014 Australia introduced a 'fast track assessment' (FTA) system of processing refugee claims for asylum seekers who arrived by boat, those found to be refugees were only eligible for temporary residence. Legal professionals play a pivotal role in protecting the rights of asylum seekers and gain unique insight into the impact of the legal system has on clients mental health. Aim: To investigate how legal professionals in Australia perceived the impact of the FTA process on their clients. Methods: Mixed methods comprising of two phases – (i) an online survey and (ii) follow-up focus groups and interviews with legal professionals involved in assisting asylum seekers in the FTA process. An inductive thematic analysis was used to analyse the data. Results: Survey results were obtained from 38 legal professionals. Follow up in depth qualitative focus groups and interviews were conducted with 16 survey participants. The data demonstrate that legal professionals encounter clients in complex seemingly insurmountable mental health crises including deepening mental distress and deterioration, feelings of hopelessness, defeat and entrapment. Interviewees shared compelling examples of what they believed constituted a direct connection between asylum seekers experiencing uncertainty and deteriorating mental health over time with fluctuations in hopelessness, anger, withdrawal and suicidality. These negative impacts were often compounded by separation from family. Conclusions: The legal framework for determining whether an asylum seeker is a refugee can have a detrimental impact on the mental health of asylum seekers. The mental distress of asylum seekers and refugees is exacerbated by uncertainty linked to both delays in processing accompanied by sustained and ongoing uncertainty of legal status. [ABSTRACT FROM AUTHOR]

This study examined the stability of 10 symptoms of psychological distress measured by the Kessler Psychological Distress Scale (K10) in an Australian adult sample. Data were collected at seven time points, 2 years apart, between 2007 and 2019. The average stability of the 10 symptoms was 49%. However, there were differences between items. The items can be categorised based on two characteristics: Degree of extremity and arousal. More extreme symptoms (i.e., those beginning with 'so', such as 'so sad that...') tended to change more over time, whereas milder symptoms (e.g., "nervous") tended to be more stable. Symptoms with low levels of arousal (e.g., 'hopeless') tended to reflect more situation‐specific influences, whereas symptoms with high levels of arousal (e.g., 'restless or fidgety') tended to reflect more nonsystematic influences. [ABSTRACT FROM AUTHOR]

Gay and bisexual migrants from low‐ and middle‐income countries living in high‐income countries are disproportionately diagnosed with HIV. Most research focuses on preventing HIV acquisition among HIV‐negative migrant gay and bisexual men (GBM). This study is uniquely positioned to report on migrant GBM's experiences and needs at and after an HIV diagnosis. Semi‐structured interviews were conducted with 24 migrant GBM diagnosed at sexual health clinics in Australia from 2017 onwards. Interviews were analysed using a codebook thematic analysis. Due to the stigma of HIV and homosexuality in their countries of origin, about half of participants had poor HIV knowledge prior to diagnosis. Absorbing diagnosis information was consequently difficult, and feelings of shame, hopelessness, lost sexual opportunities and infectiousness were common. However, many were thankful for the comprehensive clinical support they received and believed that over time life would 'normalise' with sustained undetectable viral load. None reported that their clinician stigmatised them, but the anticipation of stigma nonetheless infused their experiences after diagnosis. Many were selective about HIV disclosure, and some mentioned that clinic systems posed a risk to confidentiality. Non‐permanent residents were concerned about the impacts of HIV status on future visa applications. We recommend that newly HIV‐diagnosed migrant GBM receive referral to legal and culturally appropriate migration services to help absorb what a diagnosis might mean for their health and visa status. We also recommend sexual health clinics continue to assess confidentiality in their systems. Health promotion initiatives should highlight to migrant GBM that high‐HIV caseload sexual health clinicians provide confidential and comprehensive care. [ABSTRACT FROM AUTHOR]

The trauma of having a family member missing is commonly described as an ambiguous loss where the finality of the loss is not realized, as is experienced with a death. There is uncertainty due to the trauma of the absence and subsequent police investigation, leading to physical and emotional impacts for the aftercare of those left behind. There are 850 unidentified human remains and 2,600 long-term missing persons cases in Australia. The Australian Federal Police (AFP) National DNA Program for Unidentified and Missing Persons aims to scientifically link these cases using modern DNA techniques and databases. A DNA-led identification effort may assist to provide answers to Australian families searching for missing relatives, but may also contribute to the trauma experienced by these families. A literature review demonstrated empirical research for the development of scientific best practices for the collection of reference DNA samples for forensic purposes, but minimal evidence about the impact of reference DNA sample collection on kin when attempting to identify the deceased remains of missing people in non-mass casualty situations. The aim of this study was to develop an academically robust understanding of the unique impact of reference DNA sample collection on families of missing persons and support pathways tailored to the experience. This study involved 26 Australian families of long-term missing (ranging from 1 to 20+ years) people in Australia anonymously completing a mixed-methods online survey about their experiences of providing reference DNA samples to aid missing persons investigations. Respondents were representative of a range of ages, genders and relationships to the missing individual. The thematic analysis of the survey results identified the provision of a reference DNA sample: (1) resembles an overt act of hope as families perceive their sample assists the investigation, whilst also being traumatic, triggered by the prospect of scientifically matching their missing family member to a set of unknown human remains; (2) can cause immediate interpersonal impacts and ongoing impacts to families' wellbeing; and (3) can be improved by considering the environment where the sample is collected, professionalism of the police officer collecting the sample, timeliness of the provision of the sample, level of support provided during and after sample collection, and effective communication of forensic procedures and processes as they relate to the missing persons investigation. The study concludes that the complexity associated with provision of family reference samples requires the development and implementation of best practice guidelines, including psycho-education strategies to be used by practitioners to minimize the vicarious trauma for relatives already traumatized by the loss of their missing family member. These guidelines would support the objectives of the AFP Program and benefit all routine missing persons investigations. [ABSTRACT FROM AUTHOR]

This article adds to a growing body of literature that engages with failure as a way of knowing and understanding the social. Through a focus on images of sportswomen's loss or failure in three Australian newspapers during the 2018 Gold Coast Commonwealth Games we analyzed affective-discourses and patterns in images and accompanying headlines, captions and stories to explore the place of loss in the narrative of mainstream sport reporting. Through this focus on loss we hoped to find points of disruption that might generate new conceptions of women in sport. What we found was that stories of loss in mainstream newspaper coverage reproduced transphobic, racist, nationalistic, ageist and sexist discourses. We conclude by calling for research that explores how athletes self-present their losses in digital platforms subjectively rather than being reported 'on'. [ABSTRACT FROM AUTHOR]

Background: There has been widespread public and political interest in Euthanasia and Physician‐Assisted Suicide (EPAS) in recent years. Polling in Australia and New Zealand has generally shown a majority of people support some form of legal EPAS; however, the level of support varies between polls. Aim: To explore whether public support for and opposition to EPAS as measured in historic Australian and New Zealand polls has been influenced by the wording of survey questions. Methods: Australian and New Zealand random‐sample post‐1995 EPAS poll questions asked of the general public were identified and subjected to content analysis. Individual phrases and words were considered in terms of their favourability towards or unfavourability against EPAS and each poll question was assigned a net favourability score. Variation of support for EPAS based on year, location and favourability of language was analysed by various statistical methods. Results: Mean public support for EPAS in Australia and New Zealand between 1995 and the present was 70.2% with support ranging between 47 and 85%. Support did not vary by location and has remained unchanged over time. However, support was positively associated with increasing levels of favourable wording, accounting for over 20% variation in mean support. Allusions to hopelessness had an especially strong effect on increasing support for EPAS. Conclusion: Use of emotive phrases and language is associated with influencing attitudes to EPAS in Australia and New Zealand. Therefore, caution should be exercised when interpreting public support for EPAS based on individual polls. [ABSTRACT FROM AUTHOR]

This study aimed to explore the ecological influences on subjective well-being identified by current and former community-dwelling asylum seekers engaged in the process of Refugee Status Determination in Australia. This article presents the qualitative component of a prospective mixed-methods study of 131 asylum seekers and refugees (T1, N = 131; T2, N = 56). The Framework Analysis method was employed to qualitatively analyse the narrative data derived from 187 semi-structured interviews documenting pre-, peri-, and post-migration experiences, and the impact of Australia's asylum policies and procedures. Four overarching themes comprising 15 sub-themes emerged: The Refugee Status Determination process (Waiting; Uncertainty; Worry) ; Psychosocial factors (Un/employment & gainful activity; Medicare; Accommodation; Family separation & loneliness; Loss) ; Health and well-being (Mental health; Physical health & somatic issues; Hopelessness; Helplessness) ; and Protective factors (Hope; Support & social connectivity; Religion). The complex interface between the Refugee Status Determination process, un/employment, and mental health concerns was the most salient finding. Policy implications are discussed in relation to the application of the Convention and Protocol Relating to the Status of Refugees and the Guidelines on the Judicial Approach to Expert Medical Evidence. [ABSTRACT FROM AUTHOR]

Objectives: The primary objective of this study was to establish whether clinical depression and increased suicide risk differed between Australian fly-in, fly-out (FIFO) workers and their residential counterparts in the resources sector. We also sought to identify whether bullying and social support were associated with depression and suicide risk in this cohort. Methods: A cross-sectional survey design was used. Completed questionnaires were received from 751 respondents who were employed in the Australian resources sector. Primary outcomes were assessed with the Beck Depression Inventory, Beck Hopelessness Scale and Negative Acts Questionnaire – Revised. A general linear model was used to examine the association between depression, hopelessness and predictive factors. Results: The results of a general linear model analysis demonstrated that depression (partial η2 = 0.02; P = 0.01) and hopelessness (partial η2 = 0.02; P = 0.02) were significantly higher in residential than FIFO workers. In addition, bullying was significantly associated with higher levels of depression (partial η2 = 0.11; P = 0.001) and hopelessness (partial η2 = 0.04; P = 0.001). Finally, increased social support was significantly associated with lower depression rates (partial η2 = 0.13; P = 0.001) and hopelessness (partial η2 = 0.14; P = 0.001). Conclusions: Interventions should be delivered to reduce depression and hopelessness in Australian resource workers, particularly through addressing workplace bullying and enhancing social support. What is known about the topic?: One-third of Australian resource workers experience psychosocial distress. Research examining factors that influence such distress is lacking. What does this paper add?: The results of this study demonstrate that clinical depression and suicide risk were significantly higher in residential resource workers than in FIFO workers. Depression and suicide risk were directly associated with workplace bullying. In addition, social support was an important protective factor against depression and bullying in Australian FIFO and residential resource workers. What are the implications for practitioners?: There is an urgent need to introduce interventions that reduce psychosocial distress in the resource sector, particularly through the mitigation of bullying [ABSTRACT FROM AUTHOR]

While the destiny of the eldest sons of aristocratic British and Irish families was marked out from birth, younger male siblings and their male offspring were often faced with major challenges when endeavouring to find a place for themselves in the world. Unless they were fortunate enough to be educated for business or the law, to carve out a successful career in the army or the church, or to marry wealth, they could be condemned to living in reduced circumstances, dependent for survival upon more privileged relatives. This was the case with Berkeley Lennox. Although clever, he lacked the financial means and the family support necessary to exploit his talents fully, although his unlikely career as a magician in colonial Australia during the mid-1850s was not without its successes. His story exemplifies the difficulties junior members of aristocratic families could face, and it serves also to illustrate how youthful indiscretions could blight an upper-class man's later life and prospects. [ABSTRACT FROM AUTHOR]

Context: Spiritual care refers to practices and rituals addressing spiritual/religious concerns. It supports coping with loss and finding hope, meaning, and peace. Although integral to palliative care, its implementation is challenging.Objective: To understand an Australian cohort of patients' and caregivers' perspectives about experiencing and optimizing spiritual care in the context of advanced illness.Methods: Patients and caregivers of patients with ≤12 month prognosis were recruited from a broader spiritual study via criterion sampling and agreed to opt-in interviews. Participants from an Australian, metropolitan health service received a spiritual care definition and were interviewed. Transcripts were analyzed using qualitative description.Results: 30 patients (17 male; mean age 70 years) and 10 caregivers (six male; mean age 58.9 years) participated. 27 identified as Christian, and 10 had no religion. Participants described multifaceted and contested beliefs about spirituality. Many queried the tangibility of spirituality, but all valued respectful staff who affirmed personhood, that is, each individual's worth, especially when care exceeded expectations. They also resonated with positive organizational and environmental tones that improved holistic well-being. Participants stressed the importance of the hospital's welcoming context and skilled care, which comforted and reassured.Conclusion: Although many patients and caregivers did not resonate with the term "spiritual care," all described how the hospital's hospitality could affirm their values and strengthen coping. The phrase "spiritual care and hospitality" may optimally articulate and guide care in similar, pluralist inpatient palliative care contexts, recognizing that such care encompasses an interplay of generalist and specialist pastoral care staff and organizational and environmental qualities. [ABSTRACT FROM AUTHOR]

There has been a call for research on migrant and refugee women's negotiation of diverse discourses and cultural constraints associated with sexual embodiment, including menopause, in order to facilitate sexual and reproductive health and understand gendered subjectivity. This study examined the construction and experience of menopause among migrant and refugee women who had settled in Australia or Canada in the last 10 years. Eighty-four individual interviews and 16 focus groups comprising 85 participants were conducted (total n = 169), with women aged 18 years and over from Afghanistan, India (Punjab), Iraq, Somalia, South Sudan, Sri-Lanka (Tamil), Sudan and various South American (Latina) backgrounds. Thematic decomposition identified three discursive themes: Menopause as the Age of Despair; a Discourse of Silence and Secrecy; and Menopause as a Life Stage - or when Life Starts. Negative constructions of menopause, associated with silence and secrecy, were evident across different cultural groups, with implications for women's positioning and experience of menopausal change and embodiment. However, resistance to negative discourse was also evident. This was primarily associated with having received menopause education and more open communication about menopausal change, suggesting that education and health information can facilitate affirming aspects of menopause. [ABSTRACT FROM AUTHOR]

Objective: There is a growing consensus that mental health should be conceptualised as a complete state that considers both illness and well‐being components. In Australian mental health services, the Mental Health Inventory (MHI) is the only one of the three currently used consumer outcome measures that includes this broader perspective. However, the MHI has been criticised for its length, and variable factor structure. In order to improve the clinical utility of the MHI, a reliability and validity study of the MHI was undertaken. Method: The original 38‐item version of the MHI was administered to an Australian adult community sample (n = 616), along with two other consumer outcome measures (BASIS‐32 and Kessler‐10), a measure of psychological distress (DASS‐21) and a measure of well‐being (Satisfaction with Life Scale). Results: Parallel analysis did not support the original factor structure of the MHI. The data indicated a correlated three‐factor structure, measuring psychological distress, emotional well‐being, and hopelessness. Seventeen items were deleted due to split loadings > .3, producing a shorter 21‐item scale. New simplified additive scoring rules were also developed to support the practical utility of the scale. Conclusion: Research, clinical practice and consumer feedback consistently highlight the need for a balanced assessment approach to mental health, which considers not only illness symptomatology, but also the characteristics of well‐being that support recovery. Use of the three subscales of the MHI‐21 would support a complete state assessment of mental health outcomes. [ABSTRACT FROM AUTHOR]

Abstract: The mental deterioration of the so called ‘legacy caseload’ (asylum seekers who arrived in Australia by boat between August 2012–December 2013) has become a national concern and is garnering international attention. Prolonged uncertainty is contributing to mental deterioration and despair. There have been at least 11 deaths by suicide since June 2014. Social support services have been limited and legal assistance in short supply; this is associated with lengthy delays with visa applications. Thwarted belongingness, purpose and identity, a shortage of available services, and barriers to legal support for processes attendant upon Refugee Status Determination increase the likelihood that the mental health of asylum seekers will deteriorate further, potentially developing into worsening decline, which will lead to increased self‐harm and suicide. This article summarises recent suicide deaths in Australia, positing practical assistance and support for asylum seekers living in the community. Therapeutic engagement should be trauma‐informed wherever possible, helping asylum seekers to reframe their sense of lethal hopelessness. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine whether high-risk personality dimensions increased susceptibility to bullying victimisation and perpetration among Australian adolescents. Method: Longitudinal cohort study of 527 secondary school students in Australia (baseline average age = 13 years, 67% female and 93% Australian-born). Bullying was measured using an amended version of the Revised Olweus Bully/Victim Scale. Personality was measured using the Substance Use Risk Profile Scale. The data were analysed using mixed models, examining the association between baseline personality scores and frequency of victimisation/perpetration 12 months later. Results: Baseline hopelessness and baseline impulsivity were positively associated with frequency of victimisation 12 months later. Baseline anxiety sensitivity was negatively associated with victimisation 12 months later for males. There was a positive association between baseline impulsivity and frequency of bullying perpetration 12 months later. Conclusion: High-risk personality dimensions predicted later bullying victimisation and bullying perpetration among Australian adolescents. This indicates that adding a personality-focused intervention for high-risk adolescents to existing universal bullying prevention approaches may be effective in improving the prevention of bullying among adolescents, as well as reducing other associated emotional and behavioural problems. [ABSTRACT FROM AUTHOR]

Background Suicide-related behaviours are common in young people and associated with a range of negative outcomes. There are few evidence- based interventions; however, cognitive behavioural therapy (CBT) shows promise. Internet delivery of CBT is popular, with potential to increase reach and accessibility. Objective To test the effectiveness of an internet-based CBT program (Reframe-IT) in reducing suicide-related behaviours, depression, anxiety, hopelessness and improving problem solving and cognitive and behavioural skills in school students with suicide-related behaviours. Methods A parallel randomised controlled trial testing the effectiveness of Reframe-IT plus treatment as usual (TAU) compared with TAU alone in reducing suicidal ideation, suicide attempts, depression, hopelessness, symptoms of anxiety, negative problem orientation and cognitive and behavioural skill acquisition was undertaken. We recruited students experiencing suicidal ideation from 18 schools in Melbourne, Australia, between August 2013 and December 2016. The intervention comprised eight modules of CBT delivered online over 10 weeks with assessments conducted at baseline, 10 weeks and 22 weeks. Findings Only 50 of the planned 169 participants were recruited. There were larger improvements in the Reframe-IT group compared with the TAU group for the primary outcome of suicidal ideation (intervention -61.6, SD 41.6; control -47.1, SD 42.3, from baseline to 22-week follow-up intervention); however, differences were non-significant (p=0.593). There were no increases in distress in the majority of participants (91.1%) after completion of each module. Changes in depression and hopelessness partly mediated the effect of acquisition of CBT skills on suicidal ideation. conclusions The trial was underpowered due to difficulties recruiting participants as a result of the complex recruitment procedures that were used to ensure safety of participants. Although there were no significant differences between groups, young people were safely and generally well engaged in Reframe-IT and experienced decreases in suicidal ideation and other symptoms as well as improvements in CBT skills. The study is the first online intervention trial internationally to include young people demonstrating all levels of suicide risk. clinical implications Integration of internet-delivered interventions for young people with suicide-related behaviour may result in reductions in these behaviours. Further research is needed, but researchers should feel more confident about being able to safely undertake research with young people who experience these behaviours. trial registration number ACTRN12613000864729. [ABSTRACT FROM AUTHOR]

Demoralisation is a psychological state characterised by experiences of distress and sadness, helplessness, subjective incompetence and hopelessness, in the context of a stressful situation. Experiences of demoralisation may be particularly relevant to women who have recently given birth, who can feel incompetent, isolated and helpless. The psychometric properties of the Demoralisation Scale among women in the postnatal period participating in a clinical program were examined. Women admitted with their infants to a hospital mother-baby unit in Australia for five nights were recruited consecutively ( N = 209) and assessed at admission and discharge. The Demoralisation Scale was perceived as relevant and exhibited high reliability, acceptable construct validity and good sensitivity to change. The mean demoralisation score was high ( M = 30.9, SD = 15.5) and associated with negative experiences of motherhood and functional impairment, independent of depression and anxiety symptoms. Mean demoralisation decreased significantly after program completion ( M = 18.4, SD = 12.4). More participants showed a significant improvement in demoralisation (57.5 %) than in depression (34.8 %) and anxiety (9.8 %) symptoms. Demoralisation can provide a useful framework for understanding and measuring the experiences of women participating in postnatal clinical programs and in directing treatment towards helping women to acquire the necessary caregiving skills and increasing parental efficacy. The Demoralisation Scale is a useful clinical tool for assessing intervention effects. [ABSTRACT FROM AUTHOR]

Crystal methamphetamine (commonly known as 'ice') use is currently a deeply concerning problem for some Australian Indigenous peoples and can cause serious harms to individual, families and communities. This paper is intended to support best practice responses by primary health-care staff working with Australian Indigenous people who use methamphetamine. It draws on a systematic search of relevant databases to identify literature from January 1999 to February 2014, providing an overview of prevalence, treatment, education and harm reduction, and community responses. The prevalence of methamphetamine use is higher in Indigenous than non-Indigenous communities, particularly in urban and regional settings. No evidence was identified that specifically related to effective treatment and treatment outcomes for Indigenous Australians experiencing methamphetamine dependence or problematic use. While studies involving methamphetamine users in the mainstream population suggest that psychological and residential treatments show short-term promise, longer-term outcomes are less clear. Community-driven interventions involving Indigenous populations in Australia and internationally appear to have a high level of community acceptability; however, outcomes in terms of methamphetamine use are rarely evaluated. Improved national data on prevalence of methamphetamine use among Indigenous people and levels of treatment access would support service planning. We argue for the importance of a strength-based approach to addressing methamphetamine use, to counteract the stigma and despair that frequently accompanies it. [ABSTRACT FROM AUTHOR]

This article reports the evaluative findings of an Early Psychosis Education Program (EPEP) designed to support parents caring for their child who was recently admitted to the psychiatric intensive care unit of an inpatient mental health care facility in Australia. The EPEP offered education on mental illness, treatment options, and medication, as well as information on the recovery model of care. The EPEP was facilitated by two RNs and was evaluated for educational effectiveness using a simple pre- and postevaluation questionnaire. The evaluation revealed two themes expressed by parents: "We didn't see it coming," and "Hopelessness and helplessness." The themes highlighted the parents' lack of mental health care knowledge prior to the EPEP, which had a significant impact on the parents' experiences and well-being. The evaluative findings highlighted a need for a nurse-led EPEP within the community. A community EPEP has the potential to strengthen the partnership between parents, families, and mental health service providers and to help with the provision of a recovery framework of care. [Journal of Psychosocial Nursing and Mental Health Services, 52(7), 24-29.] [ABSTRACT FROM AUTHOR]

Former long-stay patients with psychotic disorders have significant unmet needs. This study assessed the long-term outcomes for the original cohort of 18 residents of the Footbridge Community Care Unit (CCU), a residential psychiatric rehabilitation unit at St Vincent's Mental Health Melbourne. A review of case records and interviews were conducted for each member of the cohort 8 years after admission to the CCU. Members of the cohort were living in a variety of settings after discharge from the CCU. Despite significant gains during the period of residential rehabilitation in the CCU after hospital discharge, by the time of follow-up individuals were in general leading restricted lives characterised by a lack of stable residential and social supports. Most reported positively on the support provided in the CCU although later experiences of moving repeatedly from one setting to another were adverse. Five key unmet needs were identified: promotion of independence; stability in accommodation; stability in social networks; consistency of care; and addressing the theme of loss. A longitudinal perspective in management that focuses on stability in residential care is required for long-stay patients. [ABSTRACT FROM AUTHOR]

The article presents an essay which seeks to explore how the Australian film "The Finished People" addresses to the audience the value and efficacy of the emotions of sadness and loss. According to the author, the feeling of despair and despondency exhibited by the characters will be examined in order to understand how the viewer is influenced in a manner that it encourages resonance and recognition from the pain of loss. Meanwhile, a brief synopsis of the film and an overview of the overall production of the movie are presented.

Objectives: To estimate rates of suicidal ideation and attempts, and psychological characteristics of demoralization among Australian income support recipients. To provide information for policy-makers to inform the current welfare reform discussion. Method: Data from the 1997 National Survey of Mental Health and Wellbeing were analysed using sequential logistic regression models, comparing working age people dependent on government income support payments with those having other main sources of income. Results: Three groups of income support recipients, unemployed, lone mothers and disability payment recipients, reported significantly higher levels on all psychological measures related to demoralization (hopelessness, worthlessness and dissatisfaction with life) than non-recipients. A similar pattern was demonstrated for measures of suicidal ideation and reported suicide attempts, with increased odds of between 3 and 9 for these high-risk groups of welfare recipients. The elevated rates of suicidal ideation, attempts and demoralization among income support recipients were in part explained by sociodemographic characteristics (socioeconomic status, age, educational qualification, experience of serious violence, loneliness, experience of psychiatric disorders), though the unemployed and disability payment recipients remained elevated on the psychological measures. Conclusions: Demoralization, poor mental health and suicidal behaviour are common among income support recipients targeted by recently announced welfare reforms. This needs to be considered in the design and implementation of Australian Government policies. Psychiatric epidemiology has a key role in policy development and evaluation. [ABSTRACT FROM AUTHOR]

Based on past cross-cultural research, it was hypothesised that people who had strong individualistic values and beliefs within an individualistic culture would have smaller social support networks, lower emotional competence, lower intentions to seek help from a variety of sources, and poorer mental health. A total of 276 first-year students attending an Australian university completed an anonymous survey assessing individual differences in individualism (i.e., idiocentrism), social support, emotional competence, hopelessness, depression, and suicide ideation. As expected, idiocentrism was associated with smaller and less satisfying social support networks, less skill in managing both self and others 'emotions, lower intentions to seek help from family and friends for personal and suicidal problems, and higher levels of hopelessness and suicide ideation. Thus, there appear to be social and psychological disadvantages associated with having strong individualistic values and beliefs within an individualistic culture. The implications of these findings for health promotion programs in schools and communities are discussed. [ABSTRACT FROM AUTHOR]

In common with colonized Indigenous people worldwide, many Australian Aboriginal people experience inequitable health outcomes. While the commitment and advocacy of researchers and health practitioners has resulted in many notable improvements in policy and practice, systemic and structural impediments continue to restrain widespread gains in addressing Indigenous health injustices. We take Rheumatic Heart Disease (RHD), a potent marker of extreme health inequity, as a case study, and critically examine RHD practitioners' perspectives regarding the factors that need to be addressed to improve RHD prevention and care. This study is an important explanatory component of a broader study to inform new clinical practices, and health system strategies and policies to reduce RHD. A decolonising, critical medical anthropology (CMA) analysis of findings from 22 RHD practitioner in-depth interviews conducted in May 2016 revealed both practitioners' perceptions of health system shortcomings and a sense of hopelessness and powerlessness to transform existing health system inequities, the negative impacts of which were subsequently confirmed in a separate study of RHD patients' lived realities. We reveal how biomedical dominance, normalized deficit discourses and systemic racism influence the current policy and practice landscape, narrowing the intercultural space for productive dialogue and reinforcing the conditions that cause disease. To counter biomedical approaches that contribute to existing health inequities in health care, we recommend localized, strength-based, community-led research projects focused on actions that use critical decolonizing social science approaches to achieve system change. We demonstrate the importance of integrating biological and social sciences approaches in research, education/training, and practice to: 1) be guided by Indigenous strengths, knowledges and worldview, and 2) adopt a critical reflexive stance to examine systems, structures and practices. Such an approach facilitates productive cross-cultural dialogue and social transformation; providing direction and hope to practitioners, enhancing their knowledge, skills and capacity and improving Aboriginal health outcomes. • Biomedical approaches result in normalization of deficit discourses and racism. • Biomedicine limits practitioners' critical and reflective skills and sense of agency to address inequities. • Cultural safety, including reflexivity regarding power and privilege is needed. • Changes in systems and practice requires a combination of Indigenous knowledges, biomedical and social science approaches [ABSTRACT FROM AUTHOR]