Biomedical subjects

Gene Hodgins

Publications and source records attributed to Gene Hodgins.

13 recordsLinked to original sources

PubMed2005

Changing places: the impact of rural restructuring on mental health in Australia.

Significant demographic, social and economic change has come to characterise much of rural Australia, with some authors arguing there are now two sharply differentiated zones, one of growth and one of decline. This restructuring process, which has been similar to other western nations, has had a profound impact upon rural places-socially, economically and physically. Findings from research investigating the relationship between health, place and income inequality suggest that rural 'desertification', which is characterised by decline of the agricultural sector, net population loss and the deterioration of demographic structures, may negatively influence mental health outcomes in these areas. By contrast, the growth in rural areas, which is associated with expanding employment opportunities and the movement of capital and people, may confer positive benefits to mental health. The aim of this study was to investigate differences in mental health and well-being between rural communities experiencing growth and decline as measured by net population change. Utilising a survey methodology, questionnaires were distributed to 20,000 people randomly sampled from the electoral role in rural Australia. We selected four sub-regions from the sample area that were characteristic of areas experiencing population growth and decline in Australia and analysed the results of respondents from these four regions (n = 1334). The analysis provided support for our hypothesis that living in a declining area is associated with poorer mental health status; however, the factors that underpin growth and decline may also be important in influencing mental health. Discussed are the mechanisms by which demographic and social change influence mental health. The findings of this study highlight the diversity of health outcomes in rural areas and suggest that aspects of place in declining rural areas may present risk factors for mental health.

Adult↗

PubMed2005

A model of supervision in mental health for general practitioners.

OBJECTIVE: If general practitioners (GPs) are to provide effective ongoing care to patients with mental health difficulties, it is argued that they need access to effective supervision. This paper aims to describe a specific framework for the provision of supervision to GPs involved in mental health-related work in a rural area. CONCLUSIONS: An innovative model of supervision is currently being trialled with GP practices in the Bendigo area of country Victoria. It is essential for a formal supervision framework to be available for GPs in mental health, so that effective outcomes in primary mental health care are maximized, facilitating better support for GPs and better outcomes for patients with mental health difficulties.

Adult↗

PubMed2005

Therapeutic group programme for women with postnatal depression in rural Victoria: a pilot study.

OBJECTIVE: The aim of this study was to examine the effectiveness of a therapeutic group programme, provided by community health workers, in reducing anxiety and depressive symptoms associated with postnatal depression (PND) among women living in a rural setting. METHOD: A prospective repeated measures design was used. Women reporting difficulties in the postnatal period were recruited through community health services. Training was provided to community health workers, who then facilitated a 9 week group programme (cognitive-behavioural strategies) for women with PND. The Edinburgh Postnatal Depression Scale and the Hospital Anxiety and Depression Scale measured depressive and anxiety symptoms before starting the group programme, at the completion of the programme and at two follow-up times. RESULTS: Fourteen women completed the group programme at two sites in rural Victoria. Comparison of mean anxiety and depressive symptom scores revealed a significant reduction in scores from pre- to post-programme. For those women who also completed the follow-up symptom measurement, this reduction in symptoms was maintained. CONCLUSIONS: The results show that therapeutic group work is an effective intervention that can be applied by community health workers in a rural setting. Challenges for clinicians working with women experiencing PND in rural areas and implications for future research are discussed.

Adult↗

PubMed2005

Primary care psychiatry: taking consultation-liaison psychiatry to the community.

OBJECTIVE: To assist psychiatrists who work closely with general practitioners (GPs) at the primary/secondary care interface. CONCLUSION: The role of primary care psychiatrists can be enhanced by a sound appreciation of the general practice context, knowledge of the local mental health services and an understanding of the educational and clinical support needs of GPs.

Community Mental Health Services↗

PubMed2004

Rural Integrated Primary Care Psychiatry Programme: a systems approach to education, training and service integration.

OBJECTIVE: To describe the development of a rural primary care psychiatry programme, within a stepped collaborative care model. CONCLUSION: Development of a system-wide approach to the provision of mental health services offers the opportunity to increase the proportion of people with mental health problems who receive effective treatment. In addition, it enables allocation of resources and matching of interventions to patient preference and clinical need. This is particularly important in rural areas where there is a shortage of specialist mental health services and practitioners.

Community Health Workers↗

PubMed2004

Introducing a professional development programme to a rural area mental health service: the importance of context.

OBJECTIVE: To describe the introduction of an ongoing professional development programme for clinicians in a rural area mental health service. The programme involved a series of workshops delivered by clinical psychologists. The training component of each workshop focused on discrete cognitive behavioural strategies, targeted at the amelioration of anxiety and mood symptoms. CONCLUSIONS: The paper emphasizes contextual aspects of the programme: its setting, the modality of delivery, resourcing issues and maximizing engagement by the participants. Preliminary evaluation data are reviewed, and it is argued that programmes that focus on local capacity building in rural settings are an important component of redressing the urban-rural imbalance in the availability of evidence-based psychological treatments.

Adolescent↗

PubMed2004

Rurality and mental health: the role of accessibility.

OBJECTIVE: The absence of an agreed definition of "rural" limits the utility of existing research into a possible relationship between rurality of residence and mental health. The present study investigates the bipolar dimension accessibility/remoteness as a possible correlate of mental health. METHOD: A continuous area of non-metropolitan Australia was selected to provide a range of scores on the Accessibility/Remoteness Index of Australia (ARIA). A questionnaire measuring demographics, the five-factor model of personality and three aspects of mental health (distress, disability and wellbeing) was mailed to 20 000 adults selected randomly from electoral rolls. RESULTS: Responses were received from 7615 individuals (response rate = 40.5%; 57.1% female). ARIA was not associated with either distress or disability measures, but a small negative association was found between accessibility and two measures of wellbeing. Individuals residing in locales with better access to services and opportunities for interaction reported higher levels of satisfaction with life (SWL) and positive affect (PA). Adjusting statistically for a range of demographic and personality correlates did not alter the effect of ARIA on SWL. The effect on PA remained significant after adjusting for demographics, but not once personality correlates entered the model. CONCLUSIONS: By sampling across a single proposed parameter of rurality, a novel profile of correlations was identified. In accord with existing data, accessibility was not associated with distress or disability. In contrast, accessibility was positively associated with the wellbeing aspect of mental health. Further attention to the measurement of rural place and the exploration of accessibility as a parameter with mental health relevance, is warranted.

Australia↗

PubMed2004

Training case managers to deliver focused psychological strategies.

Anxiety and mood disorders are prevalent in the Australian community and can be functionally disabling. Access to treatment for these disorders can be difficult, particularly in rural areas where there is limited availability of specialist mental health practitioners such as psychiatrists and clinical psychologists. One way to address this problem is to improve the skills of local mental health practitioners in recognizing and providing treatment for these disorders. This paper describes a program that aimed to enhance access to psychological treatment for depression and anxiety by improving the skills of rural mental health case managers through training and education and support by psychiatrists and clinical psychologists. Thirty-two case managers participated in the program which delivered 10 training modules using a cognitive behavioural therapy framework. Case managers consisted primarily of psychiatric nurses, with others having social work or psychology backgrounds. Participants were assessed pre- and post-training using quantitative and qualitative measures. The effect of the training was noted in several areas including attitudinal changes, improved knowledge of psychological therapies, and changes to stated practice. However, there was concern expressed by participants about their competence and confidence to translate skills learned into practice. While the results of such a program are promising, they highlight some of the complexities of delivering such programs in rural settings.

Adult↗

PubMed2004

Interpersonal counselling in general practice.

BACKGROUND: Interpersonal counselling (IPC) derives from interpersonal psycho-therapy (IPT) but is briefer in the number and duration of sessions and is particularly suited to the primary care setting. While depression and other psychological symptoms are not necessarily 'caused' by interpersonal problems, they do occur in a social and interpersonal context. Problem areas commonly associated with the onset of depression are unresolved grief, interpersonal disputes, role transition and interpersonal deficits such as social isolation. OBJECTIVE: This article discusses IPC and how it can be used in the general practice setting. DISCUSSION: The structure of IPC is of a brief treatment of six sessions, each with an explicit focus: assessment, education about the interaction between interpersonal relationships and psychological symptoms, identifying current stress areas and helping the patient deal with these more positively and termination of the IPC relationship. Interpersonal counselling can be utilised general practice to reduce psychological symptoms, restore morale, improve self esteem and the quality of the patient's social adjustment and interpersonal relationships.

Adult↗

PubMed2003

First year of practice visits for the Rural Depression Anxiety Research and Treatment General Practice program.

OBJECTIVE: To describe the first 12 months activities of a key component of a General Practice Psychiatry program - the GP practice visit. DESIGN: Questionnaire to evaluate effects on participating general practitioners practice. SETTING: Rural group general practices. SUBJECTS: Thirty-two general practitioners in the Loddon Campaspe Southern Mallee region in Victoria. INTERVENTIONS: Practice visits involved a combination of each of three key activities: primary consultation, secondary consultation and/or case discussion and formal teaching. RESULTS: General practitioners reported a variety of changes in their practice as a result of the visits. CONCLUSION: Practice visits appear to be a useful means of influencing GP's practice. Further work is required to determine whether such changes are accompanied by demonstrable benefits in patient outcome. WHAT IS ALREADY KNOWN: Several models to assist GPs effectively manage mental health problems have been described. These models require regular contact and so have had limited utility in rural settings. WHAT THIS STUDY ADDS: This study suggests that infrequent contact or input, based on well established models, can alter GP's clinical behaviour.

Anxiety↗

PubMed2002

The mental health of rural Australians: developing a framework for strategic research.

This paper argues that lack of adequate research is a barrier to the long-term improvement of the mental health and well-being of rural Australians. Following from national mental health policy, potential research avenues in four broad domains (prevention and early intervention, pathways to care, outcome of illness and aetiology) are defined. These four broad domains are interdependent and research into them can be brought together into a simple framework or model. This model could be used to guide research into rurality and mental health. The proposed model uses the inclusive concept of place to capture the potential complexities of the rural locale as a variable in mental health and disorder. The model's predictor variables include both risk and resilience factors, and the outcome variables extend beyond morbidity to positive psychological wellness. It is proposed that this provisional model, and the strategic research that it directs, will act as a useful counterpoint to the more immediate evaluation and resourcing needs that confront rural mental health.

Australia↗

PubMed2002

High prevalence disorders in urban and rural communities.

OBJECTIVE: High prevalence disorders (anxiety, depressive and substance use) are generally assumed to be more common in urban than rural dwellers. The aims of this paper are (i) to critically review studies measuring prevalence in rural as opposed to urban location, and (ii) to argue the need to look beyond the 'quantity' question to the quality question: how does urban or rural place influence mental health? METHOD: A literature review (Medline and PsychLIT) was carried out using the words 'rural, urban, mental/psychiatric, illness/disorders and prevalence', as well as a review of relevant papers and publications known to the authors. RESULTS: Many studies examining urban/rural differences in the rate of high prevalence disorders have been reported. Most use a 'one size fits all' definition of urban and rural, which assumes location is the key issue. The majority fail to show the purported difference in prevalence between the two settings. In general, studies have not examined interaction effects, but have simply treated the independent variables as main effects. Available data suggest that a variety of socio-demographic factors are more powerful predictors of difference in prevalence than is the location of residence. CONCLUSION: Further studies are required to understand if and how rural or urban place contributes to the development of psychiatric morbidity. These studies should mirror the clinical situation by taking into account a variety of individual and community-based (including urban/rural place) risk factors which may be important determinants of mental health and mental illness, and examining the interaction between them. This may then identify the nature of any differences or what issues are specific to, or especially important, in the rural setting.

Anxiety Disorders↗

PubMedDate not supplied

Dual relationships in mental health practice: issues for clinicians in rural settings.

OBJECTIVE: This paper aims to provide an overview of the literature on non-sexual dual relationships, and to discuss these in the context of rural mental health practice in Australia. METHOD: An internet-driven literature search was undertaken using OVID databases, which include MEDLINE, PsycINFO, CINAHL, and EMBASE: Psychiatry. Ethical codes of practice for the mental health professions of psychiatry, psychology, occupational therapy, social work and nursing were referred to. Searches were not limited by year of publication. Other unpublished material or information was included where relevant. RESULTS: Dual relationships are common in rural mental health practice. However, research on non-sexual dual relationship boundary issues in rural mental health is limited. Ethical codes of practice of mental health professional bodies provide little guidance regarding non-sexual dual relationships. Decision-making models addressing the ethics of dual relationships are restricted to considerations of whether to enter a dual relationship rather than how to manage such a relationship. CONCLUSIONS: Everyday' dual relationships are a predictable part of rural mental health practice. Further research is required to identify the benefits and/or problems in clinical practice resulting from non-sexual dual relationships. Responsibility for identifying and implementing ways of appropriately managing such relationships should be shared by the patient, the clinician, mental health services and professional organizations.

Australia↗