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Biomedical subjects

Helen Christensen

Publications and source records attributed to Helen Christensen.

At least 19 recordsLinked to original sources
PubMed2007

APOE genotype and cognitive functioning in a large age-stratified population sample.

There is evidence that the cognitive effects of Alzheimer's disease can be seen decades before disease diagnosis. If this is the case, then the apolipoprotein E (APOE) *E4 allele might be expected to have effects on cognitive functioning earlier in the life span. To assess such effects, the authors examined data on the *E4 allele and cognitive functioning from a population sample of 6,560 Caucasians covering the age groups of 20-24, 40-44, and 60-64 years. Participants were assessed on tests of episodic memory, working memory, mental speed, reaction time, and reading vocabulary. Although performance on all tests except reading vocabulary declined across age groups, there was no effect of the APOE *E4 allele at any age. These results indicate that APOE *E4 does not have preclinical effects early in the life span on these cognitive functions. Cognitive aging effects between the ages of 20 and 64 years must not be due to preclinical Alzheimer's disease.

Adult↗
PubMed2006

Websites as a mode of delivering mental health information: perceptions from the Australian public.

BACKGROUND: Many people with a mental disorder do not access help from mental health services. Internet websites may be a useful tool for disseminating mental health information to those who remain untreated, however little is known about people's perceptions of websites as mental health information sources. The current study examined characteristics that may influence belief in the helpfulness of websites as modes of delivering information about mental health. The study compared belief in the helpfulness websites to two traditional sources (bibliotherapy and health educators). METHODS: A total of 3,998 Australians aged 18 and above were surveyed. Logistic regression was used to explore the factors associated with rating a website, book and health educator as helpful sources of mental health information for a person described as having either depression, depression with suicidal thoughts, early schizophrenia or chronic schizophrenia. Factors investigated were demographics, exposure to mental illness, beliefs about dealing with mental illness alone, and personal and perceived stigmatising attitudes. RESULTS: Considerably more participants rated bibliotherapy and health educators as helpful in comparison to websites. Predictors of rating a website and book as helpful were identical; younger age, belief that it is helpful to deal with mental illness alone and being presented with depression and early schizophrenia vignettes in comparison to chronic schizophrenia. Predictors of rating a health educator as helpful were younger age, less personal stigma and being presented with a depression (without suicidal thoughts) vignette in comparison to chronic schizophrenia. CONCLUSIONS: These findings suggest the need for multiple modes of delivering mental health information. While many people feel that information delivered face-to-face is likely to be helpful, websites and other tools that maintain anonymity may be preferred by those who choose to or find themselves dealing with mental illness alone.

Adult↗
PubMed2006

The brain reserve hypothesis, brain atrophy and aging.

BACKGROUND: Researchers have used the concept of brain reserve to explain the dissociation between pathological brain damage and cognitive and functional performance. A variety of brain reserve hypotheses exist, and different empirical strategies have been employed to investigate these variants. OBJECTIVE: The study investigates (i) the relationship between measures of brain burden (atrophy, white matter hyperintensities (WMH)) and measures of reserve (education, creativity, and intelligence); (ii) the relationship between cognitive decline and reserve; (iii) whether measures of reserve mediate the effect of atrophy on estimated cognitive change, and (iv) the association between brain risk factors, education and atrophy. METHODS: A cross-sectional study of a sample of 446 individuals 60-64 years of age who underwent MRI scans as part of a large epidemiological study. Measures were taken of education, intelligence, creativity, cognitive speed, brain volume, WMH, estimated cognitive decline from earlier in life and brain atrophy. RESULTS: No association was found between estimated cognitive decline and brain burden (atrophy, WMH). Risk factors for brain insult were not associated with greater brain atrophy in the less well educated. Neither education, nor any other measure including intelligence or creativity, provided a buffer for cognitive decline in individuals with high levels of brain atrophy. CONCLUSION: Little support was found for the brain reserve hypothesis.

Aging↗
PubMed2006

Stigma in response to mental disorders: a comparison of Australia and Japan.

BACKGROUND: There are few national or cross-cultural studies of the stigma associated with mental disorders. Australia and Japan have different systems of psychiatric health care, and distinct differences in cultural values, but enjoy similar standards of living. This study seeks to compare the nature and extent of stigma among the public in the two countries. METHODS: A household survey of the public was conducted in each country using similar methodologies. The Australian study comprised a national survey of 3998 adults aged over 18 years. The Japanese survey involved 2000 adults aged 20 to 69 from 25 regional sites distributed across the country. Interviewees reported their personal attitudes (personal stigma, social distance) and perceptions of the attitudes of others (perceived stigma, perceived discrimination) in the community with respect to four case vignettes. These vignettes described a person with: depression; depression with suicidal ideation; early schizophrenia; and chronic schizophrenia. RESULTS: Personal stigma and social distance were typically greater among the Japanese than the Australian public whereas the reverse was true with respect to the perception of the attitudes and discriminatory behaviour of others. In both countries, personal stigma was significantly greater than perceived stigma. The public in both countries showed evidence of greater social distance, greater personal stigma and greater perceived stigma for schizophrenia (particularly in its chronic form) than for depression. There was little evidence of a difference in stigma for depression with and without suicide for either country. However, social distance was greater for chronic compared to early schizophrenia for the Australian public. CONCLUSION: Stigmatising attitudes were common in both countries, but negative attitudes were greater among the Japanese than the Australian public. The results suggest that there is a need to implement national public awareness interventions tailored to the needs of each country. The current results provide a baseline for future tracking of national stigma levels in each country.

Adult↗
PubMed2006

The effect of web based depression interventions on self reported help seeking: randomised controlled trial [ISRCTN77824516].

BACKGROUND: To date, there has been very little work investigating behaviour changes induced by interventions that are designed to increase help seeking. The present paper examines the effects of two Internet depression websites on help seeking. METHODS: 414 individuals with elevated scores on a depression assessment scale were randomly allocated to a depression information website, a cognitive-behavioural skills training website (CBT) or an attention control condition. Reports of help seeking for specific treatments, from specific sources and for categories of treatments were assessed. RESULTS: Relative to the control, the depression information site was associated with decreases in seeking support from friends and family, the use of music and of everyday treatments and no increase in seeking evidence based interventions. The CBT site was associated with the report of help seeking for CBT, massage and exercise. CONCLUSION: Methods to encourage the use of evidence-based treatments need further research to determine whether the assistance sought is evidence based and whether there are unintended effects.

Adolescent↗
PubMed2006

Effects of a cognitive-behavioural internet program on depression, vulnerability to depression and stigma in adolescent males: a school-based controlled trial.

This study evaluated the effectiveness of a cognitive behaviour therapy Internet program (MoodGYM) for depressive symptoms, attributional style, self-esteem and beliefs about depression, and on depression and depression-vulnerable status in male youth. A total of 78 boys age 15 and 16 years were allocated to either undertake MoodGYM or to standard personal development activities. Outcomes were measured before commencement, post-program and 16 weeks post-program. There were no significant between-group differences in change scores pre- to post- or pre- to follow-up using the intention to treat sample or for participants with post- and/or follow-up data. For boys completing 3 or more modules there were small relative benefits of MoodGYM for depressive symptoms (Effect Size, ES = 0.34), attributional style (ES = 0.17) and self-esteem (ES = 0.16) at post-program, although only the effect for self-esteem was sustained at follow-up. Both groups showed improvement in their beliefs about depression at follow-up, with the control group showing a moderate relative benefit (ES = 0.40). While the numbers are small, there was a reduction in the risk of being depressed in the MoodGYM group of 9% at post-treatment compared with a slightly increased risk for the control group. The risk of being classified as vulnerable to depression reduced by 17% in the MoodGYM group at post-treatment compared with no change in risk for the control group. These reductions in risk for the MoodGYM group were not sustained at follow-up. The limitations of the study highlight several important challenges for MoodGYM and other self-directed Internet cognitive behaviour therapy programs. These include how to ensure enough of the program is received and that people who could potentially benefit access the program and continue to remain engaged with it, and how to enhance the sustainability of any benefits.

Adolescent↗
PubMed2006

The warpy thoughts scale: a new 20-item instrument to measure dysfunctional attitudes.

Cognitive theories of psychopathology propose that specific negative cognitive schema held by individuals can increase their likelihood of experiencing depressive episodes. While it has been argued that such dysfunctional attitudes are state measures that occur primarily during periods of depression, a range of research has supported the view that holding dysfunctional attitudes is ongoing, persisting prior to and following depressive episodes. To date, the need for a parsimonious measure of dysfunctional attitudes has not been well addressed. Using data provided by 4545 participants in a free on-line cognitive behavioural therapy program, MoodGYM, we have developed the Warpy Thoughts Scale (WTS), a 20-item instrument measuring dysfunctional attitudes. This scale provides 3 first order factors (Relationships, Achievements and Entitlements) and a higher order factor, Warpy Thoughts, from which a Warpy Thoughts score can be obtained. Confirmatory factor analyses on this model indicated that it provides robust results for men and women and for individuals in a wide range of ages. WTS scores were moderately correlated with levels of depressive and anxiety symptoms (0.39 and 0.40, respectively) and explained up to one-fifth of the variance of these mental health measures. Further validation of the WTS against other measures of dysfunctional thoughts is required.

Achievement↗
PubMed2006

The public's ability to recognize mental disorders and their beliefs about treatment: changes in Australia over 8 years.

OBJECTIVE: A national survey of Australian adults in 1995 showed a low level of recognition of mental disorders and beliefs about treatment that were often discordant with those of professionals. The present study aimed to find out whether recognition and treatment beliefs have changed over 8 years. METHOD: A national survey of 2001 adults in 2003-2004 included the same questions as the 1995 survey. These interview questions were based on a vignette of a person with either depression or schizophrenia. RESULTS: Over the 8 years, the public showed better recognition of depression and schizophrenia and gave more positive ratings to a range of interventions, including help from mental health professionals, medications, psychotherapy and psychiatric ward admission. CONCLUSIONS: The Australian public's beliefs have changed over 8 years to be more like those of mental health professionals. This change may have positive implications for help-seeking and treatment concordance.

Adolescent↗
PubMed2006

Changes in depression awareness and attitudes in Australia: the impact of beyondblue: the national depression initiative.

OBJECTIVE: To assess changes in depression awareness and attitudes in Australia and the effect that beyondblue: the national depression initiative has had on these. METHOD: Data from national surveys of mental health literacy in 1995 and 2003-2004 were analysed to see if states and territories that funded beyondblue (the high-exposure states) had greater changes than those that did not (the low-exposure states). In both surveys, participants were shown a depression vignette and asked whether they themselves or family or friends had ever had a similar problem, whether they thought the person would be discriminated against, and questions about the likelihood of long-term positive and negative outcomes for the person. Participants were also assessed for symptoms of psychological distress in the past month. RESULTS: There was an increase in the percentage of people who said that they or their family or friends had a problem like the person in the vignette. This increase was greater in the high-exposure states. However, there was no change in reports of current psychological distress, suggesting that there is greater depression awareness or openness rather than a real increase in symptoms. People in the high-exposure states also showed an increase in the belief that discrimination would occur. There was little change in beliefs about long-term outcomes, apart from people in high-exposure states believing that a depressed person would be more understanding of other people's feelings. CONCLUSIONS: The data are consistent with beyondblue having had an effect on awareness of depression and of discrimination against depressed people.

Adolescent↗
PubMed2006

Stigma about depression and its impact on help-seeking intentions.

OBJECTIVE: Research has shown that people are reluctant to seek professional help for depression, especially from mental health professionals. This may be because of the impact of stigma which can involve people's own responses to depression and help-seeking (self stigma) as well as their perceptions of others' negative responses (perceived stigma). The aim of this article was to examine community help-seeking intentions and stigmatizing beliefs associated with depression. METHOD: A total of 1,312 adults randomly sampled from the Australian community completed a questionnaire providing a depression vignette and measures of self- and perceived-stigmatizing responses, source-specific help-seeking intentions, current depressive symptoms and depression experience, and demographics. RESULTS: Many people reported they would feel embarrassed about seeking help from professionals, and believed that other people would have a negative reaction to them if they sought such help. Some expected professionals to respond negatively to them. Responses varied according to the sources of professional help. Self-embarrassment and expectations that others would respond negatively predicted the likelihood of help-seeking from professional sources. CONCLUSION: Self- and perceived-stigmatizing responses to help-seeking for depression are prevalent in the community and are associated with reluctance to seek professional help. Interventions should focus on minimizing expectations of negative responses from others and negative self-responses to help-seeking, and should target younger people.

Adolescent↗
PubMed2006

Free range users and one hit wonders: community users of an Internet-based cognitive behaviour therapy program.

OBJECTIVE: Little is known about the predictors of symptom change or the methods that might increase user 'compliance' on websites designed to improve mental health outcomes. The present paper: (i) examines predictors of expected final depression and anxiety scores on the MoodGYM website as a function of user characteristics; and (ii) compares the compliance rates of the original site with the new public version of the site (MoodGYM Mark II). The latter site requires compulsory completion of 'core' online assessments and may increase completion of site questionnaires. METHOD: MoodGYM Mark I participants were 19,607 visitors (public registrants) between April 2001 and September 2003 plus 182 participants who had been randomly assigned to MoodGYM in an earlier trial (The BlueMood Trial). MoodGYM Mark II participants were 38,791 public registrants of the MoodGYM Mark II site collected between September 2003 and October 2004. Symptom assessments are repeated within the website intervention to allow the examination of change in symptoms. Outcome variables were gender, initial depression severity scores, number of assessments completed and final anxiety and depression scores. RESULTS: Men are predicted to be 0.19 units (SE=0.095) higher than women on depression, controlling for the initial depression level and number of modules completed. For initial depression scores above 2, it is predicted that the final score will indicate improvement relative to the initial score, the magnitude of the improvement increasing as a function of the number of modules attempted. For initial anxiety scores above 2, it is predicted that the final score will indicate improvement relative to the initial score, the magnitude of the improvement increasing as a function of the number of modules attempted. Mark II registrants were more likely than to Mark I registrants to complete onsite assessments. CONCLUSIONS: Visitors to the MoodGYM site are likely to have better psychological outcomes if they complete more of the site material. Compulsory completion of core sections increases assessment completion. There is a need to examine further the significance of attrition from online interventions, to develop methods of handling missing data, and to investigate strategies to improve visitor dropout.

Anxiety↗
PubMed2006

Prevalence, risk factors and treatment for substance abuse in older adults.

PURPOSE OF REVIEW: This paper briefly outlines new research on the epidemiology of alcohol and drug use in the older population, describes mental and cognitive consequences of substance use and summarizes recent treatment trials for alcohol dependence. RECENT FINDINGS: Cross-sectional and longitudinal studies indicate that alcohol use is less prevalent in older groups, and it decreases over time. Comorbidity (alcohol and other drugs, alcohol with mental health disorders) is high. An inverse-U-shaped curve describes the association between alcohol consumption and cognitive impairment with increased impairment for abstainers and high users as compared with moderate users. Trials of alcohol use in the older population are rare, but they suggest that brief patient education may reduce drinking levels in primary care populations, and that, for some users, integrated primary care may be more useful than referral to specialist care. SUMMARY: The basis for higher risk in abstainers is not resolved. More randomized controlled trials are needed, which target alcohol use and dependence and also focus on comorbid disorders.

Aged↗
PubMed2006

An instrument to measure engagement in life: factor analysis and associations with sociodemographic, health and cognition measures.

BACKGROUND: It has been proposed that active engagement with life may protect against cognitive decline. However, existing instruments for measuring life engagement have covered limited domains. OBJECTIVE: To present a new instrument to measure engagement with life; the RIASEC Activities List draws on activities categorised according to interest categories previously developed by Holland: Realistic, Investigative, Artistic, Social, Enterprising and Conventional (RIASEC). METHODS: Participants in a longitudinal, community-based survey were drawn from 3 age groups: 2,404 participants aged 20-24; 2,530 aged 40-44, and 2,551 aged 60-64 years. They provided information on which of 54 selected activities they had performed in the 6 months prior to their survey interview. Other information obtained from participants included measures of sociodemographic characteristics, personality attributes and mental and physical health. Two measures of cognition were also examined. Analyses were conducted separately for men and women in each of the 3 age groups. RESULTS: Confirmatory factor analyses identified six scales of activity types corresponding to Holland's six interest categories. The number of activities of any type undertaken in the past 6 months was significantly associated with cognitive measures, better physical health, and better mental health although these findings varied for men and women across the 3 age groups. Further, for both men and women in all age groups, performing activities of any type was associated with having higher extraversion and mastery scores, and lower levels of neuroticism. Associations were also found between performing specific types of activities and cognitive measures. CONCLUSIONS: This instrument has the potential to identify more clearly types of activities that may offer cognitive benefits and warrants further testing in longitudinal studies.

Adult↗
PubMed2006

Search for a common cause factor amongst cognitive, speed and biological variables using narrow age cohorts.

BACKGROUND: Cross-sectional studies have demonstrated that age-related effects on many cognitive and biological functioning variables are shared. A number of theories postulate that these associations arise from a common causal mechanism responsible for change across a wide range of functions. However, it has been claimed that the finding of shared variance among variables in these studies may be spurious because most studies have been cross-sectional and based on age-heterogeneous samples. OBJECTIVE: To examine evidence for changes with age in variance shared by cognitive variables using a narrow-age cohort design. METHODS: Three samples of adults with age ranges 20-24 years (n = 2,404), 40-44 years (n = 2,530) and 60-64 years (n = 2,510) were drawn from a population-based study. These groups were supplemented by data from an older sample of individuals (77 years and over) from a second population-based study (n = 374). Four models of the structure of a range of cognitive, speed and biological variables derived from previous cross-sectional research were fitted to data. These models were complete independence of variables within a cohort, a single common factor, multiple independent factors, and a second order factor model. RESULTS: Model fit and the magnitude of loadings from multiple-group confirmatory factor analyses was compared between age groups. The fit for all four models was worse in the 60-64 year age group. Factor loadings on the common factor specified in these models varied between the groups, but the speed factor rather than the biological factor showed increased loadings as a function of age. CONCLUSIONS: This narrow age-cohort study did not support the existence of developmental changes in the structure of cognitive and biological variables across the lifespan. Shared variation between measures of cognition and biological function may be an artifact of the research designs that have generated these findings. This casts doubt of the existence of a common causal mechanism. However, it may be that such changes manifest only in later old age.

Adult↗
PubMed2005

Automated assessment of the quality of depression websites.

BACKGROUND: Since health information on the World Wide Web is of variable quality, methods are needed to assist consumers to identify health websites containing evidence-based information. Manual assessment tools may assist consumers to evaluate the quality of sites. However, these tools are poorly validated and often impractical. There is a need to develop better consumer tools, and in particular to explore the potential of automated procedures for evaluating the quality of health information on the web. OBJECTIVE: This study (1) describes the development of an automated quality assessment procedure (AQA) designed to automatically rank depression websites according to their evidence-based quality; (2) evaluates the validity of the AQA relative to human rated evidence-based quality scores; and (3) compares the validity of Google PageRank and the AQA as indicators of evidence-based quality. METHOD: The AQA was developed using a quality feedback technique and a set of training websites previously rated manually according to their concordance with statements in the Oxford University Centre for Evidence-Based Mental Health's guidelines for treating depression. The validation phase involved 30 websites compiled from the DMOZ, Yahoo! and LookSmart Depression Directories by randomly selecting six sites from each of the Google PageRank bands of 0, 1-2, 3-4, 5-6 and 7-8. Evidence-based ratings from two independent raters (based on concordance with the Oxford guidelines) were then compared with scores derived from the automated AQA and Google algorithms. There was no overlap in the websites used in the training and validation phases of the study. RESULTS: The correlation between the AQA score and the evidence-based ratings was high and significant (r=0.85, P<.001). Addition of a quadratic component improved the fit, the combined linear and quadratic model explaining 82 percent of the variance. The correlation between Google PageRank and the evidence-based score was lower than that for the AQA. When sites with zero PageRanks were included the association was weak and non-significant (r=0.23, P=.22). When sites with zero PageRanks were excluded, the correlation was moderate (r=.61, P=.002). CONCLUSIONS: Depression websites of different evidence-based quality can be differentiated using an automated system. If replicable, generalizable to other health conditions and deployed in a consumer-friendly form, the automated procedure described here could represent an important advance for consumers of Internet medical information.

Australia↗
PubMed2005

Website quality indicators for consumers.

BACKGROUND: The rating tool DISCERN was designed for use by consumers without content expertise to evaluate the quality of health information. There is some evidence that DISCERN may be a valid indicator of evidence-based website quality when applied by health professionals. However, it is not known if the tool is a valid measure of evidence-based quality when used by consumers. Since it is a lengthy instrument requiring training in its use, DISCERN may prove impractical for use by the typical consumer. It is therefore important to explore the validity of other simpler potential indicators of site quality such as Google PageRank. OBJECTIVE: This study aimed to determine (1) whether the instrument DISCERN is a valid indicator of evidence-based Web content quality for consumers without specific mental health training, and (2) whether Google PageRank is an indicator of website content quality as measured by an evidence-based gold standard. METHODS: This was a cross-sectional survey of depression websites using consumer and health professional raters. The main outcome measures were (1) site characteristics, (2) evidence-based quality of content as measured by evidence-based depression guidelines, (3) DISCERN scores, (4) Google PageRank, and (5) user satisfaction. RESULTS: There was a significant association between evidence-based quality ratings and average DISCERN ratings both for consumers (r = 0.62, P = .001) and health professionals (r = 0.80, P < .001). Consumer and health professional DISCERN ratings were significantly correlated (r = 0.77, P < .001). The evidence-based quality score correlated with Google PageRank (r = 0.59, P = .002). However, the correlation between DISCERN scores and user satisfaction was higher than the correlation between Google PageRank and user satisfaction. CONCLUSIONS: DISCERN has potential as an indicator of content quality when used either by experts or by consumers. Google PageRank shows some promise as an automatic indicator of quality.

Consumer Behavior↗