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Biomedical subjects

Kay Wilhelm

Publications and source records attributed to Kay Wilhelm.

At least 19 recordsLinked to original sources
PubMed2006

Expressive writing for high-risk drug dependent patients in a primary care clinic: a pilot study.

BACKGROUND: Previous research has shown that expressive writing is beneficial in terms of both physical and emotional health outcomes. This study aimed to investigate the effectiveness and acceptability of a brief expressive writing intervention for high-risk drug dependent patients in a primary care clinic, and to determine the relationship between linguistic features of writing and health outcomes. METHODS: Participants completed four 15-minute expressive writing tasks over a week, in which they described their thoughts and feelings about a recent stressful event. Self-report measures of physical (SF-12) and psychological health (DASS-21) were administered at baseline and at a two-week follow-up. Fifty-three participants were recruited and 14 (26%) completed all measures. RESULTS: No statistically significant benefits in physical or psychological health were found, although all outcomes changed in the direction of improvement. The intervention was well-received and was rated as beneficial by participants. The use of more positive emotion words in writing was associated with improvements in depression and stress, and flexibility in first person pronoun use was associated with improvements in anxiety. Increasing use of cognitive process words was associated with worsening depressive mood. CONCLUSION: Although no significant benefits in physical and psychological health were found, improvements in psychological wellbeing were associated with certain writing styles and expressive writing was deemed acceptable by high-risk drug dependent patients. Given the difficulties in implementing psychosocial interventions in this population, further research using a larger sample is warranted.

Journal Article↗
PubMed2006

Serotonin transporter gene status predicts caudate nucleus but not amygdala or hippocampal volumes in older persons with major depression.

BACKGROUND: Although the short allele of the serotonin transporter promoter polymorphism (5-HTT) has been linked to increased risk of major depression in early adult life, its relationships with late-life depression and to changes in subcortical nuclei remain unclear. METHODS: 5-HTT genotypes (SS, SL, LL) were determined for 45 older persons with major depression (mean age=52.0, sd=12.8) and 16 healthy controls (mean age=55.8, sd=10.3). MRI-derived volumes of the amygdala, hippocampus, caudate and putamen were determined by reliable tracing techniques. RESULTS: In those with depression, the short allele of 5-HTT was associated with smaller caudate nucleus volumes. Although hippocampal and amygdala volumes were smaller in those with depression as compared with control subjects, 5-HTT gene status did not predict this reduction in size. LIMITATIONS: The findings are limited by the number of clinical and control participants. CONCLUSIONS: Reduced caudate nucleus volume in older patients with major depression was associated with the short allele of the 5-HTT gene. This regional brain change may be a consequence of early developmental expression as well as later vascular or degenerative effects of this genotype.

Aged↗
PubMed2006

Where there's smoke, there's fire: high prevalence of smoking among some sub-populations and recommendations for intervention.

In Australia, the prevalence of smoking is higher among certain sub-populations compared to the general population. These sub-populations include Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse backgrounds, as well as people with mental and substance use disorders and prisoners. The aims of this paper are to: describe the high prevalence of smoking among these particular sub-populations and harms associated with smoking; explore possible reasons for such high prevalence of smoking; review the evidence regarding the efficacy of existing smoking cessation interventions; and make recommendations for smoking interventions and further research among these groups. In addition to low socio-economic status, limited education and other factors, there are social, systems and psychobiological features associated with the high prevalence of smoking in these sub-groups. General population-based approaches to reducing smoking prevalence have been pursued for decades with great success and should be continued with further developments that aim specifically to affect Aboriginal and Torres Strait Islander people and some cultural groups. However, increasing attention, more specific targeting and flexible goals and interventions are also required for these and other distinct sub-populations with high smoking prevalence. Recommendations include: more funding and increased resources to examine the most appropriate education and treatment strategies to promote smoking cessation among people from Aboriginal and Torres Strait Islander and some culturally and linguistically diverse backgrounds; larger and better-designed studies evaluating smoking cessation/reduction interventions among distinct sub-groups; and system-wide interventions requiring strong leadership among clients and staff within mental health, drug and alcohol and prison settings.

Alcoholism↗
PubMed2006

Smoking cessation and depression: current knowledge and future directions.

This paper reviews the literature on comorbid smoking and depression. Current models used to explain this co-occurrence are examined, as are treatment options (both psychological and pharmacological). This paper surmises that treatment planning should consider factors that potentially confound treatment efficacy, including the nature of the depressive illness and the patient's smoking profile. Although there is limited research examining the benefits of a stepped-care framework, a tiered treatment format appears to work well, assisting those who require minimal treatment, as well as those who prolonged difficulties. Further research examining a stepped-care framework for smokers at risk of depression is required, as is appropriate training for health practitioners using this model. Further directions for research and practice are also discussed.

Combined Modality Therapy↗
PubMed2006

Smoking and its correlates in an Australian prisoner population.

Despite evidence of high rates of smoking among prisoners, there has been limited research that describes smoking patterns and risk factors associated with smoking in this group. This study describes inmate smokers and identifies factors associated with smoking in prison, using a survey comprising a cross-sectional random sample of inmates stratified by sex, age and Aboriginality. A total of 914 adult inmates (747 men, 167 women) were recruited from 29 New South Wales (Australia) correctional centres. Information on the prevalence of smoking, smoking history, smoking behaviours and other risk factors were collected. Of the participants, 79% were current smokers (78% men, 83% women). Younger inmates were more likely than older inmates to smoke (86% vs. 64%). Most individuals smoked between 11 and 20 cigarettes a day and a median of 50 grams per week. In the previous year, over half (52%) of current smokers had attempted to quit or reduce the amount they smoked. At the time of the survey, 58% of smokers had plans to quit; 21% within 3 months. Independent predictors of current smoking in the multivariate analysis were past use of cannabis and a history of illicit drug use. The prevalence of smoking in prison is extraordinarily high and exceeds that of the general community. Despite this, the majority of prisoners report plans to quit. Readily available smoking cessation advice, support and treatment are needed to assist those wanting to quit in this stressful environment. As the prevalence of smoking within the general community declines, assisting cessation in groups containing a disproportionate number of smokers will become increasingly important. Despite high levels of tobacco dependence, many prisoners intend to quit and health planners and custodial authorities need to encourage and support inmates who do attempt to quit.

Adult↗
PubMed2006

Why am I depressed?: An investigation of whether patients' beliefs about depression concur with their diagnostic subtype.

We investigated whether patients' beliefs about the causes of their depression concurred with their diagnostic subtype. Depressed patients (N = 196) attending a tertiary referral clinic completed a questionnaire regarding putative biological and nonbiological causes of their depression. Subtyping diagnoses of melancholic or nonmelancholic depression were made. Patients with nonmelancholic depression were more likely to attribute nonbiological factors as the cause of their depression than those with melancholic depression, whereas patients with melancholic depression were no more likely to attribute biological factors as the cause of their depression. Patients can distinguish differing causes of depression. The implications of the findings for the current classificatory systems of depression are discussed.

Adolescent↗
PubMed2006

A randomized controlled trial of a smoking cessation intervention among people with a psychotic disorder.

OBJECTIVE: Despite extremely high rates of smoking among individuals with psychotic disorders and the associated financial and health costs, few studies have investigated the efficacy of smoking cessation interventions among this group. The purpose of this study was to compare an integrated psychological and nicotine replacement therapy intervention for people with a psychotic disorder with routine care alone. METHOD: The authors recruited 298 regular smokers with a psychotic disorder residing in the community and randomly assigned them to a routine care comparison condition (N=151) or an eight-session, individually administered smoking cessation intervention (N=147), which consisted of nicotine replacement therapy, motivational interviewing, and cognitive behavior therapy. Outcome variables included continuous and point-prevalence abstinence rates, smoking reduction status, and changes in symptoms and functioning. RESULTS: While there were no overall differences between the treatment group and comparison group in abstinence rates, a significantly higher proportion of smokers who completed all treatment sessions stopped smoking at each of the follow-up occasions (point-prevalence rates: 3 months, 30.0% versus 6.0%; 6 months, 18.6% versus 4.0%; and 12 months, 18.6% versus 6.6%). Smokers who completed all treatment sessions were also more likely to have achieved continuous abstinence at 3 months (21.4% versus 4.0%). There was a strong dose-response relationship between treatment session attendance and smoking reduction status, with one-half of those who completed the intervention program achieving a 50% or greater reduction in daily cigarette consumption across the follow-ups, relative to less than one-fifth of the comparison subjects. There was no evidence of any associated deterioration in symptoms or functioning. CONCLUSIONS: These findings demonstrate the utility of a nicotine replacement therapy plus motivational interviewing/cognitive behavior therapy smoking cessation intervention among individuals with a psychotic disorder. Further development of more efficacious interventions is required for those who do not respond to existing interventions.

Adult↗
PubMed2006

Life events, first depression onset and the serotonin transporter gene.

BACKGROUND: A relationship between the serotonin transporter gene, adverse events and onset of major depression has been reported. AIMS: To replicate a gene x environment interaction in a cohort with longitudinal data for life events, experience of depression, parental bonding and neuroticism. METHOD: At the 25-year follow-up, genomic DNA was obtained from 127 cohort members (mean age 48 years) to determine the genotype of the serotonin transporter gene-linked promoter region (5-HTTLPR). Associations were investigated between the 5-HTTLPR genotype, positive and adverse life events and the gene x environment interaction, and also between the 5-HTTLPR genotype and risk factors for depression. RESULTS: No relationship was found between 5-HTTLPR genotype and either risk factors for depression or positive life events. Adverse life events had a significantly greater impact on the onset of depression for individuals with the s/s genotype. CONCLUSIONS: The 5-HTTLPR genotype is a significant predictor of onset of major depression following multiple adverse events. This is one of the more robust findings concerning specific biological risk factors for depression.

Adult↗
PubMed2006

Depression--what should the doctor ask?

BACKGROUND: There are barriers to doctors detecting depression in general practice. We wondered what questions patients thought the doctor should ask to explore it appropriately. METHODS: One hundred and thirty-six teacher trainees, teachers, and students in the community, most of whom had experienced depression, were studied qualitatively in interviews and focus groups. They were asked to suggest what questions they would find helpful from doctors to elicit their experience of depression. Transcripts were grouped by gender and content analysed. RESULTS: Subjects suggested starting with open questions that act as signals for moving into emotional areas followed by specific questions about specific somatic expressions of depression. Men preferred questions about shorter fuse and anger toward others, while women were happy with questions about increased crying. DISCUSSION: If confirmed in other sectors of the community, these data may allow doctors to increase patients' comfort with their exploration of possible emotional problems such as depression.

Australia↗
PubMed2005

Vascular risk and low serum B12 predict white matter lesions in patients with major depression.

BACKGROUND: While patients with depression have been shown to have a greater incidence of vascular risk factors and structural brain changes, any association with dietary co-factors is unclear. METHODS: Forty-seven patients with major depression (mean age = 52.8 years, SD = 12.6) and 21 healthy volunteers (mean age = 54.7 years, SD = 9.1) underwent high-resolution magnetic resonance imaging scanning. T2-weighted films were scored for deep white matter (DWM), periventricular (PV), and subcortical (SC) hyperintensities. RESULTS: There was no difference in lesion severity between patients and control subjects. After controlling for age, vitamin B12 levels were predictive of DWM lesions in patients. DWM and SC lesions were associated with histories of hypertension and diabetes. LIMITATIONS: A relatively small sample of patients were recruited from specialist services and the findings may not represent those observed in larger or community-based cohorts. CONCLUSIONS: In patients with major depression, vitamin B12 levels and histories of hypertension and/or diabetes are predictive of white matter lesions.

Adult↗
PubMed2005

Great expectations: factors influencing patient expectations and doctors recommendations at a Mood Disorders Unit.

BACKGROUND: Literature about expectations and management of depression within community samples reflects attitudes of people who have generally not received treatment. We examined the factors influencing treatment expectations and psychiatrists' treatment recommendations for patients referred to a mood disorders unit with identified episodes of major depression. METHODS: Prior to attending a mood disorders unit, 182 men and women who met DSM-III-R or DSM-IV criteria for current major depression provided data on sociodemographic details, history of medical and psychiatric illness and expectations of treatment. Psychiatrists' treatment recommendations to the referring clinician were assessed to determine whether the patients' initial expectations were met. RESULTS: Data analyses revealed three factors relating to patients' expectations: "enhanced coping", "providing fresh ideas for the referring doctor" and "providing fresh ideas to self". Patients' expectations were influenced by sociodemographic and illness-related characteristics. In particular, young female patients typically expected to receive strategies to enhance coping, while those with lifetime anxiety expected less active involvement on their part. Some clinicians' recommendations were dependent upon depression type and patient factors. Women and those with a history of anxiety disorders received more education and recommendations for relationship counselling and support groups. LIMITATIONS: The study design did not allow determination of the impact of patients' expectations on the psychiatrists' recommendations. CONCLUSIONS: Individual and illness characteristics are important predictors of treatment expectations prior to specialist care. It appears that doctors take these factors into account with implications for patients' satisfaction with the type of care recommended.

Adaptation, Psychological↗
PubMed2005

The stability of the Parental Bonding Instrument over a 20-year period.

BACKGROUND: The Parental Bonding Instrument (PBI) measures the perception of being parented to the age of 16 years. Low scores on the care dimension and high scores on the overprotection dimension are considered to be risk factors of depression. While the PBI has been shown to be a reliable and valid instrument, the stability of the PBI over extended periods (taking into account individual characteristics and life experience) needs to be demonstrated. METHOD: The PBI was measured in a non-clinical cohort on four waves between 1978 and 1998, along with a series of self-report measures including state depression and neuroticism. Differences in PBI change over time were examined by gender, lifetime major depression diagnosis, and life event variables, as well as by scores on neuroticism and state depression. RESULTS: Acceptable retest coefficients on PBI scores over the 20-year study were found for the cohort. No differences were found in PBI scores over time on the variables examined, including sex and depression measures. CONCLUSIONS: The results indicate long-term stability of the PBI over time. The influences of mood state and life experience appear to have little effect on the stability of the perception of parenting as measured by the PBI. The present study increases confidence in the PBI as a valid measure of perceived parenting over extended time periods.

Adolescent↗
PubMed2005

Self-harming in depressed patients: pattern analysis.

OBJECTIVE: As deliberate self-harm (DSH) is a common concomitant of depressive disorders, we undertook a study examining the relevance of possible determinants and correlates of DSH. METHOD: Three separate samples of depressed outpatients were studied to determine consistency of identified factors across samples, with principal analyses involving gender, age and diagnosis-matched DSH and non-DSH subjects. RESULTS: Across the samples, some 20% of subjects admitted to episodes of DSH. Women reported higher rates and there was a consistent trend for higher rates in bipolar patients. Univariate analyses examined the relevance of several sociodemographic variables, illicit drug and alcohol use, past deprivational and abusive experiences, past suicidal attempts and disordered personality functioning. Multivariate analyses consistently identified previous suicide attempts and high 'acting out' behaviours across the three samples, suggesting the relevance of an externalizing response to stress and poor impulse control. CONCLUSIONS: Results assist the identification and management of depressed patients who are at greater risk of DSH behaviours.

Adult↗
PubMed2005

'Big build': hidden depression in men.

OBJECTIVE: To investigate men's experience of depression. METHOD: A sample of male and female teachers and students was recruited from four sites of a tertiary education institution to a series of focus groups. A grounded theory approach to qualitative data analysis was used to elucidate men's experience of depression. Content analysis was applied to the women's data to examine similarities and contrasts with the men. Standard measures of mood and dispositional optimism confirmed the non-clinical status of the group. RESULTS: The findings suggest that some men who are depressed can experience a trajectory of emotional distress manifest in avoidant, numbing and escape behaviours which can lead to aggression, violence and suicide. Gender differences appear not in the experience of depression per se, but in the expression of depression. CONCLUSION: Emotional distress, constrained by traditional notions of masculinity, may explain why depression in men can often be hidden, overlooked, not discussed or 'acted out'. There are implications for the types of questions asked of men to detect depressive symptoms.

Adult↗
PubMed2005

Age and gender in the phenomenology of depression.

OBJECTIVE: Authors investigated the effects of current age, age at onset, and gender on the phenomenology of depression. METHODS: A mixed-age sample of 810 Mood Disorders Unit attendees with a diagnosis of unipolar major depressive episode at or near its nadir were interviewed by clinician-rated and self-report instruments assessing symptoms and severity of depression. RESULTS: Differences were found in depressive phenomenology according to current age but not age at onset, confirming previous findings. Age differences on several variables were found in women only. Subjective ratings of depression severity decreased with age, whereas objective, clinician-rated severity increased. CONCLUSIONS: The pattern and severity of depression change with increasing age. Longitudinal prospective studies would further elucidate this age-gender relationship. Clinicians should be aware of the decreased likelihood of older patients' reporting of depressive symptoms themselves.

Adolescent↗
PubMed2005

Reduced hippocampal volumes and memory loss in patients with early- and late-onset depression.

BACKGROUND: Hippocampal volume reduction has been reported inconsistently in people with major depression. AIMS: To evaluate the interrelationships between hippocampal volumes, memory and key clinical, vascular and genetic risk factors. METHOD: Totals of 66 people with depression and 20 control participants underwent magnetic resonance imaging and clinical assessment. Measures of depression severity, psychomotor retardation, verbal and visual memory and vascular and specific genetic risk factors were collected. RESULTS: Reduced hippocampal volumes occurred in older people with depression, those with both early-onset and late-onset disorders and those with the melancholic subtype. Reduced hippocampal volumes were associated with deficits in visual and verbal memory performance. CONCLUSIONS: Although reduced hippocampal volumes are most pronounced in late-onset depression, older people with early-onset disorders also display volume changes and memory loss. No clear vascular or genetic risk factors explain these findings. Hippocampal volume changes may explain how depression emerges as a risk factor to dementia.

Adult↗
PubMed2005

Small groups for supporting GPs' professional development in mental health disease--an evaluation.

BACKGROUND: Small groups provide opportunities for education, information sharing, development of clinical skills and peer support. They have been promoted in general practice in Australia, especially for mental health disease, and often by divisions of general practice. METHODS: Minutes from a series of small groups supervised by psychiatrists were analysed to observe the content and themes over 5 years. Additionally, focus groups of general practitioner participants were asked to comment on what they found most valuable. RESULTS: Forty-two GPs attended small groups (mean size 2-3) over 3 years, about half for 10-49 sessions. The most discussed diseases were depression (most frequently at 157 times), psychosis (137), personality disorders (79), drug and alcohol abuse (73), anxiety disorders (68) and suicide (42). Discussion of doctor-patient interpersonal and doctor self care issues increased from under 2% of all statements in 1995 to nearly 10% in 2000. Participating GPs found the small groups empowering, confidence increasing, and useful for addressing psychological and interpersonal issues at work. DISCUSSION: Participating GPs found small groups useful and provided helpful recommendations based on their experiences.

Australia↗