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Biomedical subjects

Vijaya Manicavasagar

Publications and source records attributed to Vijaya Manicavasagar.

12 recordsLinked to original sources
PubMed2006

Assessing personality traits associated with depression: the utility of a tiered model.

BACKGROUND: We sought to develop a refined measure of eight personality traits or constructs observed in those who develop depression. We report the psychometric properties of the derived Temperament and Personality (T and P) questionnaire, as well as a pilot study examining its capacity to differentiate over-represented personality traits in those with depression. METHOD: The factor structure of the T&P measure was examined in a general practice sample of 529 subjects. We imposed a range of factorial solutions to determine how higher-order molar constructs arborized to eight lower-order constructs. Scale scores generated at each derived tier were contrasted for 52 out-patients with major depression and control subjects from the general practice sample to pursue over-represented personality constructs, and to clarify if an optimal number of constructs could be identified. RESULTS: In the factor analysis, some 90% of the items loaded on their a priori construct. The questionnaire showed high internal consistency, test-retest reliability and minimal sensitivity to mood state effects. Analyses rejected the hypothesis that risk to depression might be generally affected by individuals merely scoring high on all 'normal' personality styles, whether higher-order or lower-order traits. CONCLUSIONS: Findings suggest that, while identified constructs linked well with the widely accepted theoretical model of personality (the Five Factor Model) at one tier, such a fixed model may be too inflexible. We therefore detail potential advantages to using a multi-tiered model of personality traits in application studies.

Adolescent↗
PubMed2006

The Black Dog Institute Depression Clinic: a subtyping model in practice.

OBJECTIVE: The new Black Dog Institute Depression Clinic adopts a novel clinical service model that argues for the importance of clinically defining separate mood disorders in order to apply specific management strategies. This paper describes clinic nuances and the impact on diagnosis and management for the first 100 patients assessed. METHOD: Patients are assessed via a computerized structured self-report program, a semistructured interview undertaken by a psychiatrist and a colloquium involving several practitioners where diagnostic decisions are formulated. A detailed report with treatment recommendations, incorporating psychiatric and psychological perspectives, is sent to the referring clinician. Such data are examined in this report. RESULTS: We offered a differing diagnostic and treatment paradigm for nearly 90% of those diagnosed with a primary mood disorder. Difficulties encountered by referring practitioners are highlighted and the need for an alternative diagnostic and management model is discussed. CONCLUSIONS: A subtyping diagnostic management model has the capacity to advance treatment outcome, but requires validation. Our future research will assess the comparative utility of the subtyping model in clinical and research arenas.

Ambulatory Care Facilities↗
PubMed2006

Characteristics of Vietnamese patients attending an anxiety clinic in Australia and perceptions of the wider Vietnamese community about anxiety.

This article examined the causes underlying low utilization of mental health services by Vietnamese immigrants in Australia. Study 1 examined cases of Vietnamese patients who had attended an anxiety disorders clinic, while Study 2 surveyed Vietnamese people in the community on their knowledge and attitudes towards common mental problems. Results from Study 1 showed that Vietnamese patients had significantly higher attrition rates, and presented with a larger number of nonanxiety disorders than their Australian-born counterparts. Study 2 results indicated that many Vietnamese people did not differentiate clearly between the terms 'stress', 'anxiety' and 'depression'. Additionally, many participants felt that there was a generally negative cultural attitude towards people suffering from these problems and the mental health system itself. These outcomes suggest the importance of education for ethnic communities regarding available mental health facilities and treatments offered, as well as specific information on mental illness to help remove stigma.

Ambulatory Care↗
PubMed2006

Fraternal birth order and ratio of heterosexual/homosexual feelings in women and men.

Studies of the 2-3% of persons who identify as homosexual found men but not women had more older brothers than persons who identify as heterosexual. The present study investigated the birth order in the approximately 20% of men and women who anonymously report some homosexual feelings, few of whom identify as homosexual. The number of older brothers and sisters was investigated in seven cohorts: 319 male twins; and 49, 54, and 61 female and 66, 116, and 50 male medical students. Both women and men who anonymously reported homosexual feelings had a greater mean number of older brothers and sisters than did those who reported no homosexual feelings. The difference was stronger in relation to brothers than sisters. The birth order effect was not related to the strength of the subjects' degree of homosexual compared with heterosexual feelings. Its presence in women could not be accounted for by the widely accepted hypothesis that the birth order effect is due to a maternal immune reaction provoked only by male fetuses. The lack of relationship between the strength of the effect and degree of homosexual feelings in the men and women suggests the influence of birth order on homosexual feelings was not due to a biological, but a social process in the subjects studied. Investigating the neglected significant percentage of predominantly heterosexual men and women who anonymously report some homosexual feelings may aid in understanding the factors influencing sexual orientation, and identity.

Adult↗
PubMed2004

Comorbidity of PTSD and depression: associations with trauma exposure, symptom severity and functional impairment in Bosnian refugees resettled in Australia.

BACKGROUND: Posttraumatic stress disorder (PTSD) is common in refugees but its association with longer-term psychosocial dysfunction remains unclear. We examined whether a subgroup of refugees with comorbid PTSD and depression were at particularly high risk of disability. We also investigated whether specific trauma experiences were linked to this comorbid pattern. METHODS: Consecutive Bosnians (and one or two compatriots nominated by them) were recruited from a community centre, yielding a total sample of 126 participants (response rate 86%). Measures included a trauma inventory, the Clinician Administered PTSD Scale (CAPS) (Blake et al., 1995) and the depression module of the Structured Clinical Interview (SCID) (First et al., 1997). RESULTS: Three diagnostic groupings emerged: normals (n=39), pure PTSD (n=29), and comorbid PTSD and depression (n=58). Of four trauma dimensions derived from principle components analysis (human rights violations, dispossession and eviction, life threat and traumatic loss), life threat alone was associated with pure PTSD, with life threat and traumatic loss both being associated with comorbidity. Compared to normals and those with pure PTSD, the comorbid group manifested more severe PTSD symptoms as well as higher levels of disability on all indices (global dysfunction: odds ratio=5.0, P<0.001, distress: odds ratio=6.0, P<0.001, social impairment: odds ratio 5.9, P<0.001, and occupational disability: odds ratio 5.0, P<0.001). LIMITATIONS: Recruitment was not random, the sample size was modest, and trauma event endorsement was based on retrospective accounts. CONCLUSIONS: The combination of life threat and traumatic loss may be particularly undermining to the psychological well-being of refugees and consequent comorbidity of PTSD and depression may be associated with longer-term psychosocial dysfunction. The findings raise the question whether the comorbid pattern identified should be given more recognition as a core posttraumatic affective disorder.

Adolescent↗
PubMed2004

The use of international videoconferencing as a strategy for teaching medical students about transcultural psychiatry.

Videoconferencing is an innovative method that potentially allows medical students exposure to international teachers in refugee mental health who would otherwise be inaccessible. This article reports a pilot study using videoconferencing with international teachers from Australia, Sweden and the USA participating in the training of ten senior Swedish medical students. Interviews with an actual and a simulated patient were conducted at the U.S. and Australian sites respectively, followed by discussions involving those two sites with students and their supervisors in Sweden. Students evaluated the method favourably, as did the teachers, although the brevity of the program was seen as a limitation. Teachers noted the importance of preparing students and patients and ensuring that the technology operates smoothly to ensure success. Although cost-effective in teaching medical students in developed countries, videoconferencing may still be out of the reach of training programs in many developing countries where it is most needed.

Adult↗
PubMed2003

Separation anxiety in the elderly.

Separation anxiety has been studied in children and young adults but little is known about this form of anxiety in older people. This study aimed to examine socio-demographic, psychological and physical health correlates of separation anxiety in the elderly. Eighty-six ambulatory subjects aged 62-87 years were recruited from primary medical care practices to participate in this study. The presence of lifetime DSM-IV affective and anxiety disorders was determined by structured clinical interview. Subjects also completed a battery of self-report questionnaires measuring levels of state and trait anxiety, juvenile and adult separation anxiety. Adult separation anxiety scores were moderately correlated with juvenile separation anxiety scores (r= .52, P < .001), trait anxiety (r = .55, P < .001) and state anxiety scores (r = .66, P < .001), as well as younger age (r = .39, P < .001). Higher adult separation anxiety scores were also associated with a lifetime history of any anxiety disorder (t = 3.74, df = 84, P < .001) or any affective disorder (t = 2.12, df = 84, P < .05). However, adult separation anxiety was not associated with increasing age, being widowed, living alone or poorer physical health. Clinicians working with the elderly need to routinely explore this form of anxiety as it may complicate the pattern of presentation of other anxiety and affective disorders, and require specific forms of intervention.

Aged↗
PubMed2003

Relationship between mental health disorders and unemployment status in Australian adults.

OBJECTIVES: To compare the prevalence of anxiety and affective disorders among employed and unemployed patients and to compare the type of treatment received between the two groups for these disorders. METHOD: A secondary analysis of the 1997 National Survey of Mental Health and Wellbeing of Adults cross-sectional study was undertaken. RESULTS: Unemployed adults were more likely to have symptoms of anxiety (OR = 3.09, 95% CI = 2.80-3.41) or an affective disorder (OR = 2.11, 95% CI = 1.95-2.27) or anxiety and/or affective disorders (OR = 2.53, 95% CI = 2.37-2.69). Unemployed participants with symptoms were less likely to have seen a general practitioner for treatment but when they did they received similar care to employed participants. CONCLUSIONS: These results confirm studies reported elsewhere that the prevalence of symptoms of anxiety and/or affective disorders is higher for unemployed people. The data provide further evidence that people with an anxiety and/or affective disorder who are unemployed are not seeking medical treatment. However, unlike previous research undertaken by our group, these results indicate that symptomatic adults who seek help receive comparable treatment in general practice irrespective of their employment status.

Adult↗
PubMedDate not supplied

Complicated grief in Bosnian refugees: associations with posttraumatic stress disorder and depression.

Complicated grief is likely to be common among refugee populations exposed to war trauma. However, there have been few studies investigating the traumatic antecedents and correlates of complicated grief in refugees, and the relationship of that symptom pattern with other common disorders such as posttraumatic stress disorder (PTSD) and depression. We studied Bosnian refugees recruited from a community center in Sydney, Australia, with the sample being supplemented by a snowball method (N = 126; response rate, 86%). Measures included a trauma inventory, the Clinician Administered PTSD Scale (CAPS), the depression module of the Structured Clinical Interview (SCID), and the Core Bereavement Items (CBI). A dimension of traumatic loss derived from the trauma inventory was a specific predictor of complicated grief, with exposure to human rights violations being associated with images of the traumatic events surrounding the lost person. There was no link between PTSD and grief other than for a low-order association with the PTSD intrusion dimension. In contrast, depression was strongly associated with grief and its subscales. Only the subgroup with comorbid grief and depression reported higher levels of traumatic loss. The results suggest that complicated grief in refugees can become persistent and associated with depression. While PTSD and grief share common symptoms of intrusion, the two symptom domains are sufficiently distinct to warrant independent assessment of grief in refugee populations.

Adolescent↗
PubMedDate not supplied

Challenges and early experiences in the development of an anxiety clinic in the public health sector.

This paper argues the importance of establishing specialist anxiety clinics within the public sector of the Australian health system. It describes the development of such a service and summarizes the characteristics of the first 1000 clients. Factors such as staffing, utilization trends, referral patterns, assessment and treatment procedures, and the clinical and demographic characteristics of the first 1000 cases are reviewed and discussed. The model of the clinic, which operates in partnership with community mental health and an academic research unit, has proven itself to be a suitable, cost-effective and efficient prototype in the treatment of anxiety disorders. Anxiety disorders exact a high social and economic cost. At a time of global funding cuts and savings in the mental health system, it is vital to think ethically as well as cost-efficiently, considerations that require that we offer the most efficient treatment to the greatest number of people.

Adult↗
PubMedDate not supplied

Indices of social risk among first attenders of an emergency mental health service in post-conflict East Timor: an exploratory investigation.

OBJECTIVE: Little is known about the profile of patients treated in mental health services in low-income, post-conflict countries, especially in the post-emergency phase. We postulated that patients attending the first community mental health service in East Timor would be characterized not only by mental disturbance but by high levels of social vulnerability. METHOD: Drawing on existing methods and on consultations with East Timorese mental health staff, five social indicators were identified: dangerousness; inability to undertake life-sustaining self-care; bizarre behaviour; incapacitating distress; and social unmanageability. Adequate levels of interrater reliability (65-91%) were achieved in identifying these indicators from case notes. Forty-eight randomly selected case notes were analyzed to ascertain the prevalence of social risk factors as well as the referral source and broad diagnostic groupings. RESULTS: Major referral sources were the family, humanitarian agencies and the police. Twenty-nine percent met criteria for dangerousness; 42% for inability to undertake self-care; 58% for bizarre behaviour; 75% for distress; and 19% for unmanageability. Ninety-eight percent fulfilled at least one social indicator, with the modal score being 2. CONCLUSIONS: Although the approach to documentation and analysis was preliminary, the data suggest that a focus on social risk indicators may assist in determining those mentally disturbed persons in need of priority care in resource-poor post-conflict countries.

Adult↗