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PubMed2006

Do older Australians truly have low rates of anxiety and depression? A critique of the 1997 National Survey of Mental Health and Wellbeing.

This paper sets out to critically evaluate reports from the Australian-wide National Survey of Mental Health and Wellbeing of very low rates of ICD-10 anxiety and depressive disorders in community resident older Australians. Data from the National Survey, which relied on the Composite International Diagnostic Interview (CIDI) were re-computed and re-analysed to address concerns about population sampling, interview response patterns and alternate measures of mental health. Rates of anxiety and depressive disorders fell to low levels after 65 years and continued to fall thereafter. This is at odds with findings from gerontological surveys that used assessment tools better suited to frail older people. Scores on mental health scales, together with diagnostic algorithms that obviated CIDI skip patterns, showed much less change in mental wellbeing across generations. It is argued that sampling and case ascertainment bias combined to reduce rates of anxiety and depression in very old people, especially when adjustments are made for the high morbidity levels encountered in aged residential facilities. Functional mental disorders almost certainly rise in frequency in advanced old age, often in conjunction with dementia.

Adult↗

PubMed1998

Customary physical activity and psychological wellbeing: a longitudinal study.

OBJECTIVES: to assess longitudinal relationships between habitual levels of physical activity and indices of psychological wellbeing in older people. DESIGN: baseline assessment with 4- and 8-year follow-ups. SUBJECTS: 1042 people originally aged 65 and over randomly sampled from general practitioner lists in Nottingham, UK. METHODS: logistic regression analysis of selected T1 (1985) and T2 (1989) variables, with depression at T2 as dependent; multiple regression analyses of selected T1, T2 and T3 (1993) variables, with life satisfaction at T2 (model 1) or T3 (model 2) as dependent. MAIN OUTCOME MEASURES: questionnaire-assessed levels of physical activity; 14-item Symptoms of Anxiety and Depression scale; 13-item Life Satisfaction Index; health, demographic and social activity variables. RESULTS: in the logistic regression model, depression at T2 was most strongly associated with depression [odds ratio (OR) = 7.13; 95% confidence interval (CI) = 3.25-15.64; P < 0.001] and lower physical health status (OR = 1.26 per unit change in score; 95% CI = 1.17-1.42; P < 0.001) at T1. Lower levels of outdoor/leisure activities at T1 were also associated with some increased risk of depression 4 years later (OR = 0.92 per hour of activity; 95% CI = 0.85-0.99; P < 0.05). Similar predictive patterns emerged from the multiple regression analyses where, in both models, earlier levels of life satisfaction, social engagement and health accounted for most of the explained variance in life satisfaction (R2 = 0.42 for model 1; R2 = 0.35 for model 2). Again, however, earlier levels of physical activity (as walking and housework) did contribute significantly, although modestly, to longitudinal changes in morale. CONCLUSIONS: while the results provide some support for the conclusion that physical activity contributes independently to the promotion and maintenance of psychological wellbeing in later life, this contribution is, at best, extremely modest.

Activities of Daily Living↗

PubMed2005

Effects of resident-oriented care on quality of care, wellbeing and satisfaction with care.

In a resident-oriented care model applied in nursing homes, the residents are assigned to primary nurses. These primary nurses are responsible for the total care of the residents assigned to them. The purpose of the present study, using a pretest, post-test and control group quasi-experimental design, was to evaluate the effects of the implementation of resident-oriented care on the following aspects of quality of care: coordination of care, instrumental aspects, expressive aspects, resident wellbeing and satisfaction with care, and family satisfaction with care. The study was carried out on somatic and psycho-geriatric wards in three nursing homes in the Netherlands. Data were collected by questionnaires, interviews and observations. The results of the study showed that the intervention was partly successful in the experimental group. Some aspects of the resident-oriented care model were not clearly evident. Moreover, the effects on quality-of-care aspects were limited. The results revealed that the 'coordination of care' increased on half of the experimental wards. Furthermore, there was an indication that 'expressive aspects' changed in favour of the experimental wards. The implementation of resident-oriented care had no effect on resident wellbeing and satisfaction or on family satisfaction. Finally, the results are discussed in the light of some methodological limitations that often go together with intervention studies in the real world.

Aged↗

PubMed2001

Short term effects of corticosteroid pulse treatment on disease activity and the wellbeing of patients with active rheumatoid arthritis.

OBJECTIVE: To investigate the short term effects of corticosteroid pulse treatment (CPT) on disease activity, functional ability, and psychological wellbeing of patients with active rheumatoid arthritis (RA). METHODS: Of 66 consecutive patients with active RA admitted for CPT, erythrocyte sedimentation rate, C reactive protein level, haemoglobin concentration, platelet count, duration of early morning stiffness, a joint score, and grip strength were assessed before and after CPT. Additionally, a health status questionnaire was administered. Effects of CPT were expressed as before to after intervention effect sizes and, to place them in perspective, compared with the (long term) effect sizes of disease modifying antirheumatic drug (DMARD) treatment in a historical contrast group of patients with early RA. RESULTS: Statistically significant improvement from baseline in disease activity, physical functioning, and psychological wellbeing after CPT was seen, with moderate to large effect sizes, resembling the effects seen after DMARD treatment. Neither depression nor psychosis occurred during and after CPT. CONCLUSION: Qualitatively and quantitatively the short term effects of CPT in patients with active established RA on various dimensions of health status resemble the long term effects of conventional DMARD treatment in patients with early RA. Psychological disorders do not seem to be common short term side effects of CPT in patients with active RA.

Adult↗

PubMed1979

Fetal breathing movements and other tests of fetal wellbeing: a comparative evaluation.

Sixty pregnant women whose fetuses were considered to be at high risk were intensively studied with fetal and placental function tests. Fetal breathing movements were studied with real-time ultrasound and the amount of time spent breathing and the variability of the breath-to-breath interval were measured. A reduction in the amount of time the fetus spent making breathing movements and decreased variability were indicative of fetal compromise. When these results were compared with those of other tests of fetal wellbeing measurement of fetal breathing movements and ultrasound assessment of growth were more sensitive tests of fetal wellbeing than the biochemical measures (urinary oestrogen, human placental lactogen, pregnancy-specific beta-1-glycoprotein, and unconjugated oestriol concentrations) or fetal heart rate. The predictive value was highest with serum unconjugated oestriol but the results of other tests were similar. Study of fetal breathing movements or an ultrasonic assessment of growth may provide a better screening test for fetal compromise than biochemical estimations.

Estriol↗

PubMed1982

Effect of reduction of anticonvulsants on wellbeing.

An attempt was made over a period of a year to reduce the number of anticonvulsants used to treat epilepsy in a hospital for the mentally handicapped. At least one drug was withdrawn for each of 20 patients, without loss of seizure control. Effect on wellbeing was assessed by a behavioural scale completed before and after withdrawal, and in the 20 cases of successful withdrawal wellbeing was significantly improved.

Anticonvulsants↗

PubMed1998

Randomised controlled trial of patient centred care of diabetes in general practice: impact on current wellbeing and future disease risk. The Diabetes Care From Diagnosis Research Team.

OBJECTIVE: To assess the effect of additional training of practice nurses and general practitioners in patient centred care on the lifestyle and psychological and physiological status of patients with newly diagnosed type 2 diabetes. DESIGN: Pragmatic parallel group design, with randomisation between practice teams to routine care (comparison group) or routine care plus additional training (intervention group); analysis at one year, allowing for practice effects and stratifiers; self reporting by patients on communication with practitioners, satisfaction with treatment, style of care, and lifestyle. SETTING: 41 practices (21 in intervention group, 20 in comparison group) in a health region in southern England. SUBJECTS: 250/360 patients (aged 30-70 years) diagnosed with type 2 diabetes and completing follow up at one year (142 in intervention group, 108 in comparison group). INTERVENTION: 1.5 days' group training for the doctors and nurses-introducing evidence for and skills of patient centred care and a patient held booklet encouraging questions. MAIN OUTCOME MEASURES: Quality of life, wellbeing, haemoglobin A1c and lipid concentrations, blood pressure, body mass index (kg/m2). RESULTS: Compared with patients in the C group, those in the intervention group reported better communication with the doctors (odds ratio 2.8; 95% confidence interval 1.8 to 4.3) and greater treatment satisfaction (1.6; 1.1 to 2.5) and wellbeing (difference in means (d) 2.8; 0.4 to 5.2). However, their body mass index was significantly higher (d=2.0; 0.3 to 3.8), as were triglyceride concentrations (d=0.4 mmol/l; 0.07 to 0.73 mmol/l), whereas knowledge scores were lower (d=-2.74; -0.23 to -5.25). Differences in lifestyle and glycaemic control were not significant. CONCLUSIONS: The findings suggest greater attention to the consultation process than to preventive care among trained practitioners; those committed to achieving the benefits of patient centred consulting should not lose the focus on disease management.

Adult↗

PubMed1996

Comparison of eight and 12 hour shifts: impacts on health, wellbeing, and alertness during the shift.

OBJECTIVES: The generally agreed view is that there is no ideal shift system, and that most systems will have both advantages and disadvantages. As such, attention has been placed on trying to identify good and bad features of shift systems, with a view to minimising the possible ill health as a consequence of shiftwork. The present study focuses on the duration of the shift and looks at the implications for individual health, wellbeing, and alertness during the shift of extending the shift from the traditional eight hours to 12. METHODS: Two groups of chemical workers, one working 12 hour shifts and the other working eight hour shifts, took part. All completed a modified version of the standard shiftwork index (SSI), a set of self reported questionnaires related to health and wellbeing. RESULTS: The two groups did not differ on most outcome measures, although the differences that did exist suggested advantages for the 12 hour shift workers over the eight hour shift workers; with the notable exception of rated alertness at certain times of day. CONCLUSIONS: The results are explained in terms of the design of the 12 hour shift system and the specific sequencing of shifts that seem to minimise the potential for the build up of fatigue. Although the current data moderately favour 12 hour shifts, a cautionary note is sounded with regard to the implications of the alertness ratings for performance and safety.

Adult↗

PubMed2004

Food and nutrient intake in relation to mental wellbeing.

BACKGROUND: We studied food consumption and nutrient intake in subjects with depressed mood, anxiety and insomnia as indices of compromised mental wellbeing. METHODS: The study population consisted of 29,133 male smokers aged 50 to 69 years who entered the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study in 1985-1988. This was a placebo-controlled trial to test whether supplementation with alpha-tocopherol or beta-carotene prevents lung cancer. At baseline 27,111 men completed a diet history questionnaire from which food and alcohol consumption and nutrient intake were calculated. The questionnaire on background and medical history included three symptoms on mental wellbeing, anxiety, depression and insomnia experienced in the past four months. RESULTS: Energy intake was higher in men who reported anxiety or depressed mood, and those reporting any such symptoms consumed more alcohol. Subjects reporting anxiety or depressed mood had higher intake of omega-3 fatty acids and omega-6 fatty acids. CONCLUSIONS: Our findings conflict with the previous reports of beneficial effects of omega-3 fatty acids on mood.

Journal Article↗

PubMed2005

Helping baccalaureate nursing students care for the wellbeing of older adults.

Because the world's population is aging there is a dire need for gerontologically prepared registered nurses. Baccalaureate nursing students, therefore, need experiences with older adults. However, due to constraints on their practice, students might have insufficient opportunities to learn about how to contribute to older adults' wellbeing. Students provided with a combination of learning experiences may understand how to contest constraints on their practice and create conditions that facilitate the provision of age-responsive care for older adults. In this paper gerontological-nursing content, constraints on practice, and learning experiences to help students come to understand their contributions to older adults' wellbeing are identified. Potential benefits of these learning experiences for students, older adults, and the nursing profession are discussed.

Aged↗

PubMed2005

Exercise and older women's wellbeing.

Older women are one of the most inactive groups in the population despite being at an age where they are at greater risk of health problems. Knowing what influences these women to exercise regularly may help the development of strategies to assist sedentary women in this age group to become active. This paper reports the findings of a study that explored why a group of older women attending a fitness centre participate in regular exercise activities. The study used a qualitative approach to data collection and analysis. Data were collected using in-depth interviews from ten women over 50 years of age who exercised on a regular basis. The findings revealed four themes relating to the maintenance of general wellbeing: exercise as a socially supportive activity, exercising to maintain wellbeing, exercising to maintain independence, and exercise as liberating. The implications of the findings for nursing education, clinical practice and research are discussed.

Adaptation, Psychological↗

PubMed2001

[Prediction of fetal wellbeing with Doppler flowmetric profile in pregnant hypertensive women].

In order to evaluate the diagnostic accuracy of the Doppler ultrasonography profile in the assessment of fetal wellbeing in hypertensive pregnancies, 171 women at 36-42 week's gestation were included. A Doppler color ultrasound scanning was made and the score of the Doppler ultrasonography profile were correlated with the neonatal outcome, with one minute Apgar's score or admission to neonatal intensive care unit as main outcome. The Doppler ultrasonography profile includes: umbilical artery Doppler flow velocity waveforms, amniotic fluid volume, fetal movements, placental grading and fetal growth pattern. In 145 cases (84.7%) had gestational hypertension without proteinuria, 22 patients (12.9%) had chronic hypertension and only in 4 cases (2.4%) preeclampsia was found. In 101 patients (59%) a cesarean section was made, 66 cases delivered normally and 4 (2.4%) patients had complicated vaginal delivery. Scores of diagnostic tests were: sensitivity 44%, specificity 99%, positive predictive value 80% and negative predictive value 97%, with an average accuracy of 71.5%. The multiple logistic regression analysis with 5 parameters of the Doppler ultrasonography profile had a determination coefficient (R2 = 0.15125) P < 0.01, and umbilical artery Doppler flow velocity waveforms had a regression coefficient--31.3959 (P < 0.05). It was concluded that the Doppler ultrasonography profile is a test with high predictive values in assessing fetal wellbeing in hypertensive pregnancies and the umbilical artery Doppler flow velocity alone is a significant variable in the multiple logistic regression analysis.

Adolescent↗

PubMed2000

Supporting staff in employment: the emotional wellbeing of staff in an NHS psychiatric hospital.

OBJECTIVE: The objective of this study was to assess the emotional wellbeing of a broad sample of NHS employees in a psychiatric setting; to seek their views on sources of distress; and to identify preferred ways of dealing with it. DESIGN: A cross-sectional postal survey, employing two questionnaires: GHQ-28, and a semi-structured questionnaire. These were sent to a nominal 50% sample (n = 599). SETTING: The population was the staff of a large Scottish psychiatric service. RESULTS: A 47.9% response rate was achieved; 32.9% of respondents exceeded a cut-off score of four on the GHQ-28. Neither occupational, group nor gender effects were significant on this measure. The reporting of emotionally-distressing problems affecting their performance was found to be more common amongst doctors; males, overall, showed a non-significant trend towards having been affected more than females by such problems; and older staff (above 45) were affected significantly more often than younger staff. Almost a third of staff were unaware of the availability of an internal organisational resource (the Occupational Health service). CONCLUSION: NHS Trusts should ensure the culture at work is appropriate from a preventative point of view and be aware that factors outwith the workplace can affect employees emotional wellbeing and performance. Preventative and supportive measures to minimise psychological distress in the workforce should be considered; the Scottish Needs Assessment Programme: Mental Health in the Workplace offers useful guidance.

Adult↗

PubMed2005

[Parents' unemployment, selected life conditions, adolescents' wellbeing and perceived health].

Unemployment in Poland is one of the most negative outcomes of the economical transformations taking place in the last decade of the XX and first years of the XXI century. Therefore, the study on an influence of parents' unemployment upon adolescents' life conditions and health was undertaken in Health Promotion and Postgraduate Training Department of the National Institute of Hygiene. The data were collected from randomly selected sample of 783 students aged 14-15 years attending to ten private and public secondary schools (gymnasiums) in Warsaw. A part of the questionnaire elaborated in Health Promotion and Postgraduate Department covered information about negative life events, which had occurred in the previous year, also about a loss of the job by father or mother. The self-assessment of health, and physical and psychical wellbeing measured the perceived health. The study showed that significantly higher percentage of the students, whose father or mother had lost a job in the previous year, noticed also occurrence of father and mother health disorders, lack of support from father and mother, frequent quarrels between parents, too much of home duties, worsening a housing conditions, lack of possibilities to travel away on vacation and lack of own money. The differences were higher, if both the parents were unemployed. Moreover, the children of unemployed parents significantly lower assessed their health, and physical and psychical wellbeing. It is necessary to help immediately the students, whose parents are unemployed, with financial and psychological support in frame of the programmes of unemployment overcoming.

Adolescent↗

PubMed1991

[A clinical evaluation of fetal wellbeing--based on fetal behavior with emphasis on conditions contributing to the dissociation of behavior].

The recent developments in Medical Electronics (M.E) have led to the possibility of noninvasive methods of evaluating conditions which previously were considered to be a "Black Box". Among the conditions now evaluable are fetal and placental morphology and functional aspects including fetal movements and behavioral studies. This has led to the discovery that the progressive development of the fetal Central Nervous System (CNS) is concurrent with the progression of fetal maturity and attainment of synchronicity of various fetal activities. This has led to the clinical application of ME for the evaluation of various fetal parameters in an attempt to assess fetal wellbeing. However in the presence of increase in frequency and strength of the various fetal activities with the advance of pregnancy, there is in fetuses of less than 28 weeks of development no synchronicity of the fetal activities, and in IUGR and fetuses under various forms of stress, the relationships between CNS development and fetal activity may become misaligned, or dissociated leading to the pitfall of misdiagnoses. Thus, in order to better understand the effects of chronic stress on the fetus we ran long term studies on pregnant ewes using physiologic and biochemical evaluations as our parameters for assessment. We observed a convergence of the various fetal behavior parameters with advancement of fetal age which we termed as the achievement of association of fetal behavior. However, when fetal hypoxemia is induced as a chronic condition, the phenomenon of convergence of the various behavioral parameters is inhibited, leading to a so called dissociation of those functions. Further, the greater the severity of the hypoxemia (stress), the greater the inhibitory effect on the convergence of the various activities, thus the greater the dissociation. A possible reason for this effect is the inhibition of respiratory activity. In order to clarify the hypothesis stated above, we induced hypoxemia in fetal lambs, as well injecting them with various materials. We found that AVP which increases in hypoxemia has no effect on pulse rate, but does inhibit respiratory activity, a clear representation of dissociation of fetal behavior. In conclusion, if fetal behavior is to be used as a method for evaluating wellbeing, it is necessary to also assess the convergence or association of the various behavioral parameters in order for it to be utilized as a clinical tool.

Animals↗

PubMed1997

Interpersonal factors and post-treatment drinking and subjective wellbeing.

AIMS: A conceptual clarification of the domain of social relationships defines three aspects of social relationships (structure, function and quality), which have both alcohol-specific and general components. We analyse the correlations among post-treatment indicators of social relationships and the association between these interpersonal variables and post-treatment drinking and subjective wellbeing. DESIGN: This is a secondary analysis of data from an alcohol treatment outcome study, in which subjects were randomly assigned to one of three treatment conditions and followed for 18 months. SETTING: The outpatient treatment program is located within a private psychiatric hospital in the north-eastern United States. PARTICIPANTS: We analyzed the 140 subjects who completed a social network instrument 12 months following treatment assignment. INTERVENTION: This secondary analysis combined clients from three treatment conditions, all of which were based upon social learning theory. MEASUREMENTS: Interview and questionnaire self-report data were collected by trained interviewers. FINDINGS: Indicators of social relationships are found to be relatively independent of one another. Only alcohol-specific social relationship indicators are significantly associated with drinking outcomes, and only general indicators are significantly associated with subjective wellbeing. Functional indicators, addressing social interaction content, have stronger effects on outcomes than structural or quality indicators. General and alcohol-specific support from friends have more influence than support from family; both surpass the influence of co-workers. CONCLUSIONS: A better understanding of the roles of social relationships during the course of treatment and recovery or relapse may help clarify how treatment personnel can utilize clients' interpersonal relationships more effectively to maximize treatment effectiveness.

Adult↗

PubMed2002

Who seeks treatment for alcohol dependence? Findings from the Australian National Survey of Mental Health and Wellbeing.

BACKGROUND: This paper presents findings from the Australian National Survey of Mental Health and Wellbeing (NSMHWB) regarding prevalence and treatment seeking for Australians with DSM-IV alcohol dependence and examines the influence of alcohol use variables on treatment seeking. METHOD: A standardised interview (including CIDI 2.1) was administered to a stratified random sample of 10,641 Australians aged 18 years and over. Demographic variables, common DSM-IV mental disorders, physical health status, perceived disability and treatment-seeking behaviour were assessed. Multiple logistic regression was used to ascertain the independent effects of all variables considered. RESULTS: The prevalence of DSM-IV alcohol dependence was 4.1 % in this population, with 75 % being male and nearly 60 % in the 18-34 year age group. Variables that correlated independently with alcohol dependence were sex (male), age (young), not being in a married or de facto relationship and having any affective, anxiety or other substance use disorder. Functional disability did not correlate with a dependence diagnosis. Correlates of treatment seeking for those with dependence were sex (female) and having a comorbid affective disorder. Having a diagnosis of dependence and/or abuse and having more dependence symptoms did not predict treatment seeking. However, meeting either of two criteria assessing psychological, physical or social problems due to alcohol use tended to increase service use. CONCLUSIONS: People with alcohol dependence do not perceive themselves as disabled and do not seek treatment. However, having a comorbid affective disorder or other problems directly attributable to alcohol use increases the likelihood that such individuals will seek treatment. Efforts should be made at the primary care level to encourage those engaged in harmful drinking practices to recognise the risks of such drinking and reduce it or seek treatment. Similarly, it is recommended that integrated services are enhanced at both primary and specialist levels in order that those with multiple problems are appropriately treated. Further research is required to refine measurement of disability and diagnoses of alcohol use disorders and to examine the relationship between disability and alcohol use.

Adolescent↗

PubMed1997

A longitudinal study of wellbeing in widowed women.

Changes in mental and physical health, morale and social functioning were assessed in a random sample of elderly women widowed during the course of an 8-year study, compared with never-married and still-married controls. The sample as a whole showed age-related declines in mental and physical health. As a function of ageing there were increases in personal disturbance and in physical health problems and declines in both morale and social engagement. However, over and above these age-related changes the windows showed significant changes in mental health. There were decreases in morale after widowhood, followed by slight increases in morale in the longer term. Similarly, there were increases in personal disturbance following widowhood, with slight decreases later. The results confirm that, even after several years, widowhood has differential effects on wellbeing and morale.

Activities of Daily Living↗