An Evaluation of beyondblue,Australia's National Depression Initiative

beyondblue is a five-year Australian initiative which takes a populationhealth approach to combating depression. This paper's aim is to describe the findings of an evaluation of beyondblue, conducted four years into its existence.The achievements of beyondblue were examined in the light of its objectives, using synthesised data from 15 secondary sources. Many of beyondblue's lower-level objectives have been completely achieved, with a plethora of key initiatives in place that have led to greater availability of information about depression, improvements in consumer networks, better support for mental health care delivery in primary care settings and increases in targeted research. Most of its intermediate-level and high-level objectives have been partly achieved, with headway made in terms of the community's ‘depression literacy’, acknowledgement of the consumer/carer perspective, the degree to which the health workforce is equipped to deal with depression, the likelihood that individuals will seek help, the range of prevention and early intervention options, the role of primary care practitioners in mental health care, and scientific knowledge about depression. However, in all these areas, ongoing efforts are required. beyondblue's vision, or highest-level objective, has not yet been realised. Society does not optimally understand, respond to or work actively to prevent depression. beyondblue has begun to make an impression, but it is unrealistic to expect systemic and cultural change of this magnitude to occur quickly. beyondblue has partly achieved its goals, and careful consideration should be given to what action is necessary to foster sustainable positive change.     

beyondblue,Australia's National Depression Initiative: An Evaluation for the Period 20052010

beyondblue is Australia's national depression initiative and is intended to increase the capacity of the Australian community to prevent depression and anxiety and to respond effectively. This study examines the achievements of beyondblue for the period 20052009 and compares them with the earlier period 20002004. A ‘hierarchy of objectives’ derived from a program logic of beyondblue's activities was used, based on beyondblue's vision, mission and priority areas. Relevant data sources were identified to assess whether objectives on this hierarchy were achieved. Outputs and outcomes of beyondblue programs improved during the present funding period. The lower and lower intermediate objectives have been fully and largely achieved respectively. The higher intermediate objectives were achieved in two of beyondblue's five priority areas, ‘primary care’ and ‘targeted research’. beyondblue compares favourably with depression initiatives in other countries. Its activities should continue, at least at current levels, if its higherlevel objectives are to be achieved.     

Uptake of Web-Based Clinical Resources from the MacArthur Initiative on Depression and Primary Care

This study assessed the usability and desired enhancements for the MacArthur Foundation’s Depression and Primary Care (MDPC) Web site to determine if resources for integrated depression care that are disseminated through the Web site are incorporated into routine clinical care. Since its launch in 2003, more than 20,000 users registered as members of the MDPC website to read and download depression care resources. Subjects were randomly selected from MDPC Web site users who had previously downloaded the depression toolkit. Web-based survey, which was administered anonymously, included the following domains: (1) socio-demographic data, (2) confidence in managing depression (3) Web site content and design features, (4) desired enhancements to Web site and content, (5) use of resources downloaded from the Web site, and (6) importance of depression care resources. Of the 3,478 randomly selected participants, 666 (19.1%) responded. Web site content was rated “good” or “excellent” for screening and diagnosis (84.3%), treatment (69.8%), patient education (66.2%), and care management (66.9%). The Patient Health Questionnaire-9 (PHQ-9) was rated “very useful” by 68.3%; 47.1% reported using it in at least 25% of encounters with patients who are depressed. PHQ-9 use was significantly associated with higher self-confidence in managing depression (P = 0.05). Evidence-based resources for depression care can be disseminated effectively through a dedicated Web site and may help clinicians incorporate effective care models into routine practice.     

Screening for Postpartum Depression in a Rural Community

Postpartum depression is a serious mental health issue affecting as many as 10-15% of families during the postpartum period. The current study discusses implementation of a screening protocol for postpartum depression in a rural community health setting with a sample of 498 primarily minority women utilizing the Postpartum Depression Screening Scale. Results indicate that 22.5% of the sample population demonstrate some symptoms of postpartum depression, with Hispanic women demonstrating less symptoms than other minority groups. Results also indicate that variables such as race, feeding method and history of depression impact scale scores.     

An Implementation Evaluation of the Community Engagement and Planning Intervention in the CPIC Depression Care Improvement Trial

The goal of this paper is to document and evaluate the process of implementing an evidence-based depression intervention in community settings through the use of community-academic partnered approaches. We discuss how and to what extent the goals of community engagement and collaborative planning were achieved in the intervention arm of the Community Partners in Care study that aimed to adapt evidence-based depression care toolkits for diverse agencies in Hollywood and South Los Angeles. We find that partnered research strategies have a potential to effectively engage community members around depression and involve them in intervention planning activities. Our results suggest that successful collaboration among diverse agencies requires that they understand what is expected of them, are comfortable with the role they choose to perform, and have organizational support to contribute to the project. To facilitate the development of collaborative relationships, time and effort should be devoted to explaining how collaboration among diverse agencies may take place.     

An Update on Antidepressant Use in Bipolar Depression

The effective treatment of depression in people with bipolar disorder remains a clinical challenge. The role of antidepressant medication in treating bipolar depression has been controversial. While early studies and meta-analyses supported a role for antidepressant medication, more recent, high quality randomized controlled trials in bipolar depression have generally not demonstrated efficacy for antidepressant medications. Although the risk of affective switch and long-term de-stabilization remains a concern when using antidepressant medications in bipolar disorder, the magnitude of this risk has been difficult to ascertain with confidence. Maintenance use of antidepressant medication has generally not demonstrated a favorable risk-benefit ratio. Future studies should explore the patient characteristics and response patterns that predict a more favorable response profile to antidepressants amongst patients with bipolar disorder so that the medications can be rationally used in those who are most likely to benefit.     

Screening for Anxiety and Depression in Community Mental Health: The Beck Anxiety and Depression Inventories

Accurate diagnosis is key to providing quality services in community mental health. This research examined the ability of the Beck Anxiety and Depression Inventories to identify anxiety and depression in community settings. The diagnostic accuracy of these instruments was compared with the Structured Clinical Interview for DSM-IV in a sample of 288 distressed women seeking treatment for their children. Operating characteristic curves indicated the Beck Anxiety and Depression Inventories hold utility as screens for panic and major depressive disorder, respectively. Deploying these instruments as initial screens in a tiered diagnostic system may improve diagnostic accuracy in community settings.     

Pediatric Depression: An Evidence-Based Update on Treatment Interventions

The combination of depression and activation presents clinical and diagnostic challenges. It can occur, in either bipolar disorder or major depressive disorder, as increased agitation as a dimension of depression. What is called agitation can consist of expressions of painful inner tension or as disinhibited goal-directed behavior and thought. In bipolar disorder, elements of depression can be combined with those of mania. In this case, the agitation, in addition to increased motor activity and painful inner tension, must include symptoms of mania that are related to goal-directed behavior or manic cognition. These diagnostic considerations are important, as activated depression potentially carries increased behavioral risk, especially for suicidal behavior, and optimal treatments for depressive episodes differ between bipolar disorder and major depressive disorder.     

Bipolar Depression: An Evidence-Based Approach

Bipolar disorder is a complex, multidimensional illness that is often difficult to treat. Unfortunately, bipolar patients are much more likely to experience depression, which is all too often severe and a potentially lethal phase of the illness. In addition, pharmacotherapies with strong evidence for bipolar depression are limited. Most treatments are based on unsupported extrapolation from the treatment of unipolar depression or are derived largely from the clinical practice experience. In this article, we focus on the treatment of bipolar depression, with particular focus on evidence from the existing literature, to help guide readers in clinical practice.     

Recurrent Brief Depression and Mild Learning Disability: Successful Community Management

A 58 year old woman with a 30 year history of mental illness, and numerous hospital admissions, was assessed by two members of a community team for people with learning disability. A 10cm analogue scale (rated by her family) was used to record changes in her behaviour. A diagnosis of recurrent brief depression was made and appropriate pharmacological treatment and support provided without admission to hospital. A marked increase in the intervals between episodes of depression, and a shortening of depressive episode length, have been observed over 18 months of followup. Recurrent brief depression is a recently recognised sub-type of depressive illness which may occur in association with learning disability. It is treatable, and assessment and treatment may be possible without recourse to hospital admission.     

Community Violence Exposure,Experiential Avoidance and Depression in Chinese Adolescents

This study aimed to investigate the link between community violence exposure, experiential avoidance and depression among Chinese adolescents. A total of 468 middle school students from China completed the Survey of Children’s Exposure to Community Violence, Acceptance and Action Questionnaire-Second Edition (AAQ-II) and Children’s Depression Inventory (CDI). The results suggested that the depression was positively correlated with the level of community violence exposure and experiential avoidance, and community violence exposure was positively correlated with experiential avoidance. Mediation analysis revealed that experiential avoidance partially mediated the association between exposure to community violence and depression. These results suggest that educators and parents can help adolescents prevent or reduce the happening of depression by reducing their risk of exposure to community violence and decreasing experiential avoidance.     

Depression in the aged. An overview

Depression in the aged is common and associated with substantial medical and social morbidity and mortality. It is often missed or misdiagnosed because of masked or somatic symptoms, delusions, and pseudodementia. At any given time, about 2 per cent of the elderly have major depression and a third to a half of older psychiatric inpatients and outpatients have mood disorders. Aged depressives have more somatization, hypochondriasis, anxiety, retardation, and delusionality but less guilt, loss of libido, and family history of depression than young ones. Both the illnesses common in the elderly and the medicines used to treat them may be etiologically connected with depression. After precipitating causes are remedied, remaining symptoms respond to antidepressant treatment. Medication doses are much lower and side effects more troublesome. ECT or concomitant antipsychotic medication are more likely to be indicated.     

An assessment of the Newcastle Anxiety Depression Index

The Newcastle Anxiety and Depression Diagnostic Index (NADDI) has been reviewed, and its advantages and disadvantages discussed. One hundred eighty-seven patients were examined, and grouped into three categories by means of the NADDI, which produced a unimodal distribution of score. These three groups were studied in respect of the Hamilton Depression and SCL-90 self-rating scales. Significant profile differences were found on both scales. Patients with pure anxiety and pure depression were more distressed than the intermediate group of mixed anxiety-depressed patients. The NADDI scale items were compared in four clinical groups of primary endogenous, primary nonendogenous depression, generalized anxiety, and panic disorder. Most differences were found when panic disorder was compared to the other three groups, and generalized anxiety disorder received minimal validation. Treatment response was also examined.     

Borderline Personality Disorder and Depression: An Update

To review the literature related to recent temperamental and biological findings on borderline personality disorder (BPD) and major depression, the close link between the two disorders, and the latest therapeutical findings on BPD, focusing on the conditions of co-morbidity between depression and BPD. The National Institutes of Health's PubMed database was used to identify indexed studies on BPD, depression and the co-morbidity between the two. Only studies published between 2000 and 2011 were assessed. Similar temperamental features have been demonstrated in BPD and depression. The strong link between the two disorders seems to be widely recognized by scientific community. Psychotherapy and new antipsychotics are the topics of current major interest of research. The therapeutic targets in the case of co-morbidity are BPD features associated with depressive symptoms, thus influencing prognosis. A global assessment is, in fact, fundamental for a successful therapy for the treatment of the several aspects of a complex psychopathological phenomenon.     

Integrative Medicine for Treating Depression: An Update on the Latest Evidence

Globalization of ADHD and the rise of cognitive enhancement have raised fresh concerns about the validity of ADHD diagnosis and the ethics of stimulant drug treatment. We review the literature on these two emerging phenomena, with a focus on the corresponding social, scientific and ethical debates over the universality of ADHD and the use of stimulant drug treatments in a global population of children and adolescents. Drawing on this literature, we reflect on the importance of ethically informed, ecologically sensitive clinical practices in relation to ADHD diagnosis and treatment.     

Self-Help Epilepsy Groups: An Evaluation of Effect on Depression and Schizophrenia

The general prevalence of depression and schizophrenia was determined in a random outpatient population (n = 67) of refractory epileptic patients by Minnesota Multiphasic Personality Inventory (MMPI) and Beck Depression Inventory (BDI). Of those patients 25% showed scores of moderate or severe depression. Self-help group intervention modifies significantly (p < 0.001) general mean depression rates, especially dystimia. Male and female differences emerged in our study for previous prevalence and pattern of recovery.