Sarah Hetrick - Academia.edu (original) (raw)

Papers by Sarah Hetrick

Australian family physician, 2014

Monitoring depressive symptoms and suicidality is essential in the management of depression in yo... more Monitoring depressive symptoms and suicidality is essential in the management of depression in young people, yet routine monitoring is rare. This qualitative study sought to explore the experiences and beliefs of general practitioners about factors associated with monitoring youth depression in primary care settings. Two focus groups with general practitioners (n = 12) were audio-recorded, transcribed verbatim and analysed using thematic analysis. A semi-structured interview schedule was used. In the primary care setting, monitoring was perceived as part of a continuum of care that begins with screening and diagnosis and as beneficial mostly in regards to informing treatment planning. Benefits and risks were reported, along with challenges and facilitators. Monitoring youth depression in primary care settings is perceived as both beneficial and potentially risky. Monitoring tools need to inform treatment planning, be brief and fit within existing electronic software used by general ...

Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists, 2008

In the context of controversy and uncertainty about the role of selective serotonin reuptake inhi... more In the context of controversy and uncertainty about the role of selective serotonin reuptake inhibitors (SSRIs) for the treatment of depressive disorders in children and adolescents, we consider the evidence of the benefits and risks of this class of medication and the possible role of shared decision-making as a practical way to guide clinicians, young people and their families through treatment decisions. We suggest that there is an imperative for clinicians to engage young people in a process of shared decision-making, given the uncertainties about SSRI medication in this age group. Shared decision-making provides a way for clinicians to engage young people and ensure they receive the treatment required for this disorder, the potential outcomes of which are severe.

Mental disorders account for a large proportion of the disease burden in young people in all soci... more Mental disorders account for a large proportion of the disease burden in young people in all societies. Most mental disorders begin during youth (12-24 years of age), although they are often fi rst detected later in life. Poor mental health is strongly related to other health and development concerns in young people, notably lower educational achievements, substance abuse, violence, and poor reproductive and sexual health. The eff ectiveness of some interventions for some mental disorders in this age-group have been established, although more research is urgently needed to improve the range of aff ordable and feasible interventions, since most mental-health needs in young people are unmet, even in high-income countries. Key challenges to addressing mental-health needs include the shortage of mental-health professionals, the fairly low capacity and motivation of non-specialist health workers to provide quality mental-health services to young people, and the stigma associated with mental disorder. We propose a population-based, youth focused model, explicitly integrating mental health with other youth health and welfare expertise. Addressing young people's mental-health needs is crucial if they are to fulfi l their potential and contribute fully to the development of their communities.

©FSRH J Fam Plann Reprod Health Care 2009: 35(3)

To investigate sociodemographic variation in antidepressant utilisation. Cross-sectional analysis... more To investigate sociodemographic variation in antidepressant utilisation. Cross-sectional analysis of antidepressant prescription under the Pharmaceutical Benefits Scheme in Australia, 2003-2005. Antidepressant utilisation (defined daily dose/1000/day) by sex, age, socioeconomic status (SES) and geographical area. Total antidepressant utilisation increased with age. Among those aged > or = 15 years, female utilisation was about double that of males. About half of antidepressant utilisation was accounted for by sertraline, venlafaxine, citalopram, and paroxetine. SES differentials in antidepressant utilisation changed across age groups for males and females: among those aged < or = 19 years, total antidepressant utilisation was significantly less in lower SES groups (P < 0.001); there was no relationship to SES among 20-29-year-olds; and among those aged > or = 30 years, antidepressant utilisation was significantly higher in lower SES groups (P < 0.001). SES differences were attenuated after adjusting for urban or rural residence, but remained statistically significant. Antidepressant utilisation rates were highest in regional centres. Antidepressant utilisation in Australia partially reflects sociodemographic differences in the prevalence of affective disorder. Discrepancies between treatment provision and treatment need suggest that not all social strata in Australia have equal access to these treatments.

Background: Long-term memory impairments are extensively documented in schizophrenia. Despite gen... more Background: Long-term memory impairments are extensively documented in schizophrenia. Despite general acceptance of the idea that memory is not localized to one neural structure, there is overwhelming evidence that the hippocampus plays a central role in memory formation. Brain imaging studies of adult schizophrenia patients have found smaller hippocampal volumes, while in early onset schizophrenia patients (EOS, onset between 12-18 years of age), differences have not reached statistical significance, but bilateral reductions of about 8-9% has been reported. In healthy individuals volume-memory correlations change from generally negative to extremely variable as the age of the sample increases. No other study has looked into correlations between hippocampal volumes and memory functions in EOS. Methods: 25 adolescents with a schizophrenia spectrum diagnosis were included in the study. Mean age was 15.9 (SD = 1.9) years. The average age of onset of psychosis was 14.4 (SD = 2.1) years. 33 healthy controls screened for mental problems were included in the study. Mean age for the controls was 15.8 (SD = 1.8) years. Intelligence quotient (IQ) was above 70 for all subjects in the study. Verbal learning and memory was assessed using the Hopkins Verbal Learning Test (HVLT). The test is composed of 12 items, organized into three semantic categories, and presented over three consecutive learning trials. After 20 minutes, a delayed recall of the list is recorded. All participants were scanned using a 1.5 T Siemens Trio system (Siemens Medical Systems, Erlangen, Germany). Segmentation of the hippocampal formation was performed using Freesurfer v. 4.0.4 software. Results: The groups did not differ in age or handedness. The patients had a significantly lower IQ score (97.2 (SD = 16.1) IQ points vs 107.3 (SD = 14.8), df = 56, t = -2.478, p = 0.016). The groups did not differ in hippocampal volumes. The patient group performed significantly poorer on all the HVLT subscales: Total learning and delayed recall, both p < 0.01, and percent retained and recognition p < 0.05. There were no significant correlations between any of the HVLT subscales with the hippocampal volumes in the control group. There were significant correlations between left hippocampal volume and delayed recall (correlation = -0.451, p = 0.031) and left hippocampal volume and percent retained (correlation = -0.412, p = 0.051) in the patient group. There was no significant correlation with the other two subscales and the left hippocampus volume, and, finally, no significant correlations between any memory measure and the right hippocampal volume in the patient group. Discussion: There is a significant and moderate negative correlation between left hippocampal volume and performance on both delayed recall and percent retained on HVLT in the EOS group. Why there was no significant relationships in the control group is not clear. Part of the explanation may be that they performed relatively well on the HVLT, and thus had a tighter range of results and standarddeviations compared to the patients. This study indicates that there is noteworthy relations between left hippocampal volume and verbal memory performance in an EOS group. This is of importance as schizophrenia in many aspects is considered a neurodegenerative disorder, where one of the most affected structures in adolescent patient populations is the hippocampus. Treatment efforts to preserve the hippocampal structure, can possibly preserve memory functions in this patient group.

Monitoring depressive symptoms and suicidality is essential in the management of depression in yo... more Monitoring depressive symptoms and suicidality is essential in the management of depression in young people, yet routine monitoring is rare. This qualitative study sought to explore the experiences and beliefs of general practitioners about factors associated with monitoring youth depression in primary care settings. Two focus groups with general practitioners (n = 12) were audio-recorded, transcribed verbatim and analysed using thematic analysis. A semi-structured interview schedule was used. In the primary care setting, monitoring was perceived as part of a continuum of care that begins with screening and diagnosis and as beneficial mostly in regards to informing treatment planning. Benefits and risks were reported, along with challenges and facilitators. Monitoring youth depression in primary care settings is perceived as both beneficial and potentially risky. Monitoring tools need to inform treatment planning, be brief and fit within existing electronic software used by general practitioners.

Australian family physician, 2014

Monitoring depressive symptoms and suicidality is essential in the management of depression in yo... more Monitoring depressive symptoms and suicidality is essential in the management of depression in young people, yet routine monitoring is rare. This qualitative study sought to explore the experiences and beliefs of general practitioners about factors associated with monitoring youth depression in primary care settings. Two focus groups with general practitioners (n = 12) were audio-recorded, transcribed verbatim and analysed using thematic analysis. A semi-structured interview schedule was used. In the primary care setting, monitoring was perceived as part of a continuum of care that begins with screening and diagnosis and as beneficial mostly in regards to informing treatment planning. Benefits and risks were reported, along with challenges and facilitators. Monitoring youth depression in primary care settings is perceived as both beneficial and potentially risky. Monitoring tools need to inform treatment planning, be brief and fit within existing electronic software used by general ...

Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists, 2008

In the context of controversy and uncertainty about the role of selective serotonin reuptake inhi... more In the context of controversy and uncertainty about the role of selective serotonin reuptake inhibitors (SSRIs) for the treatment of depressive disorders in children and adolescents, we consider the evidence of the benefits and risks of this class of medication and the possible role of shared decision-making as a practical way to guide clinicians, young people and their families through treatment decisions. We suggest that there is an imperative for clinicians to engage young people in a process of shared decision-making, given the uncertainties about SSRI medication in this age group. Shared decision-making provides a way for clinicians to engage young people and ensure they receive the treatment required for this disorder, the potential outcomes of which are severe.

Mental disorders account for a large proportion of the disease burden in young people in all soci... more Mental disorders account for a large proportion of the disease burden in young people in all societies. Most mental disorders begin during youth (12-24 years of age), although they are often fi rst detected later in life. Poor mental health is strongly related to other health and development concerns in young people, notably lower educational achievements, substance abuse, violence, and poor reproductive and sexual health. The eff ectiveness of some interventions for some mental disorders in this age-group have been established, although more research is urgently needed to improve the range of aff ordable and feasible interventions, since most mental-health needs in young people are unmet, even in high-income countries. Key challenges to addressing mental-health needs include the shortage of mental-health professionals, the fairly low capacity and motivation of non-specialist health workers to provide quality mental-health services to young people, and the stigma associated with mental disorder. We propose a population-based, youth focused model, explicitly integrating mental health with other youth health and welfare expertise. Addressing young people's mental-health needs is crucial if they are to fulfi l their potential and contribute fully to the development of their communities.

©FSRH J Fam Plann Reprod Health Care 2009: 35(3)

To investigate sociodemographic variation in antidepressant utilisation. Cross-sectional analysis... more To investigate sociodemographic variation in antidepressant utilisation. Cross-sectional analysis of antidepressant prescription under the Pharmaceutical Benefits Scheme in Australia, 2003-2005. Antidepressant utilisation (defined daily dose/1000/day) by sex, age, socioeconomic status (SES) and geographical area. Total antidepressant utilisation increased with age. Among those aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 15 years, female utilisation was about double that of males. About half of antidepressant utilisation was accounted for by sertraline, venlafaxine, citalopram, and paroxetine. SES differentials in antidepressant utilisation changed across age groups for males and females: among those aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 19 years, total antidepressant utilisation was significantly less in lower SES groups (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001); there was no relationship to SES among 20-29-year-olds; and among those aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 30 years, antidepressant utilisation was significantly higher in lower SES groups (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). SES differences were attenuated after adjusting for urban or rural residence, but remained statistically significant. Antidepressant utilisation rates were highest in regional centres. Antidepressant utilisation in Australia partially reflects sociodemographic differences in the prevalence of affective disorder. Discrepancies between treatment provision and treatment need suggest that not all social strata in Australia have equal access to these treatments.

Background: Long-term memory impairments are extensively documented in schizophrenia. Despite gen... more Background: Long-term memory impairments are extensively documented in schizophrenia. Despite general acceptance of the idea that memory is not localized to one neural structure, there is overwhelming evidence that the hippocampus plays a central role in memory formation. Brain imaging studies of adult schizophrenia patients have found smaller hippocampal volumes, while in early onset schizophrenia patients (EOS, onset between 12-18 years of age), differences have not reached statistical significance, but bilateral reductions of about 8-9% has been reported. In healthy individuals volume-memory correlations change from generally negative to extremely variable as the age of the sample increases. No other study has looked into correlations between hippocampal volumes and memory functions in EOS. Methods: 25 adolescents with a schizophrenia spectrum diagnosis were included in the study. Mean age was 15.9 (SD = 1.9) years. The average age of onset of psychosis was 14.4 (SD = 2.1) years. 33 healthy controls screened for mental problems were included in the study. Mean age for the controls was 15.8 (SD = 1.8) years. Intelligence quotient (IQ) was above 70 for all subjects in the study. Verbal learning and memory was assessed using the Hopkins Verbal Learning Test (HVLT). The test is composed of 12 items, organized into three semantic categories, and presented over three consecutive learning trials. After 20 minutes, a delayed recall of the list is recorded. All participants were scanned using a 1.5 T Siemens Trio system (Siemens Medical Systems, Erlangen, Germany). Segmentation of the hippocampal formation was performed using Freesurfer v. 4.0.4 software. Results: The groups did not differ in age or handedness. The patients had a significantly lower IQ score (97.2 (SD = 16.1) IQ points vs 107.3 (SD = 14.8), df = 56, t = -2.478, p = 0.016). The groups did not differ in hippocampal volumes. The patient group performed significantly poorer on all the HVLT subscales: Total learning and delayed recall, both p < 0.01, and percent retained and recognition p < 0.05. There were no significant correlations between any of the HVLT subscales with the hippocampal volumes in the control group. There were significant correlations between left hippocampal volume and delayed recall (correlation = -0.451, p = 0.031) and left hippocampal volume and percent retained (correlation = -0.412, p = 0.051) in the patient group. There was no significant correlation with the other two subscales and the left hippocampus volume, and, finally, no significant correlations between any memory measure and the right hippocampal volume in the patient group. Discussion: There is a significant and moderate negative correlation between left hippocampal volume and performance on both delayed recall and percent retained on HVLT in the EOS group. Why there was no significant relationships in the control group is not clear. Part of the explanation may be that they performed relatively well on the HVLT, and thus had a tighter range of results and standarddeviations compared to the patients. This study indicates that there is noteworthy relations between left hippocampal volume and verbal memory performance in an EOS group. This is of importance as schizophrenia in many aspects is considered a neurodegenerative disorder, where one of the most affected structures in adolescent patient populations is the hippocampus. Treatment efforts to preserve the hippocampal structure, can possibly preserve memory functions in this patient group.

Monitoring depressive symptoms and suicidality is essential in the management of depression in yo... more Monitoring depressive symptoms and suicidality is essential in the management of depression in young people, yet routine monitoring is rare. This qualitative study sought to explore the experiences and beliefs of general practitioners about factors associated with monitoring youth depression in primary care settings. Two focus groups with general practitioners (n = 12) were audio-recorded, transcribed verbatim and analysed using thematic analysis. A semi-structured interview schedule was used. In the primary care setting, monitoring was perceived as part of a continuum of care that begins with screening and diagnosis and as beneficial mostly in regards to informing treatment planning. Benefits and risks were reported, along with challenges and facilitators. Monitoring youth depression in primary care settings is perceived as both beneficial and potentially risky. Monitoring tools need to inform treatment planning, be brief and fit within existing electronic software used by general practitioners.