Julie Pallant - Academia.edu (original) (raw)

Papers by Julie Pallant

Research paper thumbnail of A Rasch analysis of the Hospital Anxiety and Depression Scale (HADS) among cancer survivors

OBJECTIVE: The Hospital Anxiety and Depression Scale (HADS) is commonly used to assess distress a... more OBJECTIVE: The Hospital Anxiety and Depression Scale (HADS) is commonly used to assess distress among individuals with cancer. However, previous studies cast doubt on the most appropriate dimensional structure for the HADS, suggesting that 1- or 3-dimensional structures might offer superior fit to the original 2-dimensional one. This article is the first to use Rasch analysis to examine the psychometric properties of the subscales corresponding to each of these alternative structures.

METHOD: The HADS was completed by 1,360 cancer survivors. Rasch analyses were conducted to examine summary and individual model fit statistics, person separation index, response format, item bias, redundancy, and dimensionality.

RESULTS: The HADS-Total scale was found to be multidimensional, and it was necessary to remove almost half of the items to achieve fit. Analyses only partially supported the original structure, as both HADS-Anxiety and HADS-Depression showed initial model misfit and item deletion was necessary to achieve fit. Within the 3-dimensional structures, the Rasch statistics for the anxiety subscales were within acceptable range and no adjustment was needed. Analyses did not support adding Item 7 to HADS-Depression.

CONCLUSIONS: Results supported modified versions of the HADS-Anxiety and HADS-Depression; however, combining all items to form HADS-Total is not recommended. Numerous studies using classical test theory and Rasch analyses have corroborated the exclusion of some items (e.g., Item 7) and appropriateness of the subscales defined by a 3-dimensional structure. Further research is required to identify the incremental validity of potential revised subscales.

Research paper thumbnail of Child's Challenging Behaviour Scale

Research paper thumbnail of Evaluation of the internal construct validity of the Personal Care Participation Assessment and Resource Tool (PC-PART) using Rasch analysis

BMC Health Services Research, 2014

Research paper thumbnail of Evaluation of the Ability to Sing Easily Instrument

Research paper thumbnail of Erratum: Guillain-Barré Syndrome: Prevalence and Long-Term Factors Impacting Bladder Function in an Australian Community Cohort

Journal of Clinical Neurology, 2013

ABSTRACT [This corrects the article on p. 144 in vol. 9, PMID: 23894237.].

Research paper thumbnail of Guillain-Barré Syndrome: Prevalence and Long-Term Factors Impacting Bladder Function in an Australian Community Cohort

Journal of Clinical Neurology, 2013

Research paper thumbnail of Deriving utility scores from the SF-36 health instrument using Rasch analysis

Quality of Life Research, 2008

Research paper thumbnail of Factors associated with long-term functional outcomes and psychological sequelae in women after breast cancer

Research paper thumbnail of Maternal depressive symptoms have a negative impact on prenatal attachment – findings from a Swedish community sample

Journal of Reproductive and Infant Psychology, 2014

ABSTRACT Objective: The objective of this study was to evaluate attachment and its association to... more ABSTRACT Objective: The objective of this study was to evaluate attachment and its association to obstetric and demographic factors as well as emotional well-being using a standard measure of prenatal attachment during pregnancy. Background: The strength of the mothers’ relationship with her baby has important implications in the postnatal period, influencing the relationship she develops with her child, and the quality of the care she provides. Methods: This was a population-based longitudinal survey comprising a consecutive sample from a one-year cohort in a Swedish county. In this study the three subscales of PAI-R (Prenatal Attachment Inventory – Revised) were used for evaluation of attachment. In total, 718 pregnant women participated in this study. Results: Women with elevated levels of depression (HADS-D > 8) recorded lower attachment scores across all three PAI-R subscales. Lack of perceived support from partner was associated with lower scores on Interaction. Lack of support from own mother and own father were also associated with lower scores on all subscales. Attachment was also associated with feelings about the approaching birth and about the first weeks with the newborn, with women who reported less than positive feelings recording lower scores on each of the PAI-R subscales. Conclusion: A focus on attachment during antenatal care and the use of PAI-R during pregnancy provides a means of identifying those women who show lower levels of attachment and possible emotional problems that may impact on emotional health and the birth process.

Research paper thumbnail of Impact of Cataract Surgery on Quality of Life in Patients with Early Age-Related Macular Degeneration

Optometry and Vision Science, 2007

Research paper thumbnail of Use of Goal Attainment Scaling in Inpatient Rehabilitation for Persons With Multiple Sclerosis

Archives of Physical Medicine and Rehabilitation, 2008

Khan F, Pallant JF, Turner-Stokes L. Use of goal attainment scaling in inpatient rehabilitation f... more Khan F, Pallant JF, Turner-Stokes L. Use of goal attainment scaling in inpatient rehabilitation for persons with multiple sclerosis.To use goal attainment scaling (GAS) to measure clinically important functional change in persons with multiple sclerosis (MS) and to assess its responsiveness compared with standard measures used to evaluate progress in rehabilitation.Prospective, observational cohort study.Tertiary inpatient rehabilitation unit in Victoria, Australia.Consecutive sample of 24 persons with MS admitted for comprehensive rehabilitation program. The male-to-female ratio was 10:14, and the mean age ± standard deviation was 52.0±8.3 years (range, 37−62y). Over half (n=14 [58.3%]) had secondary progressive MS.Not applicable.GAS scores were calculated for 5 to 10 priority goals set prospectively by each patient in agreement with the multidisciplinary treating team and compared with standard outcome measures—the FIM instrument and Barthel Index—rated on admission and discharge from the program. Patients were categorized into responders and nonresponders based on an overall clinical global impression.Of 203 selected goals, 167 were achieved at the predicted level. GAS recorded outcomes for 105 individualized goals not measured by the FIM and Barthel Index. Although all 3 measures showed statistically significant change from admission to discharge (P<.001), only GAS scores strongly correlated with the Clinical Global Impression scale (ρ=−.86, P<.001). GAS discharge scores differed significantly between the responder and nonresponder groups (Mann-Whitney, z=−3.78, P<.001). Different measures of effect size gave different results, but GAS was consistently more responsive than either the FIM or Barthel Index.This preliminary study suggests that GAS is a responsive and useful outcome measure for the rehabilitation of persons with MS, providing added value to standardized outcome measurement.

Research paper thumbnail of Women's satisfaction with antenatal care: Comparing women in Sweden and Australia

Women and Birth, 2013

Satisfaction with antenatal care could differ depending on the organisation and the context of ca... more Satisfaction with antenatal care could differ depending on the organisation and the context of care. To compare antenatal care in Australia and Sweden, to identify deficiencies in the content of antenatal care and what aspects contributed most in dissatisfaction with antenatal care. A longitudinal survey of 123 Australian and 386 Swedish women recruited during one year in regional hospitals in Sweden and Australia. Data collected by three questionnaires. Women in Australia had more antenatal visits, less continuity of midwife caregiver but were more satisfied with antenatal education and the emotional aspects of antenatal care. Although the overall satisfaction was high, deficiencies were found in more than half of the studied variables in the content of care. Women in Sweden were more dissatisfied with information about labour and birth (OR 3.1; 1.8-5.3) and information about the time following birth (OR 3.8; 2.2-6.3), but more satisfied with the involvement of the father (OR 0.3; 0.2-0.6). Factors that contributed most to dissatisfaction with antenatal care overall were deficiency in information about pregnancy related issues (OR 3.4; 1.3-8.7) and not being taken seriously by the midwife (OR 4.1; 1.6-10.1). Satisfaction with antenatal care was high in both groups of women. Australian women were more satisfied than the Swedish women with the emotional aspects of care. Deficiencies were found in more than half of the variables measured relating to the specific aspects of care. Lack of information and not being treated seriously were important factors for not being satisfied.

Research paper thumbnail of The association between chronic illness, multimorbidity and depressive symptoms in an Australian primary care cohort

Social Psychiatry and Psychiatric Epidemiology, 2012

To assess the link between multimorbidity, type of chronic physical health problems and depressiv... more To assess the link between multimorbidity, type of chronic physical health problems and depressive symptoms The study was a cross-sectional postal survey conducted in 30 General Practices in Victoria, Australia as part of the diamond longitudinal study. Participants included 7,620 primary care attendees; 66% were females; age range from 18 to 76 years (mean = 51 years SD = 14); 81% were born in Australia; 64% were married and 67% lived in an urban area. The main outcome measures include the Centre for Epidemiologic Studies Depression Scale (CES-D) and a study-specific self-report check list of 12 common chronic physical health problems. The prevalence of probable depression increased with increasing number of chronic physical conditions (1 condition: 23%; 2 conditions: 27%; 3 conditions: 30%; 4 conditions: 31%; 5 or more conditions: 41%). Only 16% of those with no listed physical conditions recorded CES-D scores of 16 or above. Across the listed physical conditions the prevalence of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;probable depression&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; ranged from 24% for hypertension; 35% for emphysema; 35% for dermatitis to 36% for stroke. The dose-response relationship is reduced when functional limitations and self-rated health are taken into account, suggesting that these factors mediate the relationship. A clear dose-response relationship exists between the number of chronic physical problems and depressive symptoms. The relationship between multimorbidity and depression appears to be mediated via self-perceived health related quality of life. Primary care practitioners will identify more cases of depression if they focus on those with more than one chronic health problem, no matter what the problems may be, being especially aware in the group who rate their health as poor/fair.

Research paper thumbnail of Sexual Dysfunction in Multiple Sclerosis

Sexuality and Disability, 2011

Research paper thumbnail of Predicting mental health among mothers of school-aged children with developmental disabilities: The relative contribution of child, maternal and environmental factors

Research in Developmental Disabilities, 2012

Many mothers of children with developmental disabilities are known to experience high levels of s... more Many mothers of children with developmental disabilities are known to experience high levels of stress, and compromised mental health. Research is crucial to better understand and assist mothers with compromised mental health, and ultimately better service families raising and supporting a child with a disability. Data were collected using cross sectional mail-out survey with follow up phone call. Instruments included the Short Form 36 version 2 (SF-36v2) and instruments that measured maternal, child and environmental factors. Descriptive statistics examined characteristics of participants. Correlation, t-tests, and multiple regression analyses were used to identify factors associated with mothers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; mental health. Mothers (N=152) cared for a school-aged child (aged 5-18 years) with high care needs and developmental disabilities including autism spectrum disorder (n=94); cerebral palsy (n=29); attention deficit hyperactivity disorder (n=19). Factors associated with maternal mental health included the child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s psychosocial health (r=.36) and challenging behaviour (r=-.33); maternal empowerment (r=.40); maternal participation in health promoting activities (r=.43); and the child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s unmet service needs (r=-.29). The strongest predictors of maternal mental health in this cross sectional study were maternal participation in healthy activity and empowerment, the child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s emotional functioning and unmet service needs. This study identified maternal factors as the most important influence on self reported mental health among this sample of mothers. Findings suggest that service changes that provide mothers with information about their own health and need for health enhancing activities, as well as education that empowers mothers to manage and master their child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disability and needs, may contribute to maternal mental health and well being.

Research paper thumbnail of Adjustment of Mothers of Children With Obstetrical Brachial Plexus Injuries: Testing a Risk and Resistance Model

Rehabilitation Psychology, 2004

Research paper thumbnail of Using Rasch analysis to examine the distress thermometer’s cut-off scores among a mixed group of patients with cancer

Quality of Life Research, 2014

The distress thermometer (DT) is commonly used in cancer care to improve detection of distress. T... more The distress thermometer (DT) is commonly used in cancer care to improve detection of distress. The DT&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s recommended cut-off score of 4 or 5 has typically been established using the Hospital Anxiety and Depression Scale (HADS) by receiver operating characteristic curve analysis. The present analysis complements these studies by critically examining the use of the HADS to identify the DT&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s cut-off score and corroborating the DT&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s cut-off scores using item response theory (Rasch analysis). The DT and HADS were completed by 340 patients with cancer. Rasch dimensionality analysis was performed on the HADS-Total, and test characteristic curves were examined to equate the DT and the HADS subscales. Identified DT cut-off scores were then examined for their sensitivity and specificity. Rasch analysis did not support the unidimensionality of HADS-Total. The test characteristic curves indicated that a cut-off score of ≥8 on the HADS-Anxiety and HADS-Depression subscales was equivalent to a score of 6 and 7 on the DT, respectively. However, a DT cut-off score of 5 resulted in the best balance between sensitivity and specificity across the HADS-Anxiety and HADS-Depression subscales. Despite being a popular practice, the present findings did not support combining the HADS-Anxiety and HADS-Depression subscales to identify the DT&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s cut-off score. Furthermore, these results inform the use of the DT as a preliminary screening tool and suggest that when a single screen is used, a DT cut-off score of 6 or 7 might be more appropriate than the typical cut-off score of 4.

Research paper thumbnail of Rasch analysis of the Hospital Anxiety and Depression Scale among caregivers of cancer survivors: implications for its use in psycho-oncology

Research paper thumbnail of A Rasch analysis of the Hospital Anxiety and Depression Scale (HADS) among cancer survivors

Psychological Assessment, 2013

Research paper thumbnail of Can Clinicians Use the PHQ-9 to Assess Depression in People with Vision Loss?

Optometry and Vision Science, 2009

Research paper thumbnail of A Rasch analysis of the Hospital Anxiety and Depression Scale (HADS) among cancer survivors

OBJECTIVE: The Hospital Anxiety and Depression Scale (HADS) is commonly used to assess distress a... more OBJECTIVE: The Hospital Anxiety and Depression Scale (HADS) is commonly used to assess distress among individuals with cancer. However, previous studies cast doubt on the most appropriate dimensional structure for the HADS, suggesting that 1- or 3-dimensional structures might offer superior fit to the original 2-dimensional one. This article is the first to use Rasch analysis to examine the psychometric properties of the subscales corresponding to each of these alternative structures.

METHOD: The HADS was completed by 1,360 cancer survivors. Rasch analyses were conducted to examine summary and individual model fit statistics, person separation index, response format, item bias, redundancy, and dimensionality.

RESULTS: The HADS-Total scale was found to be multidimensional, and it was necessary to remove almost half of the items to achieve fit. Analyses only partially supported the original structure, as both HADS-Anxiety and HADS-Depression showed initial model misfit and item deletion was necessary to achieve fit. Within the 3-dimensional structures, the Rasch statistics for the anxiety subscales were within acceptable range and no adjustment was needed. Analyses did not support adding Item 7 to HADS-Depression.

CONCLUSIONS: Results supported modified versions of the HADS-Anxiety and HADS-Depression; however, combining all items to form HADS-Total is not recommended. Numerous studies using classical test theory and Rasch analyses have corroborated the exclusion of some items (e.g., Item 7) and appropriateness of the subscales defined by a 3-dimensional structure. Further research is required to identify the incremental validity of potential revised subscales.

Research paper thumbnail of Child's Challenging Behaviour Scale

Research paper thumbnail of Evaluation of the internal construct validity of the Personal Care Participation Assessment and Resource Tool (PC-PART) using Rasch analysis

BMC Health Services Research, 2014

Research paper thumbnail of Evaluation of the Ability to Sing Easily Instrument

Research paper thumbnail of Erratum: Guillain-Barré Syndrome: Prevalence and Long-Term Factors Impacting Bladder Function in an Australian Community Cohort

Journal of Clinical Neurology, 2013

ABSTRACT [This corrects the article on p. 144 in vol. 9, PMID: 23894237.].

Research paper thumbnail of Guillain-Barré Syndrome: Prevalence and Long-Term Factors Impacting Bladder Function in an Australian Community Cohort

Journal of Clinical Neurology, 2013

Research paper thumbnail of Deriving utility scores from the SF-36 health instrument using Rasch analysis

Quality of Life Research, 2008

Research paper thumbnail of Factors associated with long-term functional outcomes and psychological sequelae in women after breast cancer

Research paper thumbnail of Maternal depressive symptoms have a negative impact on prenatal attachment – findings from a Swedish community sample

Journal of Reproductive and Infant Psychology, 2014

ABSTRACT Objective: The objective of this study was to evaluate attachment and its association to... more ABSTRACT Objective: The objective of this study was to evaluate attachment and its association to obstetric and demographic factors as well as emotional well-being using a standard measure of prenatal attachment during pregnancy. Background: The strength of the mothers’ relationship with her baby has important implications in the postnatal period, influencing the relationship she develops with her child, and the quality of the care she provides. Methods: This was a population-based longitudinal survey comprising a consecutive sample from a one-year cohort in a Swedish county. In this study the three subscales of PAI-R (Prenatal Attachment Inventory – Revised) were used for evaluation of attachment. In total, 718 pregnant women participated in this study. Results: Women with elevated levels of depression (HADS-D &gt; 8) recorded lower attachment scores across all three PAI-R subscales. Lack of perceived support from partner was associated with lower scores on Interaction. Lack of support from own mother and own father were also associated with lower scores on all subscales. Attachment was also associated with feelings about the approaching birth and about the first weeks with the newborn, with women who reported less than positive feelings recording lower scores on each of the PAI-R subscales. Conclusion: A focus on attachment during antenatal care and the use of PAI-R during pregnancy provides a means of identifying those women who show lower levels of attachment and possible emotional problems that may impact on emotional health and the birth process.

Research paper thumbnail of Impact of Cataract Surgery on Quality of Life in Patients with Early Age-Related Macular Degeneration

Optometry and Vision Science, 2007

Research paper thumbnail of Use of Goal Attainment Scaling in Inpatient Rehabilitation for Persons With Multiple Sclerosis

Archives of Physical Medicine and Rehabilitation, 2008

Khan F, Pallant JF, Turner-Stokes L. Use of goal attainment scaling in inpatient rehabilitation f... more Khan F, Pallant JF, Turner-Stokes L. Use of goal attainment scaling in inpatient rehabilitation for persons with multiple sclerosis.To use goal attainment scaling (GAS) to measure clinically important functional change in persons with multiple sclerosis (MS) and to assess its responsiveness compared with standard measures used to evaluate progress in rehabilitation.Prospective, observational cohort study.Tertiary inpatient rehabilitation unit in Victoria, Australia.Consecutive sample of 24 persons with MS admitted for comprehensive rehabilitation program. The male-to-female ratio was 10:14, and the mean age ± standard deviation was 52.0±8.3 years (range, 37−62y). Over half (n=14 [58.3%]) had secondary progressive MS.Not applicable.GAS scores were calculated for 5 to 10 priority goals set prospectively by each patient in agreement with the multidisciplinary treating team and compared with standard outcome measures—the FIM instrument and Barthel Index—rated on admission and discharge from the program. Patients were categorized into responders and nonresponders based on an overall clinical global impression.Of 203 selected goals, 167 were achieved at the predicted level. GAS recorded outcomes for 105 individualized goals not measured by the FIM and Barthel Index. Although all 3 measures showed statistically significant change from admission to discharge (P<.001), only GAS scores strongly correlated with the Clinical Global Impression scale (ρ=−.86, P<.001). GAS discharge scores differed significantly between the responder and nonresponder groups (Mann-Whitney, z=−3.78, P<.001). Different measures of effect size gave different results, but GAS was consistently more responsive than either the FIM or Barthel Index.This preliminary study suggests that GAS is a responsive and useful outcome measure for the rehabilitation of persons with MS, providing added value to standardized outcome measurement.

Research paper thumbnail of Women's satisfaction with antenatal care: Comparing women in Sweden and Australia

Women and Birth, 2013

Satisfaction with antenatal care could differ depending on the organisation and the context of ca... more Satisfaction with antenatal care could differ depending on the organisation and the context of care. To compare antenatal care in Australia and Sweden, to identify deficiencies in the content of antenatal care and what aspects contributed most in dissatisfaction with antenatal care. A longitudinal survey of 123 Australian and 386 Swedish women recruited during one year in regional hospitals in Sweden and Australia. Data collected by three questionnaires. Women in Australia had more antenatal visits, less continuity of midwife caregiver but were more satisfied with antenatal education and the emotional aspects of antenatal care. Although the overall satisfaction was high, deficiencies were found in more than half of the studied variables in the content of care. Women in Sweden were more dissatisfied with information about labour and birth (OR 3.1; 1.8-5.3) and information about the time following birth (OR 3.8; 2.2-6.3), but more satisfied with the involvement of the father (OR 0.3; 0.2-0.6). Factors that contributed most to dissatisfaction with antenatal care overall were deficiency in information about pregnancy related issues (OR 3.4; 1.3-8.7) and not being taken seriously by the midwife (OR 4.1; 1.6-10.1). Satisfaction with antenatal care was high in both groups of women. Australian women were more satisfied than the Swedish women with the emotional aspects of care. Deficiencies were found in more than half of the variables measured relating to the specific aspects of care. Lack of information and not being treated seriously were important factors for not being satisfied.

Research paper thumbnail of The association between chronic illness, multimorbidity and depressive symptoms in an Australian primary care cohort

Social Psychiatry and Psychiatric Epidemiology, 2012

To assess the link between multimorbidity, type of chronic physical health problems and depressiv... more To assess the link between multimorbidity, type of chronic physical health problems and depressive symptoms The study was a cross-sectional postal survey conducted in 30 General Practices in Victoria, Australia as part of the diamond longitudinal study. Participants included 7,620 primary care attendees; 66% were females; age range from 18 to 76 years (mean = 51 years SD = 14); 81% were born in Australia; 64% were married and 67% lived in an urban area. The main outcome measures include the Centre for Epidemiologic Studies Depression Scale (CES-D) and a study-specific self-report check list of 12 common chronic physical health problems. The prevalence of probable depression increased with increasing number of chronic physical conditions (1 condition: 23%; 2 conditions: 27%; 3 conditions: 30%; 4 conditions: 31%; 5 or more conditions: 41%). Only 16% of those with no listed physical conditions recorded CES-D scores of 16 or above. Across the listed physical conditions the prevalence of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;probable depression&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; ranged from 24% for hypertension; 35% for emphysema; 35% for dermatitis to 36% for stroke. The dose-response relationship is reduced when functional limitations and self-rated health are taken into account, suggesting that these factors mediate the relationship. A clear dose-response relationship exists between the number of chronic physical problems and depressive symptoms. The relationship between multimorbidity and depression appears to be mediated via self-perceived health related quality of life. Primary care practitioners will identify more cases of depression if they focus on those with more than one chronic health problem, no matter what the problems may be, being especially aware in the group who rate their health as poor/fair.

Research paper thumbnail of Sexual Dysfunction in Multiple Sclerosis

Sexuality and Disability, 2011

Research paper thumbnail of Predicting mental health among mothers of school-aged children with developmental disabilities: The relative contribution of child, maternal and environmental factors

Research in Developmental Disabilities, 2012

Many mothers of children with developmental disabilities are known to experience high levels of s... more Many mothers of children with developmental disabilities are known to experience high levels of stress, and compromised mental health. Research is crucial to better understand and assist mothers with compromised mental health, and ultimately better service families raising and supporting a child with a disability. Data were collected using cross sectional mail-out survey with follow up phone call. Instruments included the Short Form 36 version 2 (SF-36v2) and instruments that measured maternal, child and environmental factors. Descriptive statistics examined characteristics of participants. Correlation, t-tests, and multiple regression analyses were used to identify factors associated with mothers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; mental health. Mothers (N=152) cared for a school-aged child (aged 5-18 years) with high care needs and developmental disabilities including autism spectrum disorder (n=94); cerebral palsy (n=29); attention deficit hyperactivity disorder (n=19). Factors associated with maternal mental health included the child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s psychosocial health (r=.36) and challenging behaviour (r=-.33); maternal empowerment (r=.40); maternal participation in health promoting activities (r=.43); and the child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s unmet service needs (r=-.29). The strongest predictors of maternal mental health in this cross sectional study were maternal participation in healthy activity and empowerment, the child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s emotional functioning and unmet service needs. This study identified maternal factors as the most important influence on self reported mental health among this sample of mothers. Findings suggest that service changes that provide mothers with information about their own health and need for health enhancing activities, as well as education that empowers mothers to manage and master their child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disability and needs, may contribute to maternal mental health and well being.

Research paper thumbnail of Adjustment of Mothers of Children With Obstetrical Brachial Plexus Injuries: Testing a Risk and Resistance Model

Rehabilitation Psychology, 2004

Research paper thumbnail of Using Rasch analysis to examine the distress thermometer’s cut-off scores among a mixed group of patients with cancer

Quality of Life Research, 2014

The distress thermometer (DT) is commonly used in cancer care to improve detection of distress. T... more The distress thermometer (DT) is commonly used in cancer care to improve detection of distress. The DT&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s recommended cut-off score of 4 or 5 has typically been established using the Hospital Anxiety and Depression Scale (HADS) by receiver operating characteristic curve analysis. The present analysis complements these studies by critically examining the use of the HADS to identify the DT&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s cut-off score and corroborating the DT&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s cut-off scores using item response theory (Rasch analysis). The DT and HADS were completed by 340 patients with cancer. Rasch dimensionality analysis was performed on the HADS-Total, and test characteristic curves were examined to equate the DT and the HADS subscales. Identified DT cut-off scores were then examined for their sensitivity and specificity. Rasch analysis did not support the unidimensionality of HADS-Total. The test characteristic curves indicated that a cut-off score of ≥8 on the HADS-Anxiety and HADS-Depression subscales was equivalent to a score of 6 and 7 on the DT, respectively. However, a DT cut-off score of 5 resulted in the best balance between sensitivity and specificity across the HADS-Anxiety and HADS-Depression subscales. Despite being a popular practice, the present findings did not support combining the HADS-Anxiety and HADS-Depression subscales to identify the DT&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s cut-off score. Furthermore, these results inform the use of the DT as a preliminary screening tool and suggest that when a single screen is used, a DT cut-off score of 6 or 7 might be more appropriate than the typical cut-off score of 4.

Research paper thumbnail of Rasch analysis of the Hospital Anxiety and Depression Scale among caregivers of cancer survivors: implications for its use in psycho-oncology

Research paper thumbnail of A Rasch analysis of the Hospital Anxiety and Depression Scale (HADS) among cancer survivors

Psychological Assessment, 2013

Research paper thumbnail of Can Clinicians Use the PHQ-9 to Assess Depression in People with Vision Loss?

Optometry and Vision Science, 2009