Seed and Capacity Building funding

The vision of the diamond Consortium is that of a primary care system that promotes emotional well-being and provides Australians experiencing depression with accessible, responsive and effective management options to assist recovery and maintain well-being. To enable diamond Consortium members to build upon this vision, seed and Capacity Building funding applications were available to consortium members for research projects related to depression in primary care. Seven projects were funded with summaries of each presented below:

1. Problem solving approaches to depression in general practice

Investigator: Dr David Pierce, Department of General Practice, The University of Melbourne
This project, called PS-GP, was based at the Department of General Practice at the University of Melbourne. It has explored the use by Australian general practitioners (GPs), of problem solving therapy (PST) as evidence based treatment for depression. It has also both developed and tested an intervention aimed at increasing GPs’ knowledge and skill in providing PST to their patients. The intervention included a training program that was completed by 24 GPs which included the use of simulated patients (experienced actors) to facilitate the development of GPs’ skill and confidence in the provision of PST. This project is now completed and the results have been published in two journals (details below).

Publications:

• D Pierce, J Gunn. Using problem solving therapy in general practice. Aust Fam Physician 2007; 36(4):230-233
• Pierce D, Gunn J. GPs' use of problem solving therapy for depression: a qualitative study of barriers to and enablers of evidence based care. BMC Fam Pract, 2007, 8:24

2. Depression Screening and Assessment Feasibility Study

Investigators: Mr Russell Nunn, Royal District Nursing Service; Dr Jane Sims, The University of Melbourne; Prof. Merilyn Annells, La Trobe University & Royal District Nursing Service.
This study involved the participation of nursing staff at a single Royal District Nursing Service Centre (Essendon Centre) and their elderly clients. Immediately prior to the delivery of an education session on depression and the use of the Geriatric Depression Scale (GDS), nurses completed a questionnaire on their knowledge and attitudes towards depression. This was followed by a three-month implementation phase in which the nurses routinely screened their elderly clients for depression using the GDS. Clients who screened positive for depression received a detailed assessment by a Psychiatric Nurse and a referral to the client's doctor or a specialist mental health service. In addition, a post-implementation questionnaire was administered to obtain the nurse's views on the feasibility of routinely screening their clients for depression. Finally, semi-structured qualitative interviews will be conducted with six staff members to obtain their opinions about screening older RDNS clients for depression. It is hoped that the results of this study may lead to higher rates of identification and better management of depression in a group of people whose depression frequently remains unrecognised and untreated.

Publications:

• Nunn R, Annells M, Sims J. Screening for depression in older district nursing clients: feasibility study. Br J Community Nurs. 2007 12(3): 108-14

3. Management of depression 2 (MOD 2)

Investigators: Dr Heather McGarry, A/Prof Kelsey Hegarty, Prof Jane Gunn, Dr Marie Pirotta, Dr Grant Blashki, Dr Caroline Johnson, Dr David Pierce, Department of General Practice, The University of Melbourne

This project aimed to explore the methods GPs use to treat people with depression and whether these methods have changed over time. The project looked at a range of management strategies, including whether the number of GPs trained in mental health care have increased; whether there has been an increase in the use of psychological treatments and whether training influences the use of these treatments. Perceived barriers to using such treatments were be explored. The current project will compare the results with those of a similar survey conducted in 2001.

A questionnaire was sent to a random sample of GPs throughout Australia asking them about how they currently treat people with depression. Their answers were examined to understand what most GPs do. Understanding the methods GPs use to treat patients with depression and how they have changed since the previous survey is important, particularly following the introduction of government incentives which encourage training. This will inform future education for GPs and ongoing research in this area.


4. Women’s Attitudes to Screening for Postnatal Depression in a Rural Victorian Community.

Investigators: Susan Armstrong, Mother and Child Health Research, LaTrobe University; Dr. Rhonda Small, Mother and Child Health Research, LaTrobe University.

A postal survey of all women in a rural Victorian town who gave birth over a 12 month period, followed by in-depth interviews to elucidate women’s experience of and attitudes to a screening program for postnatal depression. The postal survey has been completed and contact made with the 85 women who have expressed willingness to be involved in further research. In-depth interviews with 20 of these women have been established, of which 16 have been completed to date.

5. Development, pilot testing and evaluation of an Enhanced Discharge Summary Form (EDSF) to improve uptake of ongoing primary health care after admission to a residential early parenting centre

Investigators: A/Prof Jane Fisher, Key Centre for Women’s Health in Society, School of Population Health, The University of Melbourne; Dr Heather Rowe, Key Centre for Women’s Health in Society, School of Population Health, The University of Melbourne and Prof Jane Gunn, Department of General Practice, The University of Melbourne

Australia’s residential early parenting centres provide brief structured psycho-educational interventions to treat unsettled infant behaviour and maternal distress, to which 3000 Victorian mother-infant dyads are admitted annually. Most women admitted to these services have poor mental and physical health and their social circumstances are complex. Ongoing primary health care is needed and recommended after completion of the residential program, but only one in five women contact a general practitioner for personal health care in the three months after discharge. The objective of this project was to improve ongoing comprehensive primary health care for mothers and infants who have been treated in brief residential early parenting programs. The specific aims were to establish prevalence of common mental and physical health problems in a consecutive cohort of women admitted to two residential early parenting services; and to assess their perceptions of primary health care and the acceptability of an enhanced discharge summary form to promote uptake of primary health care after discharge. A consecutive cohort of 145 mothers admitted to two residential early parenting services: Masada Private Hospital Mother Baby Unit and Tweddle Child and Family Health Service were surveyed about their mental and physical health, social circumstances, infant’s behaviour and relationship with primary health care providers.

5. The experience of depression after birth and views about primary care services among Persian-speaking women in Melbourne

Investigators: Ms Touran Shafiei, Mother & Child Research, La Trobe University; Dr Rhonda Small, Mother & Child Research, La Trobe University;  Dr Helen McLachlan, Mother & Child Research, La Trobe University & Division of Nursing and Midwifery, La Trobe University

The objectives of this study were to explore views of maternity care, emotional well-being and the experience of depression after birth among Iranian and Afghan immigrant women; to describe Iranian and Afghan women’s use of, and experiences with, primary care services after birth, particularly in relation to help-seeking for depression; and to compare the findings with previous Victorian studies of Australian-born women and of other groups of immigrant women.

Women born in Iran and Afghanistan were recruited from Melbourne hospitals (Monash Medical Centre, Dandenong Hospital, Mercy Hospital for Women and The Royal Women’s Hospital). Between October 2006 and May 2007, 83 eligible women were approached at antenatal visits or on the postnatal ward and 55 have agreed to participate in the study. Eight women later withdrew or could not be followed up, and 47 women were interviewed four months after birth. The main telephone interviews commenced in mid February 2007 and finished at the end of August 2007. The telephone interview schedule was developed, translated and piloted, and the Edinburgh Postnatal Depression Scale (EPDS) was translated independently by two Persian translators and independently back-translated by two other translators. A focus group discussion involving the translators and a small number of Persian-speaking women achieved further agreement about the most appropriate translation to be used, followed by piloting with bilingual and monolingual Iranian and Afghan women.

6. Men’s experience of partner abuse and depression

Investigators: A/Prof Kelsey Hegarty, Department of General Practice, The University of Melbourne; Dr Gail Gilchrist, Department of General Practice, The University of Melbourne