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Service Related Research: current projects
1. Understanding interpersonal hostile-dominance and its role in aggressive behaviour in psychiatry inpatients
This project is being undertaken by MAPrc in collaboration with the Centre for Forensic Behavioural Science, Monash University. The study is being conducted at the Alfred Hospital.
Aggressive behaviour by patients admitted to psychiatric hospitals occurs frequently and causes problems for patients and staff. Considerable research has explored the various factors that appear to contribute to aggression in psychiatric hospitals. Historically, this research has focussed on the clinical characteristics of aggressive patients, although environmental factors and interactional aspects of aggression have recently been emphasised.
There is some evidence to suggest that interpersonal style, which refers to the characteristic ways in which a person manages their relationships with others and is a significant feature of personality, and levels of perceived coercion, may have an effect on the risk of violent and aggressive behaviour during hospitalisation.
The project aims to:
* to explore the relationship over time between interpersonal style, psychiatric symptoms and aggression in hospitalised psychiatric inpatients,
* to delineate the psychological characteristics of patients with a hostile-dominant interpersonal style,
* to examine whether a history of early childhood abuse predicts hostile-dominance.
A total of 200 adult acute psychiatric patients have been recruited from the inpatient unit at the Alfred Hospital.
Anyone newly admitted to the acute inpatient psychiatry services at The Alfred over a specific period were eligible for inclusion. Participants who consented to take part in the study were asked to spend approximately 60 minutes with a research assistant to discuss their experience of being admitted to hospital. This step involved completion of the Impact Message Inventory-Circumplex, Positive and Negative Syndrome Scale, Life History of Aggression Questionnaire, State-Trait Anger Expression Inventory and the Childhood Trauma Questionnaire. Participants were also asked to give permission for the research assistant to have access to their Alfred Psychiatry file to check for incidents of aggression and behaviours during their admissions.
Data collection has completed and publications detailing project findings are currently being prepared.
Dr Michael Daffern
Dr Yitzchak Hollander
Dr Stuart Lee
2. The impact of psychosocial factors on psychological distress, quality of life and survival of patients undergoing haematopoietic stem cell transplantation
This project is being undertaken by MAPrc in collaboration with the Cabrini Monash Psycho-oncology Unit and staff from Alfred Health. The study is being conducted at the Alfred Hospital.
Stem cell transplantation is often the last course of treatment for patients with haematological cancer who have experienced a relapse or previously unsuccessful treatment attempts. It is often experienced as a very difficult treatment with a number of physical side effects, and many patients experiencing this treatment have been found to experience high levels of psychological distress that impacts on quality of life and capacity to follow treatment recommendations.
While much is known about the physical and medical predictors of treatment success, less is known about the level of distress and when distress is experienced, as well as how social, medical and other coping approaches help or worsen the experience of distress over time. One particular dispositional factor that is being explored in this study is Sense of Coherence which captures the extent to which people view a difficult situation as comprehensible, manageable and meaningful.
The project aims to:
* to examine the level of emotional distress and quality of life of patients immediately before HSCT, 2-3 weeks post-transplant and 3 months post-transplant,
* to determine if clinical risk factors, demographic factors and Sense of Coherence predicts psychosocial distress in patients undergoing HSCT,
* to determine retrospectively whether various demographic factors, clinical indicators, coping styles and psychological distress experienced pre-transplant predicted survival at 12 months post-transplant.
Two separate studies have been conducted. Study 1 collected data from the hospital files of 122 people who underwent a stem cell transplant at The Alfred hospital between 20052011. Study 2 which began in 2012, directly collected information from 60 people directly who were about to undergo a stem cell transplant at The Alfred hospital as a treatment for a haematological cancer.
For Study 1, measures completed with patients as part of the pre-transplant preparation were collected assessing aspects of cancer coping response, quality of life, and distress. For Study 2, participants were invited to complete a set of questionnaires at three timepoints: immediately prior to the transplant, 2-3 weeks after the transplant (while usually still in hospital) and at 3 months after the transplant. Included measures assessed distress, sense of coherence, quality of life and severity of trauma symptoms related to the transplant experience.
Data collection has completed for both studies and publications are currently being prepared.
Dr Stuart Lee
Sue De Bono
Dr Sue Burney
Dr Sharon Avery
3. Piloting the effectiveness of physical health nurses in community based mental health services
This project is being undertaken by MAPrc in collaboration with the Alfred Psychiatry and Inner South Community Health Service.
Previous research has shown that in comparison to people in the general population, people with a severe mental illness die on average 25 years earlier. A particular reason for this is that people with a severe mental illness have higher rates of cardiovascular disease, metabolic disorders, obesity and hypertension, and reduced engagement with health services.
A pilot study has been implemented within a community team of Alfred Psychiatry and Inner South Community Health Service, which was compared to usual care, to appoint a physical health nurse to lead members of their clinical team in monitoring and establishing plans to address identified physical health difficulties for their clients.
The project aims to:
* Measure whether a physical health intervention led by a physical health nurse for case managed community mental health consumers produces greater improvements in physical health indicators compared to treatment as usual.
* Explore how staff encountering the physical health nurse and receiving provided training about physical illness in people with a severe mental illness, experienced these initiatives.
People who are case managed by Alfred Psychiatry and Inner South Community Health Service and have a Client Physical Health Guide completed with their case manager are eligible to participate in this study.
Participants who are case managed by a clinician who has access to a physical health nurse will be compared with participants whose case manager does not have access to the physical health nurse. Their scores on the Client Physical Health Guide will be compared between the initial assessment and 6 month follow-up to determine whether there has been a greater improvement in health indicators with the intervention condition. Case managers employed by both services will also be invited to complete a questionnaire to explore their experience of the initiative.
Baseline completion of Client Physical Health Guides has completed and follow-up assessment will shortly commence. The staff experience questionnaire is also currently being finalised.
Dr Stuart Lee