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Authors
Ellen S1, Devlin H2, Aizenstros J3, Shields R4, Doherty P5, Wesselingh S6, Mijch A7, Wright E8, Cherry K9
1-5Psychiatry Department, Alfred Hospital, Melbourne
6-9Infectious Diseases Department, Alfred Hospital, Melbourne
Objectives
- To determine whether a proactive HIV, HBV and HCV testing and counselling program increases the rate of detection in psychiatry inpatients.
- To assess sexual and drug taking risk behaviours among psychiatry inpatients.
- To estimate the prevalence of HIV, HBV, and HCV in psychiatry inpatients.
Background
Estimates for the prevalence of HIV (3.1%-7.8%), HBV (23.4%) and HCV (19.6%) among people with mental illness in the US are higher compared with the general population. High-risk behaviours commonly associated with mental illness (needle sharing and other drug use as well as impulsive, coercive and unprotected sex) are thought to precipitate these higher rates of infection. Despite this evidence, prevalence rates among this group in Australia remain unclear and testing rates are low.
Methodology
Designed to run from August 2002 to February 2003, the six month study has involved participants from the Alfred Hospital's psychiatry inpatient program. Participants have completed a modified Risk Behaviour Questionnaire (RBQ) measuring sexual and drug related risk behaviour, a demographic form and had a blood test for the presence of the three virus'. Pre- and post- test counselling, including a thorough risk assessment was offered to all participants. The final results are currently being analysed. Pre-program prevalence rates (based on current pathology records) will be compared with post-program prevalence rates. Risk behaviour patterns will be compared with previous Australian studies using the same questionnaire. Costs associated with the program will also be analysed.
Inclusion criteria
- diagnosis of mental disorder
- inpatient stay of more than 2 days
- age 18 and above
- capacity for informed consent
- English speaking
Preliminary Results
During the initial 5 months of the study, 68 patients out of a possible 360 have participated (18.9% excluding patients with less than a 3 day stay and repeat admissions). Of these 68 participants, 62 consented to being tested for HIV, HCV and HBV. There were no positive HIV results, however 12 participants (19.4%) tested Hepatitis C positive, 5 of which were new diagnoses. 1 (1.6%) participant tested positive for active Hepatitis B infection while 5 (8.1%) tested positive for past Hepatitis B infection.
Clinical pathology results (including patients not participating in the study) demonstrate that a total of 78 patients were tested during the first 5 months of the study compared with 29 patients tested in the 5 months prior to the commencement of the study.
Preliminary analysis of the results find high numbers of risk factors among this group, 50% (n=34) of whom have injected drugs, with 67.6% (n=23) of these having shared injecting equipment. While 42.6% (n=29) of participants have not had casual sexual intercourse in the last year, 22.1% (n=15) have used a condom less than half the time or not at all with casual partners.
Conclusions
- The proactive testing program has more than doubled the testing rate.
- Preliminary results confirm high rates of risk taking behaviours amongst psychiatry inpatients.
- Rates of Hep C appear to be high in keeping with US studies, however HIV and Hep B infection rates at this preliminary stage do not appear to be elevated.
Conferences
Alfred Research Week 2002 Poster/Abstract
ASPR 2002 Poster/Abstract
RANZCP 2003 Abstract/Presentation
Hepatitis C Council Community Conference 2003 Abstract/Presentation
Investigators:
Dr Steve Ellen
Harriet Devlin
Bridget Fitzgerald
Background
Cystic Fibrosis (CF) is a life-threatening, genetic disease that affects most mucus producing systems of the body. The majority of complications are however due to lung disease. Over the last thirty years improved medical management has lead to an increase in numbers of people with CF reaching adulthood. While the physical impact of CF on adults has been well studied, less is known about the psychological correlates of the disease. Research suggests that cognitive and/or behavioural factors like coping can positively or negatively affect health, and this pilot study investigates this relationship among adults with CF.
Research question
Are particular coping strategies related to better health and quality of life among adults with CF?
Inclusion Criteria
We are looking for up to 200 patients who:
- attend the Alfred Hospital's CF Centre
- are over 18 years of age
- have a diagnosis of cystic fibrosis
Exclusion Criteria
- persons deemed clinically unwell at time of study
- non-English speaking patients
Project Design
Adults with CF have been asked to participate via questionnaire mail-outs. Coping strategies, measured by the CISS (Coping Inventory for Stressful Situations) will be compared with psychological health (GHQ-30) responses, physical health scores (ie. lung function) and quality of life (CFQoL) responses.
Analyses
Relationships between the coping and the different measures of health will be analysed using correlation matrices and regression analysis.
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