The Medical journal of Australia
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The reduction of coercive or inadequate parenting is essential if the mental health status of Australian children and adolescents is to be improved. Of the available approaches that address parenting practices, behavioural family interventions have the strongest empirical support and are effective in reducing parenting practices that contribute to the development of behavioural and emotional problems in children. ⋯ A comprehensive multilevel, evidence-based parenting and family support strategy needs to be implemented on a wide scale to reduce the prevalence of mental health problems in children and youth. The Triple P - Positive Parenting Program is an example of a population-level strategy that can be used to improve the mental health status of children and their parents.
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To determine if screening in general practice and related medical settings improves management and clinical outcomes in people with depression. ⋯ Although controversial, the evidence is now in favour of the appropriate use of screening tools in primary care.
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The prevention of some mental disorders in young people appears to be possible. Several small and medium randomised controlled trials show that some anxiety, affective and substance-use disorders can be prevented. These trials show that the interventions are efficacious, but whether they will be effective in routine practice is not known. The evidence is sufficiently good to warrant a large community trial in which the roll-out is staged and school communities evaluated before and after the roll-out.
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Significant perinatal distress and depression affects 14% of women, producing short and long term consequences for the family. This suggests that measures for early detection are important, and non-identification of these women may exacerbate difficulties. ⋯ Arguments against screening pertain largely to lack of evidence about the acceptability of routine use of the EPDS during pregnancy and the postnatal period, and inadequate evidence regarding outcomes and cost-effectiveness. To address these concerns, the National Postnatal Depression Prevention and Early Intervention Program will evaluate outcomes of screening in terms of acceptability, cost-effectiveness, access and satisfaction with management in up to 100 000 women.
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Efficacy trials suggest that depression is preventable in children and adults. However, current depression prevention interventions are not deliverable to the community en masse. The Internet offers an opportunity to deliver tailored prevention interventions such as those based on cognitive behavioural therapy (CBT) to a large audience, cost-effectively, while preserving intervention fidelity and anonymity. ⋯ The feasibility and potential effectiveness of the Internet is indicated by research demonstrating the successful delivery of CBT by computer, the use of the Internet in the delivery of CBT treatment, and the effective prevention of obesity and the promotion of exercise using Internet technologies. Possible limitations to public health interventions using the Internet include selective access, the inability to promote the sites to potential users and the issue of uptake once users access the sites. Randomised controlled trials of CBT delivered by the Internet are required.