The Medical journal of Australia
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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.
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Prevention is feasible by providing quality interventions at key moments.
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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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Older people make up the majority of participants in general rehabilitation programs. Stroke and hip fracture are the major diagnostic groups. Most older people with significant disability of recent onset have the potential to benefit from rehabilitation. ⋯ The major goals of rehabilitation for older people are mobility and self-care without the assistance of another person. Evidence suggests that rehabilitation for older people involving a coordinated multidisciplinary team of health professionals (including nurses and doctors) is effective. Contemporary rehabilitation practice is not confined to traditional inpatient rehabilitation units; it also occurs in the community and other non-hospital settings, and involves general practitioners.
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Cumulative adverse experiences, including negative life events and early childhood adversity, together with parental depression and/or non-supportive school or familial environments, place young people at risk for developing depression. Enhanced life skills and supportive school and family environments can mediate the effect of stressful life events. ⋯ Current evidence suggests that for an intervention to be sustainable it must encompass multiple components across several levels: classroom, curriculum, whole school, and the school-community interface. Teaching interpersonal skills, including cognitive and problem-solving skills, should be coupled with the promotion of positive school and family environments to prevent depression in young people.