Philip B Ward
The University of New South Wales, School of Psychiatry, Faculty Member
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Emergency service workers (ESWs) are at high risk of experiencing poor mental health, including posttraumatic stress disorder (PTSD). Programs led by ex-service organizations may play an unrecognized but critical role in mental health... more
Emergency service workers (ESWs) are at high risk of experiencing poor mental health, including posttraumatic stress disorder (PTSD). Programs led by ex-service organizations may play an unrecognized but critical role in mental health prevention and promotion. Behind the Seen (BTS) is an Australian ex-service organization that runs workshops to raise awareness and facilitate conversations around the mental health of ESWs. The purpose of the study is to conduct a qualitative evaluation of workshop participants’ experiences, to understand the acceptability and perceived usefulness over the immediate- (within 1 month), intermediate- (6 months) and longer-terms (12 months). Participants (n = 59 ESWs) were recruited using purposive sampling across five fire and rescue services in metropolitan, regional, and rural locations. Focus groups methodology was used for data collection and data were analyzed using iterative categorization techniques. Participants reported (i) a high perceived nee...
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AimThe aim of this study was to comprehensively assess dietary intake, nutrition knowledge and food addiction in young people with mental illness.MethodsThis was a three‐arm cross‐sectional study of 16–25‐year‐olds attending community... more
AimThe aim of this study was to comprehensively assess dietary intake, nutrition knowledge and food addiction in young people with mental illness.MethodsThis was a three‐arm cross‐sectional study of 16–25‐year‐olds attending community mental health services who met criteria for: (i) first‐episode psychosis (FEP), (ii) ultra‐high risk for psychosis (UHR) or (iii) depression/anxiety. Participants self‐completed three validated questionnaires: (i) Australian Eating Survey, (ii) General Nutrition Knowledge Questionnaire—Revised and (iii) Yale Food Addiction Score Questionnaire.ResultsThirty participants (mean age 19.7 ± 2.5 years) completed the study (10 per study arm); 43% of the energy intake was obtained from energy‐dense, non‐nutritious foods, higher than the recommended upper limit (<15%) and the levels reported in the general population (35%). Mean diet quality score was 33.5 ± 11.8 of 73. Mean food addiction symptom score was 3.3 ± 3.7. Prevalence of food addiction was 37%. Nu...
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Objective: Carers of people with psychosis may experience psychological distress and caregiving burden. However, few studies have examined both psychological and physical health of carers of young people with first episode psychosis... more
Objective: Carers of people with psychosis may experience psychological distress and caregiving burden. However, few studies have examined both psychological and physical health of carers of young people with first episode psychosis (FEP). Method: A total of 32 young people with FEP and 42 of their carers were recruited from a mental health service. Standardised scales were administered to assess carers’ psychological distress and risk for development of Type 2 diabetes. Their body mass index, waist circumference and blood pressure were measured. Results: A total of 24% ( n = 10) of carers experienced high/very high psychological distress and 39.0% ( n = 16) had high risk for Type 2 diabetes. It was common for carers to be overweight ( n = 33, 78.6%) and to have hypertension ( n = 14, 33.3%). Carers’ higher levels of psychological distress were associated with shorter duration of illness in the young person. Conclusions: Caring for a young person with FEP is associated with poor phy...
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To comprehensively assess cardio-metabolic risk factors and their management in a large sample of outpatients treated with clozapine. Observational cross-sectional study of all clozapine users attending specialized clozapine monitoring... more
To comprehensively assess cardio-metabolic risk factors and their management in a large sample of outpatients treated with clozapine. Observational cross-sectional study of all clozapine users attending specialized clozapine monitoring outpatient clinics in three public hospitals in Sydney, Australia were approached to participate over the one-year period 01/10/2015-30/09/2016. Cardio-metabolic risk factors including metabolic syndrome, risk for future development of diabetes, smoking, physical activity, nutrition, and prescribed medications were assessed at face-to-face interview and through medical record review. Among patients who had cardio-metabolic risk factors, the proportion receiving appropriate management was assessed. Of 451 registered clozapine clinic attenders, 92.2% completed questionnaires and anthropometric measurements. 58.3% met criteria for metabolic syndrome. 79.6% were overweight or obese. 55.9% had blood pressure meeting metabolic syndrome criteria. 46.6% had e...
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Abstract Objectives: To examine the relationship of food insecurity with sexual intercourse, multiple sexual partners and non-condom use. Methods: Data on food insecurity (hunger) and sexual behaviors from 205,296 adolescents from 53... more
Abstract Objectives: To examine the relationship of food insecurity with sexual intercourse, multiple sexual partners and non-condom use. Methods: Data on food insecurity (hunger) and sexual behaviors from 205,296 adolescents from 53 countries. Associations were analyzed using meta-analysis. Results: Overall, 16.0% of the adolescents ever had sexual intercourse and the prevalence of moderate and severe food insecurity was 44.9% and 6.2%, respectively. Moderate and severe food insecurity was associated with higher odds for sexual intercourse. Any food insecurity was significantly associated with condom nonuse at last sex. Conclusions: Food insecurity was associated with higher odds of ever having sexual intercourse dose-dependently.
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Aims: Alarming reports of antiretroviral treatment failure have recently emerged in sub-Saharan Africa. The onset of virologic failure has multiple causes but suboptimal treatment adherence is one of the leading causes. This study aimed... more
Aims: Alarming reports of antiretroviral treatment failure have recently emerged in sub-Saharan Africa. The onset of virologic failure has multiple causes but suboptimal treatment adherence is one of the leading causes. This study aimed to explore correlates of adherence to HIV appointments in community care patients living with HIV/AIDS in Uganda. Methods: Two hundred and ninety-five people living with HIV (median age 37.0 years; interquartile range 16.0; female 67.8% [n = 200]) reported whether they had missed any of their four-weekly appointments during the past 24 weeks. They also completed the Internalized AIDS-Related Stigma Scale, Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, the Alcohol-Use Disorders Identification Test, and the Physical Activity Vital Sign. Results: Thirty-three (11.2%) patients missed at least one of their six scheduled appointments in the 24-week period. The adjusted odds ratio for missing at least one of six appointments was 3.03 (9...
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PURPOSE Lack of knowledge about and confidence in physical activity (PA) prescription for people with mental illness are important barriers for clinical practice in low-income countries. The aim of this study was to evaluate whether a... more
PURPOSE Lack of knowledge about and confidence in physical activity (PA) prescription for people with mental illness are important barriers for clinical practice in low-income countries. The aim of this study was to evaluate whether a 10-hour workshop improved the knowledge and confidence in PA prescription among health care professionals in 13 regional referral hospitals across Uganda. MATERIAL AND METHODS 260 health care professionals (age = 40.4 ± 10.8 years; 48% women; 63.8% nurses, 10% social workers, 8.1% psychologists, 7.3% medical doctors, 5.8% psychiatrists, 5% physical or occupational therapists) completed the Exercise in Mental Illness Questionnaire - Health Professionals Version (EMIQ-HP) pre- and post-workshop. RESULTS The EMIQ-HP PA knowledge score (3.1 ± 0.7 versus 1.3 ± 1.3, p < 0.001, Cohen's d = 1.28, 95% confidence interval, CI = 1.04-1.52, i.e., large effect) and EMIQ-HP confidence in PA prescription score (3.0 ± 0.8 versus 1.2 ± 1.2, p < 0.001, Cohen's d = 1.14, 95% CI = 0.91-1.36, i.e., large effect) improved significantly following training. Significantly more benefits and fewer barriers to prescribing PA in busy low-resourced settings were reported. CONCLUSIONS Training in PA counselling improved the knowledge and confidence in PA prescription in Ugandan health care professionals. Future research should investigate whether PA uptake in people with mental illness can be improved via additional training of health care professionals.IMPLICATIONS FOR REHABILITATIONThe majority of mental health professionals never recommend physical activity to their patients in low-resourced settings and increased awareness is needed to improve rehabilitation programs.Training in prescribing physical activity using the 5A framework improves knowledge about physical activity prescription in mental health professionals at all levels of care.Training in prescribing physical activity using motivational interviewing improves confidence in physical activity prescription in rehabilitation programs.Training in prescribing physical activity reduces perceived barriers for prescribing in rehabilitation programs in low-resourced settings.
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ABSTRACT This study explored the efficacy of a lay health worker (LHW)-led physical activity (PA) counselling program for inactive patients with HIV/AIDS and mental health problems living in a Ugandan farming community. In total 49 (35... more
ABSTRACT This study explored the efficacy of a lay health worker (LHW)-led physical activity (PA) counselling program for inactive patients with HIV/AIDS and mental health problems living in a Ugandan farming community. In total 49 (35 women) community patients (40.0 ± 11.2 years) followed an 8-week once weekly LHW-led PA counselling program based on a self-determination theory and motivational interviewing framework. Participants completed the Simple Physical Activity Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, HIV/AIDS Stress Scale and World Health Organization Disability Assessment Schedule 2 (WHODAS 2) pre- and immediately post-intervention. Small, significant (P < 0.05) effect sizes were found for reductions in HIV/AIDS-related stress (Cohen’s d = 0.26) and in global disability (Cohen’s d = 0.46). Large effect sizes were observed for reductions in time spent sedentary (Cohen’s d = 1.97) and reductions in depressive (Cohen’s d = 2.04) and anxiety (Cohen’s d = 1.47) symptoms and increases in time spent active (Cohen’s d = 1.98). Greater decrease in sedentary time was associated with greater anxiety symptoms reduction (r = 0.32, P = 0.021). In physically inactive patients with HIV/AIDS and mental health problems, an LHW-led PA counselling program reduced stress, anxiety, depression and disability. Randomized controlled trials are needed to confirm these preliminary positive findings.
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Background The novel coronavirus pandemic calls for a rapid adaptation of conventional medical practices to meet the evolving needs of such vulnerable patients. People with coronavirus disease (COVID-19) may frequently require treatment... more
Background The novel coronavirus pandemic calls for a rapid adaptation of conventional medical practices to meet the evolving needs of such vulnerable patients. People with coronavirus disease (COVID-19) may frequently require treatment with psychotropic medications, but are at the same time at higher risk for safety issues because of the complex underlying medical condition and the potential interaction with medical treatments. Methods In order to produce evidence-based practical recommendations on the optimal management of psychotropic medications in people with COVID-19, an international, multi-disciplinary working group was established. The methodology of the WHO Rapid Advice Guidelines in the context of a public health emergency and the principles of the AGREE statement were followed. Available evidence informing on the risk of respiratory, cardiovascular, infective, hemostatic, and consciousness alterations related to the use of psychotropic medications, and drug–drug interact...
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ObjectivesThe Metabolic‐Barriers, Attitudes, Confidence, and Knowledge Questionnaire (M‐BACK) was developed to determine the barriers, attitudes, confidence, and knowledge of mental health practitioners regarding the metabolic health of... more
ObjectivesThe Metabolic‐Barriers, Attitudes, Confidence, and Knowledge Questionnaire (M‐BACK) was developed to determine the barriers, attitudes, confidence, and knowledge of mental health practitioners regarding the metabolic health of patients in order to determine the efficacy of targeted training interventions. This study aimed to validate the Italian version of M‐BACK questionnaire (M‐BACK‐IT) and to determine the test–retest reliability.MethodsThe M‐BACK questionnaire was translated into Italian and back‐translated using an established protocol. In order to determine the test–retest reliability of the instrument, mental health professionals were recruited from a private psychiatric hospital located in northeast Italy and completed the questionnaire on two separate occasions, seven days apart. Intraclass correlation coefficients (ICC) were calculated for the total score, as well as each of the four M‐BACK domains.ResultsThirty mental health professionals (4 psychiatrists, 9 psy...
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The aim of this cross-sectional study was to explore which variables were associated with physical inactivity in people living with HIV living in a fishing community in Uganda. Secondary aims were to explore the reasons for and barriers... more
The aim of this cross-sectional study was to explore which variables were associated with physical inactivity in people living with HIV living in a fishing community in Uganda. Secondary aims were to explore the reasons for and barriers to physical activity (PA). Two hundred and fifty-six individuals living with HIV (77 men, 40.5 ± 10.3 years) completed the Physical Activity Vital Sign (PAVS), Patient Health Questionnaire-9 (PHQ-9), and the Alcohol Use Disorders Identification Test. Women had a 1.62 (95% CI = 1.01–2.57), those not having a job a 2.81 (95% CI = 2.00–3.94), and those with depression a 5.67 (95% CI = 2.27–14.17) higher odds for not being physically active for 150 min/week at moderate intensity. Employment and depression status were the only independent significant predictors explaining 27.2% of the PAVS variance. Becoming more healthy and energetic again and reducing stress were the most important PA motives, and musculoskeletal pain, body weakness, and lack of time we...
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ABSTRACT This study explored the efficacy of physical activity (PA) counseling in inactive patients with HIV/AIDS and a co-morbid mental health disorder living in a Ugandan fishing community. We investigated associations between changes... more
ABSTRACT This study explored the efficacy of physical activity (PA) counseling in inactive patients with HIV/AIDS and a co-morbid mental health disorder living in a Ugandan fishing community. We investigated associations between changes in PA, sedentary behavior, mental health burden and quality of life (QoL) following an 8-week once per week PA counseling program using the self-determination theory and motivational interviewing framework. In total 41 (33 women) patients (39.8 ± 10.9years) completed the Simple Physical Activity Questionnaire, Patient Health Questionnaire, Alcohol Use Disorder Identification Test and World Health Organization Quality of Life Questionnaire pre- and post-intervention. Large effect sizes were found for reductions in time spent sedentary (Cohen’s d = 2.85) and reductions in depressive symptoms (Cohen’s d = 1.47). We also found large effect sizes for increases in time spent walking (Cohen’s d = 1.38), in incidental PA such as household chores (Cohen’s d = 1.69), and physical health (Cohen’s d = 1.38), psychological health (Cohen’s d = 0.95), and social relationships. (Cohen’s d = 1.39). The more time spent sedentary decreased, the more the psychological health increased (r = −0.33, P = 0.037). In sedentary patients with HIV/AIDS and a co-morbid mental disorder, the mental health burden reduces and QoL improves following PA counseling. Controlled studies are however needed to confirm our findings.
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People with posttraumatic stress disorder (PTSD) are more likely than the general population to be physically inactive. The present review systematically evaluated correlates of physical activity across the socio-ecological model for... more
People with posttraumatic stress disorder (PTSD) are more likely than the general population to be physically inactive. The present review systematically evaluated correlates of physical activity across the socio-ecological model for people with PTSD. Two independent reviewers searched Embase, PubMed, PsycARTICLES and CINAHL from inception until June 2015, combining the medical subject heading 'post-traumatic stress disorder' or 'PTSD', with 'physical activity' or 'exercise'. Data were extracted by the same independent researchers and summarized according to the socio-ecological model. Eight papers involving 1,368 (994♂) participants (age range=18-70years) were eligible and enabled evaluation of 21 correlates. The only correlate consistently (n≥4) associated with lower physical activity participation in persons with PTSD were symptoms of hyperarousal. No consistent facilitators were identified. Hyperarousal symptoms are associated with lower physical ...
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Background: Physical inactivity is a key contributor to the global burden of disease and disproportionately impacts the wellbeing of people experiencing mental illness. Increases in physical activity are associated with improvements in... more
Background: Physical inactivity is a key contributor to the global burden of disease and disproportionately impacts the wellbeing of people experiencing mental illness. Increases in physical activity are associated with improvements in symptoms of mental illness and reduction in cardiometabolic risk. Reliable and valid clinical tools that assess physical activity would improve evaluation of intervention studies that aim to increase physical activity and reduce sedentary behaviour in people living with mental illness. Methods: The five-item Simple Physical Activity Questionnaire (SIMPAQ) was developed by a multidisciplinary, international working group as a clinical tool to assess physical activity and sedentary behaviour in people living with mental illness. Investigators from 43 centres in 23 countries collected reliability and validity data on the SIMPAQ from patients with DSM or ICD mental illness diagnoses. Test-retest repeatability was assessed one-week apart. Results: Criterio...
Research Interests: Psychology, Pediatrics, Psychiatry, Assessment, Mental Health, and 14 morePhysical Activity, Public Health, Medicine, Mental Illness, Maternal and Child Health, Population, Social Science Research Network, Measurement, Exercise, Root-Mean Square Error, Clinical Sciences, Community Health and Preventive Medicine, Sedentary Behaviour, and Criterion Validity
Research Interests: Neuroscience, Clinical Neuroscience, Magnetic Resonance Imaging, Medicine, FMRI, and 15 moreFreezing of Gait, Gait, Brain, Humans, Caudate Nucleus, Cerebral Cortex, Functional Magnetic Resonance Imaging, Male, Computer User Interface Design, Aged, Middle Aged, Globus Pallidus, Basal ganglia, Neuropsychological Tests, and Medical and Health Sciences
Research Interests: Psychology, Clinical Psychology, Depression, Exercise therapy, Medicine, and 12 moreAnxiety, Humans, Affective Disorders, Major Depressive Disorder, Psychological Intervention, Meta Analysis, Prevalence, Randomized Controlled Trial, ANXIETY, Randomized Controlled Trials as Topic, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Research Interests: Psychology, Depression, Exercise therapy, Medicine, Physical Medicine and Rehabilitation, and 15 morePhysical Therapy, Humans, Affective Disorders, Antidepressant, Major Depressive Disorder, Psychological Intervention, Depressive Disorder, Meta Analysis, Publication Bias, Randomized Controlled Trial, Psychiatric, Confidence Interval, Aerobic Exercise, Psychology and Cognitive Sciences, and Medical and Health Sciences
The editors regret that therewere twominor errors in the abstract of this article. The abstract should read as follows: Selected structural and functional neuroimaging correlates of psychomotor slowing were examined in older persons with... more
The editors regret that therewere twominor errors in the abstract of this article. The abstract should read as follows: Selected structural and functional neuroimaging correlates of psychomotor slowing were examined in older persons with depression. Clinical, neuropsychological, magnetic resonance imaging (MRI) and single photon emission computerized tomography (SPECT) data were obtained for 32 persons with depression (mean age=55.5) and 17 controls (mean age=55.4). Psychomotor slowing was measured by simple (SRT) and choice (CRT) reaction times. White matter lesions (WMLs) were visually rated and caudate nucleus regional cerebral blood flow (rCBF) was obtained through the co-registration of MRI and SPECT data. Two SPECT scans were performed