Laura Catherine Edney

Objective: This study examines the factor structure, measurement invariance, and discriminative ability of the Eating Disorder‐15 (ED‐15) questionnaire in a large transdiagnostic clinical population of treatment‐seeking adults. Method: The sample consisted of 2015 participants aged 17–79 ( M _age = 30.73 years; 77.0% women; 71.1% in Australia) seeking mental health treatment across different settings of routine clinical practice. After initial completion of the ED‐15, subsamples completed additional measures within ±365 days of the initial ED‐15 and/or repeated the ED‐15 at least 7 days later. Results: Confirmatory factor analysis supported both the hypothesized two‐factor and a bi‐factor model (with a general factor), with the two‐factor model retained as the preferred structure, consistent with theory and prior research. The ED‐15 also demonstrated strong internal consistency and test–retest reliability. In subsamples, there was preliminary evidence of measurement invariance across gender, time, country, and to a lesser extent age group. Correlations supported good concurrent validity with eating disorder pathology and eating‐related impairment, while convergent validity was mixed, with moderate associations with psychological distress and maladaptive perfectionism, but weak or negligible associations with personal standards perfectionism and autism‐related traits. Receiver operating characteristic analyses deriving an optimal diagnostic cut‐off indicated good discriminative validity, with the ED‐15 discriminating probable eating disorder caseness. Discussion: Findings add to the growing evidence on the ED‐15's latent structure and provide preliminary support for measurement invariance, supporting its use as a brief, psychometrically sound tool in routine clinical practice. Future research should evaluate its intended use for session‐by‐session monitoring of eating disorder symptom change.

Objective: Body neutrality has emerged as an alternative framework within the positive body image literature. This study developed the Body Neutrality Questionnaire (BNQ), the first validated measure of body neutrality for young adults. Method: An initial item pool was developed using expert consultation and focus group review. This process resulted in 21 items which were administered online to young adults aged 18–25 years, 52.9% female ( N = 293) in study 1, and to undergraduate psychology students aged 17–52 years, 82.2% female ( N = 231) in study 2. Study 1 used exploratory factor analysis (EFA) to explore the structure of the construct, which was then examined using confirmatory factor analysis (CFA) in study 2. Results: The EFA revealed a 12‐item three‐factor model: Self‐Worth not Contingent on Body, Body Gratitude and Care, and Neutral Attitude toward Body, demonstrating good reliability and validity. This factor structure was replicated in the CFA, demonstrating good model fit, internal consistency and convergent validity, with the bifactor CFA model indicating the relevance of a single body neutrality factor. There was a strong, positive correlation between the BNQ and a measure of body appreciation. Discussion: Findings provide support for the BNQ as a reliable and valid measure of body neutrality. These results represent an important first step in our ability to further our understanding of body neutrality, its conceptual similarities and differences to existing body image constructs, and its role in non‐clinical samples. Future research should explore measurement invariance of the BNQ over time, in clinical samples, and for key demographic variables.

Background: Cancer survivors have a broad range of supportive care needs that are not consistently managed in general practice. Understanding the barriers primary healthcare providers face in providing high quality supportive care is crucial for improving the delivery of supportive care in general practice. Methods: This Australian qualitative study involved semi-structured interviews with general practitioners (n = 9), practice nurses (n = 8), and a community liaison worker employed in general practice (n = 1), to explore barriers and facilitators to identifying and managing supportive care for cancer survivors. Data were thematically analysed to develop recurring themes related to the identification and provision of supportive care. Results: Four major themes were developed: identification of supportive care needs, time and provision of supportive care, challenges in supportive care for diverse populations, and desire for more information. Improved education; enhanced communication across all levels of healthcare, including centralised access to patient information; and greater knowledge of available services were highlighted as facilitators to the management of supportive care for cancer survivors. Conclusions: Targeted efforts to support the facilitators identified here can contribute to more effective management of supportive care for diverse cancer survivor populations to improve the overall quality of care and health outcomes for these individuals.

Aim: To explore the utilization of permanent residential aged care (PRAC), healthcare costs, and mortality for frail compared with non‐frail individuals following their first assessment by an aged care assessment team (ACAT) for a government‐funded home care package. Methods: The study involved people aged 65 years and over who completed their first ACAT assessment in 2013 and were followed for up to 36 months. Frail and non‐frail study participants were matched through caliper matching without replacement to adjust for potential unobserved confounders. Poisson regression estimated the impact of frailty on PRAC admission and mortality rates. Healthcare costs, encompassing hospital admissions, emergency department presentations, primary care consultations, and pharmaceutical use, from ACAT assessment to end of follow‐up, PRAC entry or death were summarized monthly by frailty status. Results: 13 315 non‐frail controls were matched with up to three frail individuals (52 678 total). Frail individuals experienced higher mortality (incidence rate ratio [IRR] = 1.76; 95% confidence interval [CI] 1.70–1.83) and greater likelihood of entering PRAC (IRR = 1.73; 95% CI 1.67–1.79) compared with non‐frail individuals. Total healthcare costs over the 3‐year post‐assessment period for 39 363 frail individuals were $1 277 659 900, compared with expected costs of $885 322 522 had they not been frail. The primary contributor to the mean monthly excess cost per frail individual (mean = $457, SD = 3192) was hospital admissions ($345; 75%). Conclusions: Frailty is associated with higher rates of mortality and of entering PRAC, and excess costs of frailty are substantial and sustained over time. These findings emphasize the potential economic value of providing home care for older people before they become frail. Geriatr Gerontol Int 2024; 24: 939–947 .

Serving in the military can have significant impacts on the mental health of veterans and their families. Military personnel can be exposed to a range of physical stressors, psychological trauma, risky lifestyle factors, a regimented military culture, and inadequate support when transitioning out of service. This article reviews research on interventions designed to improve the mental health of Australian military veterans in order to synthesise current knowledge and identify gaps in the literature. Our scoping review followed PRISMA recommendations and comprised peer-reviewed literature published since 2000. The review demonstrates a dominance of psychologically driven research paradigms and interventions and a neglect of the importance of social factors in shaping veteran mental health. There is a wide range of interventions available; however, the literature is narrow and limited. We found little evidence that the lived experience of veterans had been harnessed in program design or delivery. We argue the need for a holistic approach that moves beyond psychological and biological understandings of health and wellbeing to incorporate social and cultural determinants. Future research could adopt a stronger multidisciplinary approach, increased socio-cultural understanding, and greater consideration of the lived experience of veterans and their families.

Objective: This scoping review sought to map the breadth of literature on the use of adaptive design trials in eating disorder research.Method: A systematic literature search was conducted in Medline, Scopus, PsycInfo, Emcare, Econlit, CINAHL and ProQuest Dissertations and Theses. Articles were included if they reported on an intervention targeting any type of eating disorder (including anorexia nervosa, bulimia nervosa, binge‐eating disorder, and other specified feeding or eating disorders), and employed the use of an adaptive design trial to evaluate the intervention. Two independent reviewers screened citations for inclusion, and data abstraction was performed by one reviewer and verified by a second.Results: We identified five adaptive design trials targeting anorexia nervosa, bulimia nervosa and binge‐eating disorder conducted in the USA and Australia. All employed adaptive treatment arm switching based on early response to treatment and identified a priori stopping rules. None of the studies included value of information analysis to guide adaptive design decisions and none included lived experience perspectives.Discussion: The limited use of adaptive designs in eating disorder trials represents a missed opportunity to improve enrolment targets, attrition rates, treatment outcomes and trial efficiency. We outline the range of adaptive methodologies, how they could be applied to eating disorder research, and the specific operational and statistical considerations relevant to adaptive design trials.Public significance: Adaptive design trials are increasingly employed as flexible, efficient alternatives to fixed trial designs, but they are not often used in eating disorder research. This first scoping review identified five adaptive design trials targeting anorexia nervosa, bulimia nervosa and binge‐eating disorder that employed treatment arm switching adaptive methodology. We make recommendations on the use of adaptive design trials for future eating disorder trials.

Objective: This novel study sought to understand lived experience and carer perspectives on the use of adaptive trials to evaluate interventions for eating disorders, in addition to understanding the factors and outcomes of most importance in eating disorder research and treatments from a lived experience perspective.Method: A total of 73 people with either lived or carer experience consented, 70 started the questionnaire, and 36 (51%) completed all questions. Participants were asked Likert scale and open‐ended questions to understand what factors and outcomes of eating disorder interventions were most important to them and understand their pre‐existing knowledge of clinical trials. Two videos were then used to explain randomized controlled trials (RCTs) and adaptive trials and participants were asked their opinions, including perceived benefits and concerns, of each trial type.Results: The thematic analysis found two key themes regarding factors important in eating disorder treatment: Person‐centred care and Evidence‐based and effective treatment; and two key themes regarding outcomes of treatment: Sustained, full recovery and The bigger picture. Both RCTs and adaptive trials were viewed favorably, however, there was a slight preference for adaptive trials. Key themes for both demonstrated perceived benefits and ethical, practical, and scientific considerations unique to each.Discussion: Findings demonstrate the support of adaptive trials in eating disorder interventions from people with lived experience and their carers. It is recommended that researchers consider the use of adaptive designs and the incorporation of lived experience perspectives when designing future intervention trials.Public Significance: This novel study found that the use of adaptive trials in eating disorder intervention research is supported by people with lived experience and carers. Furthermore, the factors and outcomes of most importance to participants in this study are comparable to those previously identified in the emerging literature. The use of adaptive designs and the incorporation of lived experience are recommended in further clinical trials.

Purpose: Improved health outcomes for individuals ever diagnosed with cancer require comprehensive, coordinated care that addresses their supportive care needs. Implementing interventions to address these is confounded by a lack of evidence on population needs and a large pool of potential interventions. This systematic review estimates the point prevalence of different supportive care needs stratified by the tool used to measure needs and cancer type in Australia. Methods: We searched MEDLINE, Embase, and Scopus from 2010 to April 2023 to identify relevant studies published on the prevalence of supportive care needs in Australia. Results: We identified 35 studies that met the inclusion criteria. The highest prevalent unmet need across all cancers was ‘fear of cancer spreading’ (20.7%) from the Supportive Care Needs Survey Short-Form 34 (SCNS-SF34), ranging from 9.4% for individuals ever diagnosed with haematological cancer to 36.3% for individuals ever diagnosed with gynaecological cancer, and ‘concerns about cancer coming back’ (17.9%) from the Cancer Survivors’ Unmet Needs (CaSUN), ranging from 9.7% for individuals ever diagnosed with prostate cancer to 37.8% for individuals ever diagnosed with breast cancer. Two studies assessed needs in Aboriginal and Torres Strait Islander populations, reporting the highest needs for financial worries (21.1%). Conclusions: Point prevalence estimates presented here, combined with estimates of the costs and effects of potential interventions, can be used within economic evaluations to inform evidence-based local service provision to address the supportive care needs of individuals ever diagnosed with cancer. Implications for Cancer Survivors: Local health services can use local evidence to prioritise the implementation of interventions targeted at unmet needs.

Aim: Home care packages (HCPs) facilitate older individuals to remain at home, with longer HCP wait times associated with increased mortality risk. We analyze healthcare cost data pre- and post-HCP access to inform hypotheses around the effects of healthcare use and mortality risk.Methods: Regression models were used to assess the impact of delayed HCP access on healthcare costs and to compare costs whilst waiting and in the 6- and 12 month periods post-HCP access for 16 629 older adults.Results: Average wait time for a HCP was 89.7 days (SD = 125.6) during the study period. Wait-time length had no impact on any healthcare cost category or time period. However, total per day healthcare costs were higher in the 6 and 12 months post-receipt of a HCP (AU$61.5, AU$63, respectively) compared with those in the time waiting for a HCP (AU$48.1). Inpatient care accounted for a higher proportion of total healthcare costs post-HCP (AU$45.1, AU$46.3, respectively) compared with in the wait time (AU$30.6), whilst spending on medical services and pharmaceuticals reduced slightly in the 6 month (AU$7.1, AU$6.3) and 12 month (AU$7.2, AU$6.3) post-HCP periods compared with in the wait time (AU$7.9, AU$7.1).Conclusions: Increased spending post-HCP on inpatient care or non-health support afforded by HCPs may offer protective effects for mortality and risk of admission to aged care. Further research should explore the association between delayed access to inpatient care for geriatric syndromes and mortality to inform recommendations on extensions to residential care outreach services into the community to improve the timely identification of the need for inpatient care.