Fiona Judd

Royal Hospital for Women, Sydney, New South Wales, Australia

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Publications (197)565.35 Total impact

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    ABSTRACT: Purpose The purposes of this study are to examine the course and prevalence of anxiety and depression over 24 months in women with newly diagnosed breast and gynaecologic cancer and, controlling for demographic and clinical confounders, to test the role of neuroticism and psychiatric history in determining outcome 6, 12, 18 and 24 months post-diagnosis. Methods Participants completed the Hospital Anxiety and Depression Scale—anxiety subscale and Centre for Epidemiological Studies Depression Scale on an 8-weekly basis from diagnosis until 96 weeks. Changes over time were analyzed with repeated measures ANOVA. Hierarchical linear regression, adjusted a priori for age, chemotherapy and radiation treatment, living alone, education and tumour stream were used to predict anxiety and depression. Results Participants were 105 women (66 breast, 39 gynaecologic). Rates of anxiety (18.1 %) and depression (33.3 %) were highest at diagnosis. Average rates of anxiety and depression were 5.9 and 22.4 %, respectively. Average scores of anxiety and depression were highest at diagnosis, with improvement at 8 and 40 weeks, respectively, subsequently maintained. Morbidity at diagnosis was particularly acute among women with a treatment history of anxiety/depression or with high neuroticism. These three variables were the best and only predictors over 24 months. Conclusions Women are most vulnerable to anxiety and depression at diagnosis, with improvement over time. Morbidity rates are lower than reported elsewhere. Women with high neuroticism and a psychiatric history are at greatest risk for future morbidity after adjusting for confounders. Early identification of these women plus heightened surveillance or early referral to psychosocial services may protect against longer-term morbidity.
    Supportive Care Cancer 01/2015; · 2.50 Impact Factor
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    ABSTRACT: Background Mindfulness interventions to reduce psychological distress are well-suited to pregnancy, due to their brief and non-pharmacological nature, but there is a need for more robust evidence determining their usefulness. This pilot study was designed to explore the feasibility of a randomised controlled trial of a mindfulness intervention to reduce antenatal depression, anxiety and stress.Methods The study was designed in two parts 1) a non-randomised trial targeting women at risk of mental health problems (a selected population) and 2) a randomised controlled trial (RCT) of a universal population. Process evaluation focused on feasibility of recruitment pathways, participant retention, acceptability of study measures, and engagement with mindfulness practices. Measurement of psychological distress was taken pre and post intervention through the Centre for Epidemiologic Studies Depression Scale Revised, the Depression Anxiety and Stress Scale-21, the State-Trait Anxiety Inventory, and the Perceived Stress Scale.Results20 women were recruited to the non-randomised trial, and 32 to the RCT. Recruitment through a mailed study brochure at the time of booking-in to the hospital resulted in the largest number of participants in the RCT (16/32; 50%), and resulted in considerably earlier recruitment (50% in first trimester, 50% second trimester) compared to recruitment through the antenatal clinic waiting room (86% in second trimester, 14% third trimester). Over a third of women in the universal population scored above clinical cut-offs for depression and anxiety, indicating a sample with more symptomology than the general population. The most common reason for loss to follow-up was delivery of baby prior follow-up (n = 9). In the non-randomised study, significant within group improvements to depression and anxiety were observed. In the intervention arm of the RCT there were significant within group improvements to anxiety and mindfulness. No between group differences for the intervention and `care as usual¿ control group were observed.Conclusions This small pilot study provides evidence on the feasibility of an antenatal mindfulness intervention to reduce psychological distress. Major challenges include: finding ways to facilitate recruitment in early pregnancy and engaging younger women and other vulnerable populations.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12613000742774 (31/10/2012).
    BMC Pregnancy and Childbirth 10/2014; 14(1):369. · 2.15 Impact Factor
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    ABSTRACT: The aim of this study was to compare the relative benefits and acceptability of two different group-based mindfulness psychotherapy interventions among women with breast and gynecologic cancer.
    Supportive Care Cancer 10/2014; · 2.50 Impact Factor
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    ABSTRACT: Objectives Some women find hot flushes and night sweats (HFNS) to interfere more in daily life and mood than others. Psychological resources may help to explain these individual differences. The aim of this study was to investigate the role of self-compassion, defined as healthy way of relating toward the self when dealing with difficult experiences, as a potential moderator of the relationship between HFNS and daily life activities, which in turn influences symptoms of depression. Study design This was a cross-sectional study using questionnaire data from 206 women aged 40–60 who were currently experiencing hot flushes and/or night sweats. Path analysis was used to model relationships among menopausal factors (HFNS frequency and daily interference ratings), self-compassion and mood. Main outcome measure Hot flush interference in daily activities and depressive symptoms. Results On average, women experienced 4.02 HFNS per day, and HFNS frequency was moderately correlated with interference ratings (r = 0.38). In the path analytic model, self-compassion made significant direct contribution to hot flush interference ratings (β = −0.37) and symptoms of depression (β = −0.42), and higher self-compassion was associated with lower interference and depressive symptoms. Self-compassion also moderated the relationship between HFNS frequency and hot flush interference. Higher self-compassion was associated with weaker effects of HFNS frequency on daily interference. Conclusions Self-compassion may weaken the association between HFNS and daily life functioning, which in turn, could lead to less HFNS-related mood problems. These findings imply that self-compassion may be a resilience factor to help women manage hot flushes and night sweats.
    Maturitas 08/2014; · 2.84 Impact Factor
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    ABSTRACT: This study aims to examine the acceptability and effectiveness of an antenatal group intervention designed to reduce the severity of depression and anxiety symptoms and improve maternal attachment in pregnant women with current or emerging depression and anxiety. Women who participated in the program completed pre- and posttreatment measures of depression (Centre of Epidemiological Studies Depression Scale) and Edinburgh Postnatal Depression Scale), anxiety (State-Trait Anxiety Inventory) and maternal attachment (Condon Maternal Antenatal Attachment Scale). Participants also completed a satisfaction questionnaire and provided general feedback about the group intervention and experience. A total of 48 women (M = 26 weeks of gestation) commenced and 37 (77 %) completed at least 80 % of the six session group intervention. Significant improvements with moderate to large effect sizes were observed for depression as measured on the Centre of Epidemiological Studies Depression Scale (CES-D) (p < 0.001), Edinburgh Postnatal Depression Scale (EPDS) (p < 0.001), state anxiety (p < 0.001) and maternal attachment (p = 0.006). Improvements in posttreatment depression scores on the EPDS were maintained at 2 months postpartum. Participants reported that the program had met their expectations. Partners (n = 21) who completed evaluation forms indicated that their attendance had improved their awareness of their partner's mental health issues and resources available to their family and would recommend the program to other fathers. These preliminary findings suggest that our antenatal group program is an effective and acceptable intervention for a clinical sample of women and partners. It is a feasible addition or alternative treatment option to perinatal mental health care. Future directions could involve more comprehensive randomised controlled trials (RCT) to examine the effectiveness of the group intervention.
    Archives of Women s Mental Health 07/2014; · 1.96 Impact Factor
  • International Psychogeriatrics 07/2014; · 1.89 Impact Factor
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    ABSTRACT: The purpose of this study was to identify psychosocial factors associated with glycemic control in a sample of adult women with type 1 or type 2 diabetes mellitus preparing for pregnancy.
    Canadian Journal of Diabetes 07/2014; · 0.46 Impact Factor
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    ABSTRACT: Women with schizophrenia and bipolar disorder are at a higher risk of obstetric and neonatal complications. The aim of this study was to better understand the factors that may influence these adverse outcomes.
    Schizophrenia Research 06/2014; · 4.43 Impact Factor
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    ABSTRACT: Background: Risky drinking criteria in older adults lack consistency across the literature. The variable definitions of risk have contributed in part, to widely differing prevalence estimates for risky drinking, ranging from 1% to 15%. Objectives: (1) To identify the prevalence of different types of risky drinking by applying several different criteria, (2) To investigate whether older adults have knowledge of the National Health and Medical Research Council recommended guidelines for safe drinking. Methods: The study population consisted of community dwelling past-year drinkers (n = 292) aged ≥60 years. Participants completed a postal survey on alcohol consumption using the AUDIT-C. Results: Applying multiple risky drinking criteria indicated that 6.6% to 31.7% of women and 21.6% to 44.8% of men were risky drinkers. Men were more likely than women to have inaccurate knowledge of the NHMRC guidelines, and nearly 59.2% of men who exceeded 14 drinks per week reported either not knowing the recommended limits or reported limits that exceeded the guidelines. Conclusions/Importance: A substantial number of older men drank at risky levels and overestimated safe drinking limits. Greater education on the vulnerability to alcohol-related harm together with greater screening practice by health professionals and service providers is recommended. Findings illustrate how different risky drinking criteria vary in their average AUDIT-C scores, with the NHMRC criteria showing greater average scores compared to other criteria. Results also imply that cutoff scores of ≥4 for women and ≥6 for men are consistent with a range of risky drinking criteria in older adults.
    Substance Use &amp Misuse 05/2014; · 1.23 Impact Factor
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    ABSTRACT: Purpose of the Study:Little research has examined factors that contribute to the formation of attitudes toward one's own aging. The current study aimed to examine personality as defined by the Five-Factor model of personality as an antecedent of attitudes, while taking into account demographic and health factors known to be relevant to such attitudes. Participants aged 60 years or older (N = 421) were part of a longitudinal study of health and well-being in Australia, and completed a postal survey comprising measures of personality, the Attitudes to Ageing Questionnaire, the SF-12 health survey, and the Satisfaction with Life Scale. Higher levels of neuroticism were associated with less positive attitudes toward old age as a time of psychological growth, and higher extraversion and agreeableness were significant predictors of less negative attitudes toward psychosocial loss. Baseline measures of self-reported mental and physical health, as well as change in those scores, also made significant contributions to attitudes toward aging. Personality was a significant antecedent of attitudes towards aging, as were mental and physical health. The data highlight the role of potentially modifiable factors, such as mental and physical health. If these factors act as resources that shape an individual's attitudes during the aging process, then one potential foundation for holding positive attitudes to aging is to maintain physical and mental health. This requires interventions and policies that are effective in encouraging health-promoting behaviors.
    The Gerontologist 05/2014; · 2.48 Impact Factor
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    ABSTRACT: Psychological disorders are commonly associated with gynecological conditions, but are frequently undetected and untreated, and may influence the presentation and treatment outcomes of the physical condition. A literature search was conducted in order to provide a narrative review of psychological aspects of menopause, premenstrual syndrome, premenstrual dysphoric disorder, chronic pelvic pain, incontinence and polycystic ovarian syndrome. All the conditions that have been addressed in this review can be associated with an increased risk of psychological symptoms and disorders. Anxiety and depression are common and are associated with significant morbidity. Gynecological conditions, by their nature, are likely to be accompanied by impairments in social, occupational and personal functioning. Greater emphasis should be placed on the mental health aspects of gynecological conditions.
    Women s Health 05/2014; 10(3):237-254.
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    ABSTRACT: Infants born <30 weeks' gestation are at increased risk of long term neurodevelopmental problems compared with term born peers. The predictive value of neurobehavioural examinations at term equivalent age in very preterm infants has been reported for subsequent impairment. Yet there is little knowledge surrounding earlier neurobehavioural development in preterm infants prior to term equivalent age, and how it relates to perinatal factors, cerebral structure, and later developmental outcomes. In addition, maternal psychological wellbeing has been associated with child development. Given the high rate of psychological distress reported by parents of preterm children, it is vital we understand maternal and paternal wellbeing in the early weeks and months after preterm birth and how this influences the parent-child relationship and children's outcomes. Therefore this study has aims to examine how 1) early neurobehaviour and 2) parental mental health relate to developmental outcomes for infants born preterm compared with infants born at term. This prospective cohort study will describe the neurobehaviour of 150 infants born at <30 weeks' gestational age from birth to term equivalent age, and explore how early neurobehavioural deficits relate to brain growth or injury determined by magnetic resonance imaging, perinatal factors, parental mental health and later developmental outcomes measured using standardised assessment tools at term, one and two years' corrected age. A control group of 150 healthy term-born infants will also be recruited for comparison of outcomes. To examine the effects of parental mental health on developmental outcomes, both parents of preterm and term-born infants will complete standardised questionnaires related to symptoms of anxiety, depression and post-traumatic stress at regular intervals from the first week of their child's birth until their child's second birthday. The parent-child relationship will be assessed at one and two years' corrected age. Detailing the trajectory of infant neurobehaviour and parental psychological distress following very preterm birth is important not only to identify infants most at risk, further understand the parental experience and highlight potential times for intervention for the infant and/or parent, but also to gain insight into the effect this has on parent-child interaction and child development.
    BMC Pediatrics 04/2014; 14(1):111. · 1.92 Impact Factor
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    ABSTRACT: Objective:While mindfulness-based cognitive therapy (MBCT) has demonstrated efficacy in reducing depressive relapse/recurrence over 12-18 months, questions remain around effectiveness, longer-term outcomes, and suitability in combination with medication. The aim of this study was to investigate within a pragmatic study design the effectiveness of MBCT on depressive relapse/recurrence over 2 years of follow-up.Method:This was a prospective, multi-site, single-blind trial based in Melbourne and the regional city of Geelong, Australia. Non-depressed adults with a history of three or more episodes of depression were randomised to MBCT + depression relapse active monitoring (DRAM) (n=101) or control (DRAM alone) (n=102). Randomisation was stratified by medication (prescribed antidepressants and/or mood stabilisers: yes/no), site of usual care (primary or specialist), diagnosis (bipolar disorder: yes/no) and sex. Relapse/recurrence of major depression was assessed over 2 years using the Composite International Diagnostic Interview 2.1.Results:The average number of days with major depression was 65 for MBCT participants and 112 for controls, significant with repeated-measures ANOVA (F(1, 164)=4.56, p=0.03). Proportionally fewer MBCT participants relapsed in both year 1 and year 2 compared to controls (odds ratio 0.45, p<0.05). Kaplan-Meier survival analysis for time to first depressive episode was non-significant, although trends favouring the MBCT group were suggested. Subgroup analyses supported the effectiveness of MBCT for people receiving usual care in a specialist setting and for people taking antidepressant/mood stabiliser medication.Conclusions:This work in a pragmatic design with an active control condition supports the effectiveness of MBCT in something closer to implementation in routine practice than has been studied hitherto. As expected in this translational research design, observed effects were less strong than in some previous efficacy studies but appreciable and significant differences in outcome were detected. MBCT is most clearly demonstrated as effective for people receiving specialist care and seems to work well combined with antidepressants.
    Australian and New Zealand Journal of Psychiatry 03/2014; · 3.77 Impact Factor
  • 中国全科医学. 01/2014; 17(7).
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    ABSTRACT: Our aim was to assess physical activity, attitudes and future intentions among a sample of individuals with schizophrenia spectrum disorders (SSDs). A cross-sectional interview was conducted with a convenience sample of 49 adults with SSDs and in receipt of community mental health services. Interview questions elicited information about exercise behaviour across time, including reasons for expressed preferences. Participants reported variable current physical activities. They were much more likely to report past exercise than current exercise or intentions for future exercise. Participants were more likely to report physical than psychological benefits as incentives for exercise. Social influence and the opportunity for social interaction emerged as reasons for exercising. Barriers to exercise included physical health problems, disinterest and one's psychiatric illness. Community mental health services should routinely integrate targeted interventions that promote exercise. Social support for exercise, strategies to increase self-efficacy and education about the multifaceted benefits of exercise are necessary considerations in the development of such interventions.
    Australasian Psychiatry 11/2013; · 0.60 Impact Factor
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    ABSTRACT: Depression is common in cancer patients but frequently undetected. Consensus regarding validity and optimal thresholds of screening measures is lacking. We investigated the validity of the Hospital Anxiety and Depression Scale (HADS-D) and Center for Epidemiological Studies Depression Scale (CES-D) relative to a referent diagnostic standard in women with breast or gynecologic cancer. Participants were 100 patients who completed the CES-D and HADS-D within a larger study. The Mini International Neuropsychiatric Interview was the criterion standard. Sensitivity, specificity, predictive values and likelihood ratios for various thresholds were calculated using receiver operating characteristics. Participants were assigned to two diagnostic groups: 'major depressive disorder' or 'any depressive disorder'. Separate analyses were conducted whereby participants found to be receiving depression/anxiety treatment at the time of validation (n=28) were excluded. Both measures had good internal consistency and criterion validity. There were no statistical differences in global accuracy between the measures for detecting either group. For optimal sensitivity and specificity in both groups, generally recommended thresholds were lowered for the HADS-D. For the CES-D, the threshold was lowered for 'any depressive disorder' and raised for 'major depressive disorder'. Negative predictive values associated with our recommended cutoffs were excellent, but positive predictive values were poor. The HADS-D and CES-D have acceptable properties and are equivalent for detecting depression in this population. Depending on the purpose of screening, the CES-D may be more suitable for identifying major depression. Threshold choice may have serious implications for screening program effectiveness, and the use of generally recommended thresholds should be cautious.
    General hospital psychiatry 11/2013; · 2.67 Impact Factor
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    ABSTRACT: The purpose of this study is to test a brief, attachment intervention added to routine maternity care that aims to improve the adolescent mother-infant relationship during transition to motherhood. A pre-test, post-test, peer-control-group trial was set in a large tertiary maternity hospital in Melbourne, Australia. Participants were multi-cultural, pregnant adolescents (n = 97). The two-session 'AMPLE' intervention was provided in late pregnancy and neonatally. The main outcome measure was mother-infant interaction quality at age 4 months, blind-coded using the Emotional Availability Scales (EAS) (fourth edition). Study acceptability was high: participation rate 82.9 % and completion rate 75.3 %. Thirty-five participants received the intervention plus usual care (intervention group) and 38 received usual care (control group). There were no pre-test between-group differences across demographic, psychosocial or obstetric domains. At post-test, mother-infant interaction was significantly better in the intervention group. MANOVA analyses showed an overall intervention effect on emotional availability in 20 min of free play (n = 73), F (6,65) = 5.05, p < .01, partial η (2) = .32, and in 25 min of play plus brief separation-reunion (n = 55), F (6,48) = 2.72, p = .02, partial η (2) = .25. T tests showed significant between-group differences in specific EAS subscales. All effect sizes were medium-large. This promising intervention appears to exert a clinically meaningful effect on the adolescent mother-infant relationship. Further research is warranted to replicate the findings and confirm causality. The study suggests a brief attachment focus, incorporated into routine maternity care, could influence the developmental trajectory of infants of young mothers from birth.
    Archives of Women s Mental Health 07/2013; · 2.01 Impact Factor
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    ABSTRACT: PURPOSE: Group-based mindfulness training is frequently described in psycho-oncology literature, but little is known of the effectiveness of mindfulness-based cognitive therapy (MBCT). We investigated the effectiveness and acceptability of MBCT for women with breast and gynecologic cancer. METHODS: Fifty women were recruited to participate in eight weekly 2-h mindfulness sessions. Outcomes of distress, quality of life (QOL), post-traumatic growth, and mindfulness were assessed pre-intervention, post-intervention, and again 3 months later using validated measures. Data were analyzed with repeated measures ANOVAs with a Bonferroni correction. Participant satisfaction and evaluation were also assessed. RESULTS: Forty-two women completed the program, and complete data were available for 36 women. Significant improvements with large effect sizes (ηρ(2)) were observed for distress (P < 0.001; ηρ(2) = 0.238), QOL (P = 0.001; ηρ(2) = 0.204), mindfulness (P < 0.001; ηρ(2) = 0.363) and post-traumatic growth (P < 0.001; ηρ(2) = 0.243). Gains were maintained 3 months post-intervention. Improvements in outcomes did not differ based on diagnostic group, psychological status, or physical well-being at entry. Change indices further support these findings. Scores on measures of distress, QOL, and post-traumatic growth decreased as a function of increased mindfulness at each time point (all P < 0.05). Participants reported experiencing the program as beneficial, particularly its group-based nature, and provided positive feedback of the therapy as a whole as well as its individual components. CONCLUSIONS: Within the limits of a non-randomized trial, these findings provide preliminary support for the potential psychosocial benefits of MBCT in a heterogeneous group of women with cancer. Future, more comprehensive trials are needed to provide systematic evidence of this therapy in oncology settings.
    Supportive Care in Cancer 06/2013; · 2.09 Impact Factor
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    ABSTRACT: Objectives: With a longitudinal prospective design, we examined the impact of floods on the mental and physical health of older adults and explored risk and protective factors. Method: Two hundred and seventy four older adults (age ≥60) completed surveys before and after a flood event. Both the surveys included measures of anxiety, depression, self-reported health, and satisfaction with life; the post-flood survey also included questionnaires on flood experience, symptoms of post-traumatic stress disorder (PTSD), stoicism, and psychological coping with floods. Results: Compared to those not personally affected (78.8%), personally affected individuals (21.2%) reported significantly higher PTSD symptoms, with about one in six reporting PTSD symptoms that might require clinical attention. Personally affected individuals also reported a greater increase in anxiety post-flood, but changes in their depressive symptoms and self-reported health were not significantly different from those not personally affected. Greater flood exposure and the lack of social support were the risk factors for poorer mental and physical health. Higher stoicism was associated with higher post-flood depression and poorer self-reported mental health. The use of maladaptive coping, such as venting and distraction, was associated with greater deterioration in mental health after floods, whilst emotion-focused coping such as acceptance, positive reframing, and humour, was protective against such deterioration. Conclusion: Floods had adverse psychological impacts on some older adults who were personally affected. Despite the evidence of resilience, a small proportion of older adults experienced significant difficulties after the floods. The findings in this study help understand older adults' psychological responses to disasters and have practical implications for service planning and delivery.
    Aging and Mental Health 05/2013; · 1.78 Impact Factor
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    ABSTRACT: IntroductionMortality in individuals with schizophrenia, including deaths not attributable to accidents and suicide, is at least twice that of the general population. While increasing physical exercise could promote positive mental and physical health outcomes in individuals with schizophrenia, only one other study of the determinants of exercise within this population has been reported. This study attempts to resolve this void in knowledge by testing the applicability of the transtheoretical model (TTM) of behaviour change to predicting exercise behaviour in those with schizophrenia.Methods Forty-nine participants (42 with schizophrenia and 7 with schizoaffective disorder) from three community mental health centres in Melbourne, Australia, completed a series of questionnaires, an interview, physical health measures, and had their medical records examined. These measures were used: TTM exercise stage, TTM mediators of change, health status, health risk behaviours, use of antipsychotic medications, psychopathology, psychiatric history, and demographic information. Variables found to be significantly correlated with exercise stage were then included in a series of regression analyses to determine their relative predictive power for exercise stage.ResultsThe results demonstrated that the TTM and its associated measures may be valid for integration into interventions for promoting exercise in individuals with schizophrenia, despite high levels of psychopathology symptoms.Conclusions Routine clinical practice should promote exercise in people with schizophrenia and the TTM may be of benefit to this end. Strategies that promote exercise when self-perceived poor health is seen as a significant barrier are particularly important, as is the reduction of caffeine consumption and other health adverse behaviours.
    Clinical Schizophrenia & Related Psychoses 03/2013;

Publication Stats

2k Citations
565.35 Total Impact Points


  • 2007–2014
    • Royal Hospital for Women
      Sydney, New South Wales, Australia
    • La Trobe University
      • School of Public Health and Human Biosciences
      Melbourne, Victoria, Australia
  • 1986–2014
    • University of Melbourne
      • Department of Psychiatry
      Melbourne, Victoria, Australia
  • 1983–2013
    • Royal Melbourne Hospital
      Melbourne, Victoria, Australia
  • 2009
    • Royal Women's Hospital in Victoria
      • Centre for Women's Mental Health
      Melbourne, Victoria, Australia
  • 1984–2009
    • Austin Health
      Melbourne, Victoria, Australia
  • 2001–2008
    • Monash University (Australia)
      • • School of Rural Health
      • • Department of General Practice
      Melbourne, Victoria, Australia
  • 2006
    • Bendigo Psychology
      Bendigo, Victoria, Australia
    • University of Ballarat
      • Department of Psychology
      Ballarat, Victoria, Australia
  • 2002–2006
    • Bendigo Health
      Bendigo, Victoria, Australia
  • 2001–2004
    • Centre for Rural and Remote Mental Health
      Орандж, New South Wales, Australia
  • 1998
    • University of Queensland 
      • Department of Psychiatry
      Brisbane, Queensland, Australia
  • 1995–1996
    • Fairfield Hospital
      Fairy Meadow, New South Wales, Australia
  • 1987–1989
    • Victoria University Melbourne
      Melbourne, Victoria, Australia