Dr Stacey McMullen

While psychotherapy is effective for treating depression, men are less likely than women to attend and more likely to drop out. The value of alternative therapeutic approaches for men needs to be investigated. In this randomised pilot trial, we investigated the feasibility and preliminary efficacy of outdoor 'walk-and-talk' therapy compared to conventional indoor therapy for 37 men with low mood (mean [SD] PHQ-9 score = 11.4 [5.0]; mean [SD] age = 44.1 [15.8] years). Over 6 weeks at the University of Newcastle participants received weekly 60-min sessions delivered (i) while walking along a 4-km route on campus or (ii) indoors in a psychology clinic, delivered by provisional psychologists using non-directive supportive counselling. Outcomes included validated measures of depression, anxiety, stress and overall psychological distress, male-type depression, mental well-being, behavioural activation and therapeutic alliance. At post-intervention, all pre-registered feasibility benchmarks were exceeded including recruitment capability, retention (89%), average attendance (walk-and-talk: 91%, indoor: 89%), proportion of sessions delivered in intended setting (walk-and-talk: 100%, indoor: 98%) and overall perceived acceptability of the therapy (walk-and-talk: 4.4/5, indoor: 4.2/5, where 1 = poor and 5 = excellent). Linear mixed model analysis demonstrated both groups achieved similar improvements in depressive symptoms (d = -0.02), but the walk-and-talk group reported greater improvements in overall psychological distress (d = -0.5), anxiety (d = -0.4) and stress (d = -0.7). In contrast, male-type depression improved more in the conventional indoor group (d = 0.6). Other outcomes were comparable between groups. Results indicate that walk-and-talk therapy may be acceptable and effective for men with depression. A powered trial to interrogate these effects and identify moderators of effectiveness is warranted. Trial Registration: Australian New Zealand Clinical Trials Registry number: ACTRN12622001318774.

Objectives: To assess the inclusion of Aboriginal and Torres Strait Islander parents in trials of parenting programs in Australia; the involvement of Indigenous fathers in such studies; and whether parenting programs are designed to be culturally appropriate for Aboriginal and Torres Strait Islander people. Study design: Scoping review of peer-reviewed journal publications that report quantitative outcomes for Australian randomised control trials of parenting programs in which the participants were parents or caregivers of children under 18 years of age, and with at least one outcome related to children's health, health behaviour, or wellbeing. Data sources: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus databases. Data synthesis: Of 109 eligible publications, nine reported how many participants were Aboriginal or Torres Strait Islander people; three specified whether they were Aboriginal, Torres Strait Islander, or both. Two publications described specific interventions for Aboriginal and Torres Strait Islander children; both reported consultation with Indigenous people regarding program design. Of the 15 559 participating parents in all included publications, 93 were identified as Aboriginal or Torres Strait Islander people. No publications noted as study limitations the absence of consultation with Indigenous people or the low participation rate of Aboriginal and Torres Strait Islander families. Conclusions: The specific needs and interests of Aboriginal and Torres Strait Islander families have not generally been considered in Australian trials of parenting programs that aim to improve the mental and physical health of children. Further, Indigenous people are rarely involved in the planning and implementation of the interventions, few of which are designed to be culturally appropriate for Indigenous people. If parenting research in Australia is to support Aboriginal and Torres Strait Islander families, it must include consultation with local communities, adapt interventions and research methods to the needs of the participating parents and their communities, and improve the recruitment and retention of Aboriginal and Torres Strait Islander participants.