Q & A with Maree Hackett: Mental health and chronic disease

Neurological and mental health expert, Associate Professor Maree Hackett, looks after a program of research that focuses on mental health with other chronic diseases like stroke. She has a background in health psychology and hospital-based clinical trials, and learned about epidemiology and systematic reviews during her PhD. Here she shares her experience as a senior researcher for over eight years with The George Institute.

What is your job and what does it involve?

My job involves a lot of thinking and a fair amount of talking. Daily tasks range from thinking of simple ways to improve health; brainstorming ‘out there ideas’ with colleagues and friends; identifying and talking with possible funders of research ideas; presenting the results of our research locally, nationally and internationally; reviewing other people’s work; teaching postgraduate students; and reviewing the existing literature … there’s an awful lot of that going on.

What inspires you in the work you do and why?

People who for one reason or another don’t have much of a voice. People with mental health problems are often overlooked, dismissed or marginalised. There is still a perception by many that their problems aren’t real … it’s all in their head after all. Mental health research isn’t prioritised and people with mental health problems receive poorer health care. I’d like to think our work will go some way to making their situation better.

Also, my colleagues and friends are pretty inspiring. I work with and know a lot of ridiculously clever people who come up with some pretty crazy ideas … that often work.

What are your research interests?

Mental health/social and emotional well-being, Indigenous health, stroke, cardiovascular disease, epilepsy, and systematic reviews.

What is your current research focus?

Assessment of fluoxetine in stroke recovery (AFFINITY), a trial of the antidepressant fluoxetine, given to people early after stroke and continued for six months. We are looking to see if fluoxetine improves physical function and reduces dependency on others. We are also interested in whether it prevents depression after stroke.

If the AFFINITY trial proves fluoxetine is a safe and effective treatment for improving survival free of disability after stroke, its widespread availability and familiarity, coupled with affordability, will see it prescribed widely for many stroke survivors. This would mean a substantial and significant reduction in the burden of long-term disability after stroke.
In a separate study, we are hoping to validate a measure of depression for use with Aboriginal and Torres Strait Islander people attending Aboriginal Medical Services across Australia.

My colleague Professor Alex Brown (South Australian Health and Medical Research Institute) and others worked with five Aboriginal language groups in Central Australia to adapt an existing depression screening tool to make it culturally meaningful and give it face validity. We would like to test the adapted tool against a structured clinical interview for depression.

During the work in Central Australia seven domains of depressive experience within Indigenous men were also identified that were not covered in in existing depression screening tools: anger, weakened spirit, homesickness, irritability, excessive worry, rumination, and drug/alcohol use. We will look to see if these domains assist with case finding.

What impact will your work have on health?

Stroke clinicians are much more aware of psychological problems after stroke now and this has gone some way to improving prevention and treatment of things like depression and anxiety in stroke populations. But, we’ve still got a long way to go.

Non-mental health professionals are not particularly confident or comfortable diagnosing mental health problems and we are still unsure of the best treatment and prevention strategies for psychological problems after stroke.

We are one step further back for mental health in Aboriginal and Torres Strait Islander populations. There is still no simple, freely available, culturally validated measure of depression for GPs to use in this population – and until we get that sorted easily treated problems will go undiagnosed. In fact, with no valid measure of depression in this population we can’t even reliably tell you the size of the problem.

What attracted you to working at The George Institute?

Being asked to come to Sydney to work here was pretty flattering, especially given the reputation of The George Institute. It was still quite a difficult decision as I was in the middle of my PhD. Everything you read about doing a PhD says ‘don’t change jobs’ … but nothing said don’t change jobs AND move countries … so I figured it would be okay.

How do you explain to people what you do?

I say I do health research. I’m particularly interested in mental health in people with other health problems, like stroke for example, and in Indigenous health.

Who is a person you admire?

I can’t say there is just one person. I admire anyone who can experience adversity and is able to fully participate in life with a smile on their face. I have family members who have a musculoskeletal disorder which means they are in constant pain and are progressively disabled yet that are fully functioning members of society with great senses of humour. I admire them greatly.

What do you do to unwind at the end of the day?

Spend time with family and friends. Laughter is the best of all medicines (except when you have a broken rib). Wine and cheese are the second best medicines …