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Current expenditure on psychosis in Australia is probably inefficient. There may be substantial opportunity costs in not delivering effective treatments in sufficient volume to people with psychotic disorders, not intervening early, and not improving access to rehabilitation and supported accommodation.

The current study evaluated the stage theory of Homosexual Identity Formation (HIF) developed by Cass (1979), in terms of the relationship between stage of gay identity development and psychosocial well-being. Four hundred twenty-five males (12 to 64 years, M = 29.2) reporting sexual attraction to other men provided demographic information and completed psychosocial measures: the Happiness-Sadness Scale (McGreal & Joseph, 1993), the Satisfaction with Life Scale (Diener, Emmons, Larsen & Griffin, 1985), the UCLA Loneliness Scale (Russell, Peplau & Ferguson, 1978), the Index of Self-Esteem (Hudson, 1982), and the Gay Identity Questionnaire (Brady & Busse, 1994). Correlation analysis and ANCOVAs controlling for age and nationality demonstrated that the 6 sequential stages of HIF were associated with a U-shaped function for the psychosocial variables. Well-being was high during the initial Confusion and Comparison stages of HIF, was reduced during the middle Tolerance and Acceptance stages, and was again high in the later Pride and Synthesis stages. Each of the psychosocial variables was significantly different according to stage of development (p <.001). Qualitative analysis of subjects' comments also revealed support for the U-shaped pattern.

ANZCTR 12606000101583.

The minor differences between the two groups may have been related to relatively small sample sizes, although some similarities between the groups were to be expected. The low rate of conversion to psychosis in the 'at-risk' group is discussed. Further analyses using larger samples are necessary to determine the validity of the various 'at-risk' categories and this will involve following a sufficiently large sample over an adequate time. The most efficient way of doing this would be to pool data across centres with comparable early intervention programs.

IntroductionMaintaining adequate nutrition for Head and Neck Cancer (HNC) patients is challenging due to both the malignancy and the rigours of radiation treatment. As yet, health behaviour interventions designed to maintain or improve nutrition in patients with HNC have not been evaluated. The proposed trial builds on promising pilot data, and evaluates the effectiveness of a dietitian-delivered health behaviour intervention to reduce malnutrition in patients with HNC undergoing radiotherapy: Eating As Treatment (EAT).Methods and analysisA stepped-wedge cluster randomised design will be used. All recruitment hospitals begin in the control condition providing treatment as usual. In a randomly generated order, oncology staff at each hospital will receive 2 days of training in EAT before switching to the intervention condition. Training will be supplemented by ongoing supervision, coaching and a 2-month booster training provided by the research team. EAT is based on established behaviour change counselling methods, including motivational interviewing, cognitive–behavioural therapy, and incorporates clinical practice change theory. It is designed to improve motivation to eat despite a range of barriers (pain, mucositis, nausea, reduced or no saliva, taste changes and appetite loss), and to provide patients with practical behaviour change strategies. EAT will be delivered by dietitians during their usual consultations. 400 patients with HNC (nasopharynx, hypopharynx, oropharynx, oral cavity or larynx), aged 18+, undergoing radiotherapy (>60 Gy) with curative intent, will be recruited from radiotherapy departments at 5 Australian sites. Assessments will be conducted at 4 time points (first and final week of radiotherapy, 4 and 12 weeks postradiotherapy). The primary outcome will be a nutritional status assessment.Ethics and disseminationEthics approval from all relevant bodies has been granted. Study findings will be disseminated widely through peer-reviewed publications and conference presentations.Trial registration numberACTRN12613000320752.

Several concurrent strategies were recommended, including early intervention programmes and assertive evidence-based rehabilitation and supported employment programmes aimed at reducing disability. The cost-effectiveness of these approaches needs to be evaluated from the perspectives of both government and society.

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