Repeat self-harm and mental health service use after self-harm in Culturally and Linguistically Diverse communities: Insights from a data linkage study in Victoria, AustraliaPham, Thi Thu Le; O’Brien, Kerry S; Liu, Sara; Gibson, Katharine; Berecki-Gisolf, Janneke
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231177237
Purpose:To examine the associations between Culturally and Linguistically Diverse backgrounds (vs non-Culturally and Linguistically Diverse) and in-hospital death due to self-harm, repeat self-harm and mental health service use after self-harm.Method:A retrospective study of 42,127 self-harm hospital inpatients aged 15+ years in Victoria, Australia, from July 2008 to June 2019. Linked hospital and mental health service data were used to assess in-hospital death, repeat self-harm and mental health service use in the 12 months following index self-harm hospital admission. Logistic regression and zero-inflated negative binomial regression models were used to estimate associations between cultural background and outcomes.Results:Culturally and Linguistically Diverse people accounted for 13.3% of self-harm hospital inpatients. In-hospital death (0.8% of all patients) was negatively associated with Culturally and Linguistically Diverse background. Within 12 months, 12.9% of patients had self-harm readmission and 20.1% presented to emergency department with self-harm. Logistic regression components of zero-inflated negative binomial regression models showed no differences in the odds of (hospital-treated) self-harm reoccurrence between Culturally and Linguistically Diverse and non- Culturally and Linguistically Diverse self-harm inpatients. However, count components of models show that among those with repeat self-harm, Culturally and Linguistically Diverse people (e.g. born in Southern and Central Asia) made fewer additional hospital revisits than non-Culturally and Linguistically Diverse people. Clinical mental health service contacts following self-harm were made in 63.6% of patients, with Culturally and Linguistically Diverse people (Asian backgrounds 43.7%) less likely to make contact than the non-Culturally and Linguistically Diverse group (65.1%).Conclusions:Culturally and Linguistically Diverse and non-Culturally and Linguistically Diverse people did not differ in the likelihood of hospital-treated repeat self-harm, but among those with self-harm repetition Culturally and Linguistically Diverse people had fewer recurrences than non-Culturally and Linguistically Diverse people and utilised mental health services less following self-harm admissions.
Association between mental health workforce supply and clusters of high and low rates of youth suicide: An Australian study using suicide mortality data from 2016 to 2020Hill, NTM; Bouras, H; Too, LS; Perry, Y; Lin, A; Weiss, D
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231192764pmid: 37608497
Objective:To examine the association between mental health workforce supply and spatial clusters of high versus low incidence of youth suicide.Methods:A cross-sectional analysis of spatial suicide clusters in young Australians (aged 10–25) from 2016 to 2020 was conducted using the scan statistic and suicide data from the National Coronial Information System. Mental health workforce was extracted from the 2020 National Health Workforce Dataset by local government areas. The Geographic Index of Relative Supply was used to estimate low and moderate-to-high mental health workforce supply for clusters characterised by a high and low incidence of suicide (termed suicide hotspots and coldspots, respectively). Univariate and multivariate logistic regression was used to determine the association between suicide clusters and a range of sociodemographic characteristics including mental health workforce supply.Results:Eight suicide hotspots and two suicide coldspots were identified. The multivariate analysis showed low mental health workforce supply was associated with increased odds of being involved in a suicide hotspot (adjusted odds ratio = 8.29; 95% confidence interval = 5.20–13.60), followed by residential remoteness (adjusted odds ratio = 2.85; 95% confidence interval = 1.68–4.89), and illicit drug consumption (adjusted odds ratio = 1.97; 1.24–3.11). Both coldspot clusters occurred in areas with moderate-to-high mental health workforce supply.Conclusion:Findings highlight the potential risk and protective roles that mental health workforce supply may play in the spatial distributions of youth suicide clusters. These findings have important implications for the provision of postvention and the prevention of suicide clusters.
Australia’s unethical deportation practice discriminates against New Zealanders with mental illness: ‘Everybody needs good neighbours!’Artus, Julie; Davison, Lorraine; Bismark, Marie; Every-Palmer, Susanna
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231193877pmid: 37605518
In this article, we explore Australia’s deportation of people with mental illness from an ethical and human rights perspective. We outline the legislative framework regulating migration policy in Australia, focussing on Section 501 (s.501) of the Migration Act 1958 (which makes provision for deportation of non-residents on character grounds) and on the recently issued Direction 99 (which provides guidance on visa refusal and cancellation under s.501). We find the definition of a failed character test embedded within the legislative framework to be discriminatory, in that it conflates mental illness with character attributes. We present recent data on s.501 deportees sourced from the New Zealand Police and Manatū Hauora (the New Zealand Ministry of Health). Drawing on our clinical experiences working in forensic psychiatry and rehabilitation services, we describe some of our patients’ experiences and the detrimental effects of deportation on their health and well-being. We argue that deportation of people with mental illness contravenes principles of psychosocial rehabilitation and recovery, is discriminatory and constitutes a moral wrong. Furthermore, while we recognise that recent policy changes reflect a tempering of the previous hard-line policy stance, it remains to be seen what effects they will have in practice. We question whether the new guidance will be enough to improve the treatment of and outcomes for those with mental illness, or whether the changes represent a case of too little, too late.
Gender affirmation and mental health in prison: A critical review of current corrections policy for trans people in Australia and New ZealandDalzell, Laura G; Pang, Sam C; Brömdal, Annette
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231195285
Background:Trans people in prison experience disproportionate rates of harm, including negative mental health outcomes, and thus require special protections. Instead, corrections policies have historically further marginalised them. This critical policy review aimed to compare corrections policies for trans people in Australia and New Zealand with human rights standards and consider their mental health impact.Methods:Online searches were conducted on corrections websites for each state/territory in Australia and New Zealand. Drawing on the Nelson Mandela Rules and Yogyakarta Principles, 19 corrections policies relevant to placement, naming, appearance and gender-affirming healthcare for trans people were reviewed. The potential mental health impact of these policies on incarcerated trans people was discussed using the Gender Minority Stress and Resilience framework.Results:Australian and New Zealand corrections policies have become more concordant with human rights standards in the past 5 years. However, gender-related discrimination and human rights violations were present in corrections policies of all jurisdictions. New South Wales and Victorian policies had the highest concordance with human rights standards, while Queensland and South Australian policies had the lowest.Conclusion:Policies that contribute to discrimination and minority stress may increase risk of mental health problems and suicide for incarcerated trans people. Mental health professionals working in prisons need to be aware of these risks to provide safe and accessible mental healthcare for trans people. Collaborative policy development with trans people is essential to protect the safety and rights of incarcerated trans people and consider models beyond the gender binary on which correctional systems have been founded.
Dynamic modelling of the impact of community-based acute mental health services for children and adolescentsSkinner, Adam; Occhipinti, Jo-An; Song, Yun Ju Christine; Scott, Elizabeth M; Hickie, Ian B
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231195555pmid: 37641519
Objective:To evaluate the potential impact of the recently announced ‘Safeguards’ initiative on mental health-related emergency department presentation rates for children and adolescents (0−17 years). This state-funded initiative aims to establish 25 Child and Adolescent Acute Response Teams across New South Wales.Methods:We estimated the effects of the ‘Safeguards’ initiative using a state-level dynamic model of child and adolescent acute mental health care. Potential reductions in total numbers of mental health-related emergency department presentations and re-presentations (i.e. presentations within 3 months of an initial presentation) were assessed via a series of simulation experiments in which we systematically varied the total number of Child and Adolescent Acute Response Teams and the mean duration of care per patient.Results:Assuming a mean treatment duration of 6 weeks per patient, 25 Child and Adolescent Acute Response Teams are projected to reduce total numbers of mental health-related emergency department presentations and re-presentations over the period 2022–2031 by 15.0% (95% interval, 12.0−18.2%) and 31.7% (26.2−37.8%), respectively. Increasing the total number of Child and Adolescent Acute Response Teams above 25 has minimal additional impact on projected reductions in numbers of emergency department presentations and re-presentations, provided the mean duration of care is no more than 8 weeks. However, where the mean duration of care is greater than 4 weeks, a decrease in the number of Child and Adolescent Acute Response Teams below 25 reduces the potential effectiveness of the ‘Safeguards’ initiative significantly.Conclusion:Our simulation results indicate that full and timely implementation will be critical if the potentially substantial impact of the ‘Safeguards’ initiative on demand for hospital-based emergency mental health care is to be realised.
A randomised controlled trial of a psychoeducational group intervention for family and friends of young people with borderline personality disorder featuresBetts, Jennifer K; Seigerman, Mirra R; Hulbert, Carol; McKechnie, Ben; Rayner, Victoria K; Jovev, Martina; Cotton, Sue M; McCutcheon, Louise K; McNab, Catharine; Burke, Emma; Chanen, Andrew M
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231172108pmid: 37170885
Objective:Preliminary evidence indicates that interventions designed to support family and friends (‘carers’) of young people with early-stage borderline personality disorder effectively improve carer outcomes. None of these interventions have been tested in a randomised controlled trial.Method:This clustered, partially nested, randomised controlled trial was conducted at Orygen, Melbourne, Australia. Carers of young people (aged 15–25 years) with borderline personality disorder features were randomly assigned as a unit in a 1:1 ratio, balanced for young person’s sex and age, to receive a 15-day intervention comprising: (1) the three-session, in-person, Making Sense of BPD (MS-BPD) multi-family group programme, plus two self-directed online psychoeducational modules (MS-BPD + Online, n = 38), or (2) the two self-directed online psychoeducational modules alone (Online, n = 41). The primary outcome was ‘negative experiences of care’, measured with the Experience of Caregiving Inventory, at the 7-week endpoint.Results:A total of 79 carers were randomised (pool of 281, 197 excluded, 94 declined) and 73 carers (51 females [69.9%], Mage = 43.8 years [standard deviation, SD = 12.9], MS-BPD + Online n = 35 [47.9%], Online n = 38 [52.1%]) provided follow-up data and were included in the intent-to-treat analysis. The intent-to-treat (and per protocol) analyses did not find any significant differences between the groups on the primary (d = −0.32; 95% confidence interval = [−17.05, 3.97]) or secondary outcomes. Regardless of treatment group, caregivers improved significantly in their personality disorder knowledge.Conclusion:Delivering MS-BPD in conjunction with an online psychoeducational intervention was not found to provide additional benefit over and above access to an online intervention alone. In accordance with national guidelines, carer interventions should be routinely offered by youth mental health services as part of early intervention programmes for borderline personality disorder. Further research is warranted into which interventions work for whom, carers’ preferences for support and barriers to care.
Preliminary results from the Australian Genetics of Bipolar Disorder Study: A nation-wide cohortLind, Penelope A; Siskind, Dan J; Hickie, Ian B; Colodro-Conde, Lucía; Cross, Simone; Parker, Richard; Martin, Nicholas G; Medland, Sarah E
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231195571pmid: 37655588
Objective:The Australian Genetics of Bipolar Disorder Study is a nation-wide cohort of adults living with bipolar disorder. The study aims to detect the relationships between genetic risk, symptom severity, and the lifetime prevalence of bipolar disorder, treatment response and medication side effects, and patterns and costs of health care usage.Methods:A total of 6682 participants (68.3% female; aged 44.8 ± 13.6 years [range = 18–90]) were recruited in three waves: a nation-wide media campaign, a mail-out based on prescriptions for lithium carbonate and through the Australian Genetics of Depression Study. Participants completed a self-report questionnaire. A total of 4706 (70%) participants provided a saliva sample and were genotyped and 5506 (82%) consented to record linkage of their Pharmaceutical and Medicare Benefits Schedule data.Results:Most participants were living with bipolar I disorder (n = 4068) while 1622 participants were living with bipolar II disorder and 992 with sub-threshold bipolar disorder. The mean age of bipolar disorder diagnosis was 32.7 ± 11.6 years but was younger in bipolar I (p = 2.0E-26) and females (p = 5.7E-23). Excluding depression with onset prior to bipolar disorder diagnosis, 64.5% of participants reported one or more co-occurring psychiatric disorders: most commonly generalised anxiety disorder (43.5%) and posttraumatic stress disorder (20.7%). Adverse drug reactions were common and resulted in discontinuation rates ranging from 33.4% for lithium to 63.0% for carbamazepine.Conclusion:Our findings highlight the high rate of comorbidities and adverse drug reactions among adults living with bipolar disorder in the general Australian population. Future genomic analyses focus on identifying genetic variants influencing pharmacotherapy treatment response and side effects.
‘Quitlink’: Outcomes of a randomised controlled trial of peer researcher facilitated referral to a tailored quitline tobacco treatment for people receiving mental health servicesBaker, Amanda L; McCarter, Kristen; Turner, Alyna; Segan, Catherine; Castle, David; Brophy, Lisa; Borland, Ron; Kelly, Peter J; Bonevski, Billie; Baird, Donita; Filia, Sacha; Attia, John; Szwec, Stuart; Palazzi, Kerrin; White, Sarah L; Williams, Jill M; Wrobel, Anna L; Ireland, Andrew; Saxby, Karinna; Ghijben, Peter; Petrie, Dennis; Sweeney, Rohan
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231181039pmid: 37353970
Objective:The aim of this study was to test the effectiveness of a tailored quitline tobacco treatment (‘Quitlink’) among people receiving support for mental health conditions.Methods:We employed a prospective, cluster-randomised, open, blinded endpoint design to compare a control condition to our ‘Quitlink’ intervention. Both conditions received a brief intervention delivered by a peer researcher. Control participants received no further intervention. Quitlink participants were referred to a tailored 8-week quitline intervention delivered by dedicated Quitline counsellors plus combination nicotine replacement therapy. The primary outcome was self-reported 6 months continuous abstinence from end of treatment (8 months from baseline). Secondary outcomes included additional smoking outcomes, mental health symptoms, substance use and quality of life. A within-trial economic evaluation was conducted.Results:In total, 110 participants were recruited over 26 months and 91 had confirmed outcomes at 8 months post baseline. There was a difference in self-reported prolonged abstinence at 8-month follow-up between Quitlink (16%, n = 6) and control (2%, n = 1) conditions, which was not statistically significant (OR = 8.33 [0.52, 132.09] p = 0.131 available case). There was a significant difference in favour of the Quitlink condition on 7-day point prevalence at 2 months (OR = 8.06 [1.27, 51.00] p = 0.027 available case). Quitlink costs AU$9231 per additional quit achieved.Conclusion:The Quitlink intervention did not result in significantly higher rates of prolonged abstinence at 8 months post baseline. However, engagement rates and satisfaction with the ‘Quitlink’ intervention were high. While underpowered, the Quitlink intervention shows promise. A powered trial to determine its effectiveness for improving long-term cessation is warranted.
Clinicians’ views on cognitive assessment with Aboriginal AustraliansHindman, Emily; Hassmén, Peter; Orchard, Abbey; Radford, Kylie; Delbaere, Kim; Garvey, Gail
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231183354pmid: 37353895
Background:A shortage of standardised cognitive assessment tools for use with Aboriginal Australians is evident. Clinicians also miss the range of guidelines necessary to inform test selection and interpretation for all Aboriginal clients. This mixed methods study examines clinicians’ confidence, views and current practices when conducting cognitive assessments with Aboriginal Australian clients.Methods:Clinicians were asked about factors that influence their likelihood of using standardised testing in Aboriginal vs non-Indigenous Australian people. Twenty-one health professionals with experience conducting cognitive assessments with Aboriginal and non-Aboriginal Australians participated. Clinicians were presented with a series of different scenarios per the client’s level of education and language of origin via an online survey. Clinicians rated their likelihood and confidence using standardised cognitive assessment for each scenario. Open-ended questions captured clinicians’ views and information about their current clinical practices.Results:Clients’ age, education and language of origin influence the likelihood of clinicians’ use of standardised cognitive assessment measures with Aboriginal people. Overall, clinicians reported feeling only slightly more confident working with non-Indigenous clients than Aboriginal clients. Qualitative data indicate a lack of consistency regarding test selection.Conclusion:Clinicians expressed concerns about the validity of available cognitive assessment tools for use with Aboriginal Australians and the absence of evidence to assist decision-making. Cited barriers included language, educational attainment and cultural factors.
Perinatal depression: The use of the Edinburgh Postnatal Depression Scale to derive clinical subtypesGalbally, Megan; Watson, Stuart J; Boyce, Philip; Howard, Louise; Herrman, Helen
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231193640pmid: 37649275
Background:Predicting the course and complications of perinatal depression through the identification of clinical subtypes has been previously undertaken using the Edinburgh Postnatal Depression Scale and has the potential to improve the precision of care and improve outcomes for women and their children.Methods:Edinburgh Postnatal Depression Scale scores were collected twice in pregnancy and twice in the postpartum in a sample of 360 women who met diagnostic criteria for perinatal depression using the Structured Clinical Interview for DSM disorder. These data were used to compare with previous, though conflicting, evidence from cross-sectional studies and extend this by undertaking longitudinal measurement invariance modelling to test the structural validity across the perinatal period. Latent profile and transition modelling was used to identify distinct subtypes of women and assess the utility of these subtypes and transition profiles to predict clinically meaningful outcomes.Results:Although our data supported one of the previously reported three-factor Edinburgh Postnatal Depression Scale structures used to compute subfactor totals for depressed mood, anxiety and anhedonia at both early pregnancy and 6 months postpartum, there was little value in using these Edinburgh Postnatal Depression Scale subfactor scores to identify subtypes predictive of clinically meaningful postpartum symptom subtypes, or of general health, pregnancy and neonatal outcomes.Conclusion:Our study does not support the use of the Edinburgh Postnatal Depression Scale to distinguish perinatal depressive subtypes for the purposes of predicting course and complications associated with perinatal depression. However, the results give guidance on alternative ways to study the value of personalised management in improved outcomes for women living with or at risk for perinatal depression.
Principles for delivering improved care of people with functional seizures: Closing the treatment gapWinton-Brown, Toby; Wilson, Sarah J; Felmingham, Kim; Rayner, Genevieve; O’Brien, Terence J; O’Brien, Patrick; Mohan, Adith; Velakoulis, Dennis; Kanaan, Richard
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231180509pmid: 37394954
Patients diagnosed with functional (psychogenic nonepileptic) seizures have similar or greater levels of disability, morbidity and mortality than people with epilepsy, but there are far fewer treatment services. In contrast to epilepsy, the current understanding of pathophysiological mechanisms and the development of evidence-based treatments for functional seizures is rudimentary. This leads to high direct healthcare costs and high indirect costs to the patient, family and wider society. There are many patient, clinician and system-level barriers to improving outcomes for functional seizures. At a patient level, these include the heterogeneity of symptoms, diagnostic uncertainty, family factors and difficulty in perceiving psychological aspects of illness and potential benefits of treatment. Clinician-level barriers include sub-specialism, poor knowledge, skills and attitudes and stigma. System-level barriers include the siloed nature of healthcare, the high prevalence of functional seizures and funding models relying on individual medical practitioners. Through the examination of international examples and expert recommendations, several themes emerge that may address some of these barriers. These include (1) stepped care with low-level, brief generalised interventions, proceeding to higher level, extended and individualised treatments; (2) active triage of complexity, acuity and treatment readiness; (3) integrated interdisciplinary teams that individualise formulation, triage, and treatment planning and (4) shared care with primary, emergency and community providers and secondary consultation. Consideration of the application of these principles to the Australian and New Zealand context is proposed as a significant opportunity to meet an urgent need.
Childhood trauma is prevalent and associated with co-occurring depression, anxiety, mania and psychosis in young people attending Australian youth mental health servicesBendall, Sarah; Eastwood, Oliver; Spelman, Tim; McGorry, Patrick; Hickie, Ian; Yung, Alison R; Amminger, Paul; Wood, Stephen J; Pantelis, Christos; Purcell, Rosemary; Phillips, Lisa
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231177223pmid: 37243364
Objectives:Childhood trauma is common and associated with mental ill health. While high rates of trauma are observed across individual disorders, there is evidence that trauma is associated with an admixture of affective, anxiety and psychotic symptoms in adults. Given that early onset of mental disorder and trauma exposure herald poor outcomes, it is important to examine trauma prevalence rates in youth mental health services and to determine whether this trauma-related clustering is present in help-seeking young people.Methods:We used data from the Transitions Study, a longitudinal investigation of young people attending headspace youth mental health services in Australia between January 2011 and August 2012. Participants were 775 young people aged 12–25. Childhood trauma was assessed using the Childhood Trauma Questionnaire. Multinomial regression was used to assess whether reported childhood trauma was more strongly associated with the co-occurrence of depression, anxiety, mania and psychosis symptoms than with any one in isolation.Results:Approximately 84% of participants reported some form of abuse (emotional: 68%; physical: 32%; sexual: 22%) or neglect (emotional: 65%; physical: 46%). Exposure to multiple trauma types was common. Childhood trauma was significantly associated with each symptom domain. More severe childhood trauma was more strongly associated with the co-occurrence of symptoms than with any one symptom domain in isolation, such that more severely trauma-exposed young people were more likely to experience increased symptom clustering.Conclusions:Childhood trauma is pervasive in youth mental health services and associated with a symptom profile that cuts across traditional diagnostic boundaries.
The mental health effects of changing from insecure to secure visas for refugeesNickerson, Angela; Byrow, Yulisha; O’Donnell, Meaghan; Bryant, Richard A; Mau, Vicki; McMahon, Tadgh; Hoffman, Joel; Mastrogiovanni, Natalie; Specker, Philippa; Liddell, Belinda J
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231177950pmid: 37248738
Objective:In response to growing numbers of refugees worldwide, host governments are increasingly implementing temporary protection policies; however, little is known regarding the mental health impact of these policies. This online longitudinal study investigated whether refugees who transitioned from low visa security (e.g. short-term transient visas) to medium (e.g. temporary protection visas) or high visa (e.g. permanent visas) security showed changes in depression symptoms, social difficulties and immigration-related fears.Methods:Participants were 1,201 refugees and asylum-seekers from Arabic, Farsi, Tamil or English-speaking backgrounds. Study variables were measured prior to and after change in visa status (6 months apart).Results:Refugees who transitioned from low to medium security visas showed reduced immigration-related fear (B = −0.09, 95% confidence interval = −0.29 to −0.06), but no change in depression symptoms or social difficulties compared to those who retained low visa security. Refugees who transitioned from low to high security visas showed reduced depression symptoms (B = −0.02, 95% confidence interval = −0.04 to −0.01), social difficulties (B = −0.04, 95% confidence interval = −0.05 to −0.01) and immigration-related fear (B = −0.03, 95% confidence interval = −0.06 to −0.01) compared to those who retained low visa security.Conclusion:Findings indicate that the increased security afforded by temporary protection policies (vs short-term transient visas) did not translate into improved mental health and social outcomes for refugees. In contrast, permanent protection was associated with significant improvements in psychological and social functioning. These results have important policy implications for countries who have committed to protect and facilitate improved mental health among refugees.
Tau in dementia with Lewy bodiesChin, Kai Sin; Churilov, Leonid; Doré, Vincent; Villemagne, Victor L; Rowe, Christopher C; Yassi, Nawaf; Watson, Rosie
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231177219pmid: 37264610
Objective:Neurofibrillary tangles are present in a proportion of people with dementia with Lewy bodies and may be associated with worse cognition. Recent advances in biomarkers for Alzheimer’s disease include second-generation tau positron emission tomography as well as the detection of phosphorylated tau at threonine 181 (p-tau181) in plasma. This study aimed to investigate tau in people with dementia with Lewy bodies using a second-generation tau positron emission tomography tracer as well as plasma p-tau181.Methods:Twenty-seven participants (mean age 74.7 ± 5.5) with clinically diagnosed probable dementia with Lewy bodies underwent comprehensive clinical assessment and positron emission tomography imaging (18F-MK6240 and 18F-NAV4694). Plasma p-tau181 levels were measured using Simoa technology.Results:Five dementia with Lewy bodies participants (18.5%) had an abnormal tau positron emission tomography (increased tau uptake in the temporal meta-region-of-interest). Higher plasma p-tau181 concentrations correlated with higher tau deposition in the temporal region (ρ = 0.46, 95% confidence interval = [0.10, 0.72]) and classified abnormal tau positron emission tomography in dementia with Lewy bodies with an area under the curve of 0.95 (95% confidence interval = [0.86, 0.99]). Plasma p-tau181 also correlated positively with cortical amyloid-beta binding (ρ = 0.68, 95% confidence interval = [0.40, 0.84]) and classified abnormal amyloid-beta positron emission tomography in dementia with Lewy bodies with an area under the curve of 0.91 (95% confidence interval = [0.79, 0.99]). There was no association found between tau deposition and any of the clinical variables.Conclusions:Tau is a common co-pathology in dementia with Lewy bodies. Plasma p-tau181 correlated with abnormal tau and amyloid-beta positron emission tomography and may potentially be used as a marker to identify co-morbid Alzheimer’s disease-related pathology in dementia with Lewy bodies. The clinical implications of tau in dementia with Lewy bodies need to be further evaluated in larger longitudinal studies.
Trends in mental health inequalities for people with disability, Australia 2003 to 2020Bishop, Glenda M; Kavanagh, Anne Marie; Disney, George; Aitken, Zoe
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231193881pmid: 37606227
Objective:Cross-sectional studies have demonstrated that people with disability have substantial inequalities in mental health compared to people without disability. However, it is not known if these inequalities have changed over time. This study compared the mental health of people with and without disability annually from 2003 to 2020 to investigate time trends in disability-related mental health inequalities.Methods:We use annual data (2003–2020) of the Household, Income and Labour Dynamics in Australia Survey. Mental health was measured using the five-item Mental Health Inventory. For each wave, we calculated population-weighted age-standardised estimates of mean Mental Health Inventory scores for people with and without disability and calculated the mean difference in Mental Health Inventory score to determine inequalities. Analyses were stratified by age, sex and disability group (sensory or speech, physical, intellectual or learning, psychological, brain injury or stroke, other).Results:From 2003 to 2020, people with disability had worse mental health than people without disability, with average Mental Health Inventory scores 9.8 to 12.1 points lower than for people without disability. For both people with and without disability, Mental Health Inventory scores decreased, indicating worsening mental health, reaching the lowest point for both groups in 2020. For some subpopulations, including young females and people with intellectual disability, brain injury or stroke, mental health inequalities worsened.Conclusion:This paper confirms that people with disability experience worse mental health than people without disability. We add to previous findings by demonstrating that disability-related inequalities in mental health have been sustained for a long period and are worsening in some subpopulations.
Country and community vs poverty and conflict: Teasing apart the key demographic and psychosocial resilience and risk factors for Indigenous clinic-referred children and adolescentsVance, Alasdair; McGaw, Janet; Winther, Jo; White, Selena; Gone, Joseph P; Eades, Sandra
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231187315pmid: 37480284
Objective:Indigenous young people are known to have adverse demographic and psychosocial factors affecting worse mental health outcomes and some household factors aiding resilience. In Australia, there has been no exploration of these factors in clinically referred Indigenous young people assessed in a culturally appropriate way.Methods:A total of 113 Indigenous children and adolescents, 217 non-Indigenous young people, age, gender, mental disorder symptom severity, symptom-linked distress and impairment matched, and 112 typically developing participants, age- and gender-matched were recruited. Cultural validity and reliability of the impairing symptoms in Indigenous young people were determined. Key demographic and psychosocial factors were compared across the three groups.Results:The Indigenous clinical group differed significantly from the other two groups that did not differ on three possibly protective measures examined. Key demographic and psychosocial risk factors in the Indigenous group differed significantly from the non-Indigenous clinical group which in turn differed from the typically developing participants. The three groups exhibited a progressively increased magnitude of difference.Conclusions:It remains imperative to nurture features that provide protection and enhance resilience for Indigenous young people and their communities. Indigenous status is linked to significant demographic and psychosocial disadvantage over and above that conferred by clinical impairment and its management. It is crucial that these features are managed and/or advocated for with those demographic and psychosocial factors of the greatest magnitude dealt with first. Future systematic investigations of the contribution of these key factors to mental health referral pathways, assessment and management are needed.
Making meaning of multimorbidity and severe mental illness: A viewpointHalstead, Sean; Siskind, Dan; Warren, Nicola
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231195560pmid: 37655619
People living with severe mental illness, such as schizophrenia and bipolar affective disorder, frequently experience poorer physical health compared to those without mental illness. This issue has hitherto been approached through the disease-centred construct of comorbidity, where subsequent conditions are viewed as secondary to an ‘index condition’. In contrast, this Viewpoint sets out to explain why multimorbidity, a patient-centred concept that instead refers to the coexistence of multiple chronic illnesses, is a more versatile and robust framework for tackling the issue of poor physical health in people with severe mental illness. In establishing this argument, this Viewpoint has sought to address three key areas. First, this article will discuss the epidemiology of both physical and psychiatric multimorbidity, with respect to how they manifest at greater frequency and at younger ages in people with severe mental illness. Second, the profound consequences of this multimorbidity burden will be explored, with respect to the ‘three D’s’ of death (premature mortality), disability (functional impacts) and deficit (health-economic impacts). Finally, the utility of multimorbidity as a framework will be illustrated through a proposal for a three-dimensional multimorbidity construct composed of (1) quantity, (2) severity and (3) duration of an individual’s chronic illnesses. Consequently, this Viewpoint aims to capture why it is necessary for modern psychiatry to grasp the concept of multimorbidity to facilitate holistic healthcare for people living with severe mental illness.
Mental health systems modelling for evidence-informed service reform in AustraliaWhiteford, Harvey; Bagheri, Nasser; Diminic, Sandra; Enticott, Joanne; Gao, Caroline X.; Hamilton, Matthew; Hickie, Ian B; Khanh-Dao Le, Long; Lee, Yong Yi; Long, Katrina M; McGorry, Patrick; Meadows, Graham; Mihalopoulos, Cathrine; Occhipinti, Jo-An; Rock, Daniel; Rosenberg, Sebastian; Salvador-Carulla, Luis; Skinner, Adam
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231172113pmid: 37183347
Australia’s Fifth National Mental Health Plan required governments to report, not only on the progress of changes to mental health service delivery, but to also plan for services that should be provided. Future population demand for treatment and care is challenging to predict and one solution involves modelling the uncertain demands on the system. Modelling can help decision-makers understand likely future changes in mental health service demand and more intelligently choose appropriate responses. It can also support greater scrutiny, accountability and transparency of these processes. Australia has an emerging national capacity for systems modelling in mental health which can enhance the next phase of mental health reform. This paper introduces concepts useful for understanding mental health modelling and identifies where modelling approaches can support health service planners to make evidence-informed decisions regarding planning and investment for the Australian population.
Predictors of the 6-year outcome of obsessive-compulsive disorder: Findings from the Netherlands Obsessive-Compulsive Disorder Association studyTibi, Lee; van Oppen, Patricia; van Balkom, Anton JLM; Eikelenboom, Merijn; Visser, Henny; Anholt, Gideon E
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231173342pmid: 37183408
Objective:Obsessive-compulsive disorder is characterized by a chronic course that can vary between patients. The knowledge on the naturalistic long-term outcome of obsessive-compulsive disorder and its predictors is surprisingly limited. The present research was designed to identify clinical and psychosocial predictors of the long-term outcome of obsessive-compulsive disorder.Methods:We included 377 individuals with a current diagnosis of obsessive-compulsive disorder, who participated in the Netherlands Obsessive Compulsive Disorder Association study, a multicenter naturalistic cohort study. Predictors were measured at baseline using self-report questionnaires and clinical interviews. Outcome was assessed using the Yale-Brown Obsessive Compulsive Scale at 2-, 4- and 6-year follow-up.Results:The overall course of obsessive-compulsive disorder was characterized by two prominent trends: the first reflected an improvement in symptom severity, which was mitigated by the second, worsening trend in the long term. Several determinants affected the course variations of obsessive-compulsive disorder, namely, increased baseline symptom severity, late age of onset, history of childhood trauma and autism traits.Conclusion:The long-term outcome of obsessive-compulsive disorder in naturalistic settings was characterized by an overall improvement in symptom severity, which was gradually halted to the point of increased worsening. However, after 6 years, the severity of symptoms remained below the baseline level. While certain determinants predicted a more favorable course, their effect diminished over time in correspondence to the general worsening trend. The results highlight the importance of a regular and continuous monitoring for symptom exacerbations as part of the management of the obsessive-compulsive disorder, regardless of the presence of putative predictors.
Self-harm and suicidal ideation among young people is more often recorded by child protection than health services in an Australian population cohortO’Hare, Kirstie; Watkeys, Oliver; Dean, Kimberlie; Tzoumakis, Stacy; Whitten, Tyson; Harris, Felicity; Laurens, Kristin R; Carr, Vaughan J; Green, Melissa J
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231179652pmid: 37282347
Objective:We investigated patterns of service contact for self-harm and suicidal ideation recorded by a range of human service agencies – including health, police and child protection – with specific focus on overlap and sequences of contacts, age of first contact and demographic and intergenerational characteristics associated with different service responses to self-harm.Methods:Participants were 91,597 adolescents for whom multi-agency linked data were available in a longitudinal study of a population cohort in New South Wales, Australia. Self-harm and suicide-related incidents from birth to 18 years of age were derived from emergency department, inpatient hospital admission, mental health ambulatory, child protection and police administrative records. Descriptive statistics and binomial logistic regression were used to examine patterns of service contacts.Results:Child protection services recorded the largest proportion of youth with reported self-harm and suicidal ideation, in which the age of first contact for self-harm was younger relative to other incidents of self-harm recorded by other agencies. Nearly 40% of youth with a health service contact for self-harm also had contact with child protection and/or police services for self-harm. Girls were more likely to access health services for self-harm than boys, but not child protection or police services.Conclusion:Suicide prevention is not solely the responsibility of health services; police and child protection services also respond to a significant proportion of self-harm and suicide-related incidents. High rates of overlap among different services responding to self-harm suggest the need for cross-agency strategies to prevent suicide in young people.
Employment-related mental health outcomes among Australian migrants: A 19-year longitudinal studyMaheen, Humaira; King, Tania
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231174809pmid: 37211808
Background:Migrants experience various stressors at different stages of migration based on their country of origin, ethnic backgrounds, migration context and host country. Employment is one important post-settlement factor associated with mental health among migrant groups. The study investigates whether the country of origin modifies the association between employment and mental health for Australian migrants.Methods:Nineteen waves of data from the Household Income and Labour Dynamics in Australia Survey were used. Using fixed-effects regression, we examined the effects of within-person changes in employment status on mental health outcomes as measured by the Mental Health Inventory (MHI-5), controlling for time-varying confounders and stratified by sex and examined effect modification by country of origin.Results:The relationship between unemployment and mental health was modified by country of origin for men but not women. Unemployed men from Asian (β = −4.85, p < 0.001), African and Middle Eastern (β = −3.61, p < 0.05) countries had lower mental health scores compared to employed Australian-born men. For men, there was evidence of effect modification of the association between employment and mental health by country of origin, with the combined effect of being unemployed and being a migrant from an Asian country was almost three points lower than the summed independent risks of these factors (β = −2.72; p = 0.01). Also, for men, the combined mental health effect of not being in the labour force and coming from a non-English-speaking European country was greater than the summed effects of these factors (β = −2.33; p < 0.001).Conclusion:Tailored employment-support programmes may be beneficial for migrants from ethnic minorities, particularly those from Asian, African and Middle Eastern countries in Australia. Further research is needed to understand why the mental health of migrant men from these countries is particularly vulnerable to unemployment.
Not heading in the right direction: Five hundred psychiatrists’ views on resourcing, demand, and workforce across New Zealand mental health servicesEvery-Palmer, Susanna; Grant, Marion L; Thabrew, Hiran; Hansby, Oliver; Lawrence, Mark; Jenkins, Matthew; Romans, Sarah
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231170572pmid: 37122137
Objective:To explore the views of psychiatrists (including trainees) regarding the current state and future direction of specialist mental health and addictions services in Aotearoa New Zealand.Methods:Psychiatrists and trainee psychiatrists (registrars) in Aotearoa New Zealand were surveyed in August 2021. Of 879 eligible doctors, 540 participated (83% qualified and 17% trainee psychiatrists), a response rate of over 60%. Data were analysed quantitatively and with content analysis.Results:Psychiatrists thought specialist mental health and addictions services had been neglected during recent reforms, with 94% believing current resourcing was insufficient, and only 3% considering future planning was heading in the right direction. The demand and complexity of on-call work had markedly increased in the preceding 2 years. Ninety-eight percent reported that people needing specialist treatment were often (85%) or sometimes (13%) unable to access the right care due to resourcing constraints. The pressures were similar across sub-specialties. A key theme was the distress (sometimes termed ‘moral injury’) experienced by psychiatrists unable to provide adequate care due to resource limitations, ‘knowing what would be a good thing to do and being unable to do it . . . is soul destroying’. Recommendations were made for addressing workforce, service design and wider issues.Conclusion:Most psychiatrists in Aotearoa New Zealand believe the mental health system is not currently fit for purpose and that it is not heading in the right direction. Remedies include urgently addressing identified staffing challenges and boosting designated funding to adequately care for the 5% of New Zealanders with severe mental health and addiction needs.
Predictors of individual mental health and psychological resilience after Australia’s 2019–2020 bushfiresMacleod, Emily; Heffernan, Timothy; Greenwood, Lisa-Marie; Walker, Iain; Lane, Jo; Stanley, Samantha K; Evans, Olivia; Calear, Alison L; Cruwys, Tegan; Christensen, Bruce K; Kurz, Tim; Lancsar, Emily; Reynolds, Julia; Rodney Harris, Rachael; Sutherland, Stewart
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231175618pmid: 37264605
Aims:We assessed the mental health effects of Australia’s 2019–2020 bushfires 12–18 months later, predicting psychological distress and positive psychological outcomes from bushfire exposure and a range of demographic variables, and seeking insights to enhance disaster preparedness and resilience planning for different profiles of people.Methods:We surveyed 3083 bushfire-affected and non-affected Australian residents about their experiences of bushfire, COVID-19, psychological distress (depression, anxiety, stress, post-traumatic stress disorder) and positive psychological outcomes (resilient coping, wellbeing).Results:We found high rates of distress across all participants, exacerbated by severity of bushfire exposure. For people who were bushfire-affected, being older, having less financial stress, and having no or fewer pre-existing mental disorders predicted both lower distress and higher positive outcomes. Being male or having less income loss also predicted positive outcomes. Severity of exposure, higher education and higher COVID-19-related stressors predicted both higher distress and higher positive outcomes. Pre-existing physical health diagnosis and previous bushfire experience did not significantly predict distress or positive outcomes.Recommendations:To promote disaster resilience, we recommend investment in mental health, particularly for younger adults and for those in rural and remote areas. We also recommend investment in mechanisms to protect against financial distress and the development of a broader definition of bushfire-related impacts than is currently used to capture brushfires’ far-reaching effects.
Internet-based cognitive behavioural therapy in the real world: Naturalistic use and effectiveness of an evidence-based platform in New ZealandGuiney, Hayley; Mahoney, Alison; Elders, Anna; David, Charlie; Poulton, Richie
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231183641pmid: 37366145
Objective:Internet-based cognitive behavioural therapy (iCBT) is an efficacious, scalable intervention that could help meet the significant demand for psychological treatment. Yet, there is limited real-world evidence for its effectiveness. This study investigated the use and effectiveness of a free iCBT programme (‘Just a Thought’) in New Zealand.Methods:We analysed 18 months of user data from the Just a Thought website to understand the characteristics of those who used the Depression and Generalised Anxiety Disorder courses, how many lessons they completed, how mental distress changed across each course and the factors associated with adherence and improvement in mental health.Results:The results for both courses followed very similar patterns. Course adherence was low overall. There were small differences in adherence by age, gender and ethnicity, and larger differences for those who were ‘prescribed’ Just a Thought by a healthcare worker. Mixed models showed significant reductions in mental distress, with some tapering of improvement across latter lessons. Those most likely to show clinically meaningful reductions in mental distress had completed more lessons, were older and had a higher baseline level of distress.Conclusion:Alongside previous efficacy research, this real-world data indicate that iCBT is most likely to be effective at the population level and across different subgroups if users complete as much of the course as possible. Strategies to increase course adherence and maximise the public health benefits of iCBT include healthcare workers ‘prescribing’ iCBT and tailored solutions to meet the needs of young people, Māori and Pasifika.
Plasma neurofilament light in behavioural variant frontotemporal dementia compared to mood and psychotic disordersEratne, Dhamidhu; Kang, Matthew; Malpas, Charles; Simpson-Yap, Steve; Lewis, Courtney; Dang, Christa; Grewal, Jasleen; Coe, Amy; Dobson, Hannah; Keem, Michael; Chiu, Wei-Hsuan; Kalincik, Tomas; Ooi, Suyi; Darby, David; Brodtmann, Amy; Hansson, Oskar; Janelidze, Shorena; Blennow, Kaj; Zetterberg, Henrik; Walker, Adam; Dean, Olivia; Berk, Michael; Wannan, Cassandra; Pantelis, Christos; Loi, Samantha M; Walterfang, Mark; Berkovic, Samuel F; Santillo, Alexander F; Velakoulis, Dennis
2023 Australian & New Zealand Journal of Psychiatry
doi: 10.1177/00048674231187312pmid: 37477141
Objective:Blood biomarkers of neuronal injury such as neurofilament light (NfL) show promise to improve diagnosis of neurodegenerative disorders and distinguish neurodegenerative from primary psychiatric disorders (PPD). This study investigated the diagnostic utility of plasma NfL to differentiate behavioural variant frontotemporal dementia (bvFTD, a neurodegenerative disorder commonly misdiagnosed initially as PPD), from PPD, and performance of large normative/reference data sets and models.Methods:Plasma NfL was analysed in major depressive disorder (MDD, n = 42), bipolar affective disorder (BPAD, n = 121), treatment-resistant schizophrenia (TRS, n = 82), bvFTD (n = 22), and compared to the reference cohort (Control Group 2, n = 1926, using GAMLSS modelling), and age-matched controls (Control Group 1, n = 96, using general linear models).Results:Large differences were seen between bvFTD (mean NfL 34.9 pg/mL) and all PPDs and controls (all < 11 pg/mL). NfL distinguished bvFTD from PPD with high accuracy, sensitivity (86%), and specificity (88%). GAMLSS models using reference Control Group 2 facilitated precision interpretation of individual levels, while performing equally to or outperforming models using local controls. Slightly higher NfL levels were found in BPAD, compared to controls and TRS.Conclusions:This study adds further evidence on the diagnostic utility of NfL to distinguish bvFTD from PPD of high clinical relevance to a bvFTD differential diagnosis, and includes the largest cohort of BPAD to date. Using large reference cohorts, GAMLSS modelling and the interactive Internet-based application we developed, may have important implications for future research and clinical translation. Studies are underway investigating utility of plasma NfL in diverse neurodegenerative and primary psychiatric conditions in real-world clinical settings.