Australasian Psychiatry

McGorry, Patrick; Mei, Cristina

doi: 10.1177/10398562231177350pmid: 37204413

Lucassen, Mathijs FG; Stasiak, Karolina; Fleming, Theresa; Shepherd, Matthew; Merry, Sally N

doi: 10.1177/10398562231153061pmid: 36683530

Objective SPARX is an online cognitive behavioural therapy self-help intervention for adolescent depression provided in serious game format. Since 2014, it has been freely available in Aotearoa New Zealand (NZ) due to funding from the NZ government. In 2020/21, feedback from sexual and gender minority youth (SGMY) was used to refine and update SPARX.MethodThree online focus groups and follow-up email consultations involved 12 SGMY (16 to 25 years old) in NZ. A general inductive approach was used to analyse data.ResultsSGMY had specific needs as well as preferences and four themes were identified: attend to our contextual realities; portrayals of sexual and gender minority people in games; envisaged ideals for serious gaming and appraisals of SPARX. SGMY feedback was used to improve SPARX for this unique population, with the updates launched in October 2021.ConclusionsSGMY are underserved in terms of their mental health needs. Refining or tailoring existing interventions proffers a potential way forward in terms of addressing these needs.

Looi, Jeffrey CL; Kisely, Stephen R; Bastiampillai, Tarun; Allison, Stephen

doi: 10.1177/10398562231153007pmid: 36752178

ObjectiveThe Australian headspace model has been proposed as an internationally significant exemplar for reducing the mental health ‘treatment gap’ amongst young people around the world. We provide a commentary that discusses the conceptualisation and delivery of headspace services within Australia, a predominantly Westernised, Educated, Industrialised, Rich and Democratic (WEIRD) society, as well as examining accessibility and suitability for culturally and linguistically diverse (CALD) communities.Conclusionheadspace was conceptualised, designed, implemented and evaluated according in a WEIRD sociocultural context, and is therefore most applicable to that setting. Australia also has CALD communities, who have not seemed to access headspace in the reported patient and staff demographics. On this basis, there may be questions about the potential generalisability of headspace models outside WEIRD societies.

Bell, Erica; Pooley, Amanda; Tam, Philip; Boyce, Philip; Bryant, Richard; Porter, Richard; Malhi, Gin S.

doi: 10.1177/10398562221141362pmid: 36421033

ObjectiveIrritability is a key symptom of mood disorders and is common in adolescence; nevertheless, it is poorly understood and assessed. Research examining irritability and its relationship to mood and anxiety disorders risk factors in adolescent males is lacking. Therefore, the current study aimed to address this gap.MethodAn online survey designed to interrogate the relationship between irritability and other risk factor variables was administered to 627 adolescent males (ages 12–17). Findings were analysed statistically using MANOVAs.ResultsWhen divided into high and low irritability groups, higher irritability scores were significantly correlated with higher scores on all risk factor variables. Further, higher irritability scores were associated with higher scores on all variables that indicate an increased risk for development of psychological disorders, such as depression and anxiety.ConclusionThis study is the first to focus on subjective irritability. In adolescent males, it identifies a potentially novel model of irritability’s involvement in maladaptive processes relating to emotional dysregulation, behavioural difficulties and anxiety.

Haysom, Leigh; Kasinathan, John; Singh, Yolisha

doi: 10.1177/10398562231155753pmid: 36779833

ObjectiveWe review issues with incarcerating mentally ill children and young people in Australia, highlighting key demographics, rates of mental disorders, consideration of brain development, developmental trauma and children’s experiences of custody.MethodsPopulation relevant literature will be outlined as applicable.ResultsChildren and adolescents in custody have high rates of mental illness, cognitive impairment and comorbid diagnoses. Childhood adversity and trauma impacts on psychosocial development from an early age. Almost half of all young people in custody are First Nations children, a 20 times over-representation. Youth custody is frequently experienced as an additional trauma for young people. Mental health diversion into community treatment is effective and reduces costs to young people, their families, communities and society generally.ConclusionYouth custody is an inappropriate setting for children and young people with mental disorders, and can be further traumatising. Economic and health benefits for mental health diversion away from youth custody are manifest.

Chanen, Andrew M

doi: 10.1177/10398562231159511pmid: 36864605

ObjectivePersonality disorder (PD) has its peak incidence between puberty and young adulthood. By any measure, it is among the most severe mental health problems occurring in young people, uniquely predicting debilitating current problems and acting as a ‘gateway’ to diverse and serious future problems. Yet, PD still struggles for legitimacy and parity of access to services, including early intervention.ConclusionAddressing PD is fundamental to youth mental health, and early intervention for PD has reached ‘proof of concept’. Yet, reform is hindered by bigotry and sectarianism. Successful early intervention calls for a shift in the culture of services, countering damaging myths, addressing bigotry, and fostering hope. Such reforms are well within the reach of youth mental health.

Chitty, Kate M.; Sawyer, Michael Gifford; Carter, Gregory; Lawrence, David

doi: 10.1177/10398562231163415pmid: 36935217

ObjectivesTo examine healthcare utilisation patterns in a sample of young people with self-reported experiences of self-harm and/or suicidal behaviours.MethodsA national survey examining mental health in a nationally representative sample of young Australians aged 12–17 years, linked to routinely collected healthcare and dispensing data. For respondents that self-reported experience of self-harm, suicidal ideation, suicidal plan and/or suicide attempt, we assessed attendance at a Medicare Benefits Scheme (MBS) subsidised MH service or non-MH general practitioner (GP) attendance at three time periods: 1) ever, 2) in the 12 months prior to completing the survey and 3) after completing the survey until 31 Dec 2015. We also assessed correlates associated with attendance and non-attendance at a MH service.ResultsThe study included 311 young people. MH services were attended in the 12 months before the survey by 38.3% with attempted suicide, 28.7% with a suicidal plan, 28.9% with suicidal ideation and 29.4% with self-harm. MH treatment administered by a GP was the most common MH service (25%); followed treatment by psychologist (15%) and psychiatrist (5%). Attendance at a MH service was observed highest alongside more severe self-reported depression.ConclusionsPotential underutilisation of MBS MH services by young people with self-harm and/or suicidal behaviours.

O'Gorman, Kieran M; Schmaal, Lianne; Ratheesh, Aswin; Habib, George; Tokatlidis, Orania; Jackson-Simpson, Jennifer; Cotton, Sue M; Rice, Simon M

doi: 10.1177/10398562231162224pmid: 36913715

ObjectiveTo investigate the clinical characteristics of tertiary students and non-students attending a specialist clinic for severe mood disorders.MethodMedical record audit of clients discharged from the Youth Mood Clinic (YMC). Data extracted included depressive symptomatology, suicidal ideation, self-harm, suicide attempt, tertiary education engagement, drop-out and deferral.ResultsData from 131 clients (M age = 19.58 years, SD = 2.66) were analysed, including 46 tertiary students. Relative to non-students, at intake, tertiary students reported more severe depressive symptomatology (d = 0.43). They were more likely to experience suicidal ideation at intake (V = 0.23), and during treatment (V = 0.18). Tertiary students were also more likely to be living separately to their family of origin (V = 0.20) but were less likely to have experienced parental separation (V = 0.19). 21.73% of tertiary students dropped out or deferred study during care.ConclusionIn this cohort, those engaged in tertiary education experience more severe depression and more commonly experienced suicidal ideation. These young people require targeted support for their mental health while they undertake tertiary education.

Kisely, Stephen R; Bastiampillai, Tarun; Allison, Stephen; Looi, Jeffrey CL

doi: 10.1177/10398562231167683pmid: 37022312

ObjectiveCommentary on the debate concerning the effectiveness of headspace, including the most recent independent evaluation of its services.ConclusionsThe available evaluations indicate that headspace does not deliver therapy of adequate duration that results in clinically significant improvement. Most evaluations have used either short-term process measures or uncontrolled satisfaction surveys, and where there have been data on outcomes using standardised instruments, findings have been disappointing. Costs are poorly quantified and probably underestimated. Even so, headspace as a primary care intervention costs twice as much as a mental health consultation by a general practitioner and, depending on the assumptions, may not be cost effective.

Cotton, Sue M; Filia, Kate M; Hamilton, Matthew P; Gao, Caroline X; Menssink, Jana M; Telford, Nic; McGorry, Patrick; Rickwood, Debra

doi: 10.1177/10398562231167691pmid: 37021582

ObjectiveWe describe a research program to advance youth mental health service research in Australia, addressing two core knowledge gaps: the lack of available routine outcome measures and lack of understanding of how to assess and monitor complexity and heterogeneity in illness presentation and trajectory.ConclusionsOur research identifies better routine outcome measures (ROM) that are: designed specifically for the developmental nuances of the 12–25-year age range; multidimensional; and meaningful to young people, their carers, and service providers. Alongside much-needed new measures of complexity and heterogeneity, these tools will inform service providers to better meet the needs of young people presenting with mental health problems.