Australian and New Zealand Journal of Psychiatry最新文献

Suicide is one of the leading causes of death in children aged 14 years and under in Australia, and child maltreatment is consistently identified as an antecedent. Despite this, not enough is known about the pathways from child maltreatment to suicidal behaviour, hampering prevention efforts. In this perspective, we examine the association between (1) various types of childhood maltreatment, and (2) the presence of mental disorders, and subsequent suicidal behaviours in children aged 14 years and under. We present a conceptual model of childhood suicidal behaviours which incorporates both direct and indirect mechanisms by which maltreatment (and other risk factors) exert an influence. Bodily intrusive maltreatment, especially sexual and physical abuse, significantly increases the risk of suicidal behaviours in childhood. Other forms of maltreatment, such as neglect and emotional abuse, may also contribute. While the presence of a mental disorder is another prominent risk factor for suicidal behaviours in adolescents and adults, there is less evidence of this association in childhood. Efforts to prevent child maltreatment can support suicide prevention efforts in children and other age groups. In addition, screening for suicidal behaviours and targeted interventions should be prioritised for populations at increased risk, particularly children with a history of maltreatment and their families.

Objectives: There is a well-established trend of increasing prevalence of mental health disorders among children and young people. Understanding patterns across diagnostic categories and predicting future changes is crucial for effective interventions and service planning.

Methods: We employed advanced time series analysis techniques, autoregressive integrated moving average-based time series modelling and forecasting, to analyse two decades of routinely collected data from the Western Australian Child and Adolescent Mental Health Services system. The large-scale dataset, with consistent sampling intervals, enabled robust time series analyses to account for secular, seasonal and random fluctuations. Models estimated both historical and forecasted future trends in mental health presentations at Western Australian Child and Adolescent Mental Health Services.

Results: Modelling of historical data from 2004 to 2024 shows significant increases for anxiety disorders, mood disorders, personality disorders, sleep disorders, attention deficit hyperactivity disorder (ADHD) and autism and eating disorders. Forecasting to 2044 suggests that while anxiety disorders will decrease, ADHD, autism, eating disorders and sleep disorders will continue to increase.

Conclusions: We have established autoregressive integrated moving average modelling and forecasting as a robust, sophisticated and useful statistical approach to characterising historical and future trends in youth mental health. The ability to forecast into the future with confidence means we can identify what services are most needed and where gaps exist in current service provision or fund distribution permitting strategic allocation of finite resources and supporting complex funding decisions. Importantly, our findings encourage other health care services, locally and internationally, to use autoregressive integrated moving average modelling and forecasting to capitalize on routine health data to support proactive service planning initiatives.

Aims: To examine self-perceived need for mental health care in the Australian adult population between 2007 and 2021.

Methods: The Perceived Need for Care Questionnaire in the 2007 and 2021 National Study of Mental Health and Wellbeing captures types of help needed in five mental health care categories: medication, information, counselling, social interventions and skills training. Needs are rated as unmet, partially met, or fully met. Twelve-month affective, anxiety and substance use disorders are assessed using WHO's Composite International Diagnostic Interview.

Results: Demand for mental health care (composite of need categories) among adult Australians increased from 14% (2007) to 20% (2021). It also increased in those with common disorders (43.3-58.9%) and without (6.5-9.9%). Highest 2021 demand was in those with affective (76%), followed by anxiety (61%) and substance use (43%) disorders. Rates of demands being fully met remained stable (45% in 2007; 48% in 2021), with rates among those with substance use (24% in 2021), affective or anxiety (38%) disorders, and those without a common disorder (63%). In 2021, needed supports were counselling (16%), information (11%), medication (10%), skills training (6%) and social interventions (5%). Fully met needs were highest for medication (81%), then counselling (57%), information (54%), skills training (41%) and social interventions (15%).

Conclusions: Despite service expansion, less than half of people with demand had fully met needs. Attention is needed on the causes, population-level prevention as well as treatment strategies to address this burgeoning mental health crisis.

Introduction: Effective management of mental health crises is a growing global concern, significantly impacting emergency services. In New Zealand the New Zealand Police have begun reducing their involvement in mental health emergencies. This shift positions paramedics as primary responders in pre-hospital mental health crisis management. This current study conducts a comparative analysis of mental health legislation in New Zealand, Australian jurisdictions and the United Kingdom to assess how laws empower paramedics in mental health crises.

Methods: A structured framework was employed to evaluate 12 key domains relevant to pre-hospital mental health interventions. These domains include criteria for involuntary detention, emergency detention and transportation powers, integration of services and legal protections for paramedics.

Results: The analysis reveals that New Zealand's Mental Health Bill (as introduced in 2024) emphasises reducing coercion and promoting culturally appropriate care but lacks provisions granting paramedics the authority to manage crises in isolation. In contrast, jurisdictions like the Northern Territory, Western Australia and Queensland empower paramedics with greater legal authority and more integrated roles in mental health emergencies.

Discussion: The absence of health-based legal tools and insufficient integration with mental health services in New Zealand may limit paramedics' effectiveness in crisis management, potentially increasing reliance on police and delaying interventions. Recommendations include expanding paramedic authority in line with other jurisdictions and improving integration with mental health services. By adopting models from leading Australian jurisdictions, New Zealand paramedics will be better placed to manage mental health responses and support a reduction in police involvement.

Background: Lesbian, gay, bisexual, transgender, queer or questioning, asexual or aromantic and more (LGBTQA+) populations face disparities in health outcomes, which are particularly pronounced in relation to mental health. While psychotic disorders are associated with added barriers to treatment, they are rarely included in conversations around improving healthcare for LGBTQA+ individuals. The present study compared the healthcare experiences reported by LGBTQA+ individuals with psychotic disorders, common mental disorders (anxiety and depressive disorders) and physical health conditions.

Methods: A large online cross-sectional survey of LGBTQA+ adults in Australia was completed by 6835 individuals: 84 diagnosed with psychotic disorders, 521 diagnosed only with common mental disorders and 318 diagnosed only with common physical health conditions. Logistic regression analyses were used to investigate the association between diagnostic groups and health service access, service satisfaction and perceived respect for identity, and the importance of service LGBTQA+ inclusivity.

Results: Compared to those with psychotic disorders and common mental disorders, participants with physical health conditions were more likely to access mainstream clinics that are not explicitly LGBTQA+ inclusive and demonstrated a trend towards lower importance of service LGBTQA+ inclusivity. Participants with psychosis reported lower levels of respect for gender identity in LGBTQA+ inclusive services than those with common mental disorders.

Discussion: Differences in healthcare experiences between LGBTQA+ participants with physical health conditions, common mental disorders and psychotic disorders are present but not marked. Findings highlight a need for improved LGBTQA+ competencies in mainstream services and resource allocation to community-led services. Further research is needed to explore the factors contributing to worsened healthcare experiences for individuals with psychosis.