Australian and New Zealand Journal of Psychiatry最新文献

Introduction: Self-poisoning is the most common form of hospitalised self-harm in young people and has been increasing over the last decade. The COVID-19 pandemic was associated with further increases in self-harm in adolescents. There are limited data on changes after pandemic restrictions ended. This study aimed to describe recent trends in self-poisoning in young people.

Setting: Australia 2018-2023.

Methods: A retrospective analysis of self-poisoning calls to Australia's poisons information centres. Intentional poisoning exposures in people aged 5-19 years were included in the main analysis. We also examined intentional poisonings in people aged 20 and over for comparison. We used interrupted time-series analysis to estimate the impact of COVID-19 (March 2020) and 're-opening' (December 2021), when many restrictions were lifted in Australia. We compared effects in the jurisdictions with most disruptions and lockdowns with other jurisdictions.

Results: There were 201,755 self-poisonings documented, 64% female, with 19,946 children (aged 5-14, 9.9%) and 44,388 adolescents (aged 15-19, 22.0%). There was a steep increase in the rate of poisoning in female children and adolescents - with the annual increase being 1.361 (95% confidence interval = [1.074, 1.735]) and 1.154 (95% confidence interval = [1.049, 1.283]) times faster than pre-pandemic trends in these two groups between March 2020 and December 2021. Following relaxation of restrictions, there was a sudden drop and then slow decline in self-poisonings (despite rising COVID-19 infection rates). There was an overall 29.6% increase in intentional poisonings in young people over the study period. This is markedly more pronounced among young females (37.0%) vs males (11.2%). There were substantial jurisdictional variations, with larger increases in Victoria, Tasmania and the Australian Capital Territory.

Conclusion: There has been a marked increase in child and adolescent female self-poisonings over the last 6 years, with increases strongly associated with COVID-19 pandemic restrictions but persisting after their removal.

The objective of this paper is to summarise the policy implications of key findings from the 2020-22 Australian National Study of Mental Health and Wellbeing (NSMHWB). We provide an analysis of policy implications of four papers in this issue of the journal from the 2020-22 NSMHWB (N = 15,893) and the 2007 NSMHWB (N = 8841). The 2020-2022 NSMHWB reported a lifetime prevalence rate of common mental disorders of 40.2% (95% confidence interval [CI] = 39.2-41.3) and 12-month prevalence rate of 20.2% (95% CI 19.5-21.0). Overall, adult Australians were significantly more likely to experience a 12-month mental disorder in 2020-22 compared with 2007, with the change most striking in among those aged 16-24 years (odds ratio [OR] 1.2, 95% CI 1.1-1.3). Individuals aged 16-24 years in 2020-22 were significantly more likely to experience a 12-month anxiety disorder (OR 2.9, 95% CI = 2.3-3.7, depressive disorder (OR 2.8 95% CI = 2.1-3.9) or comorbidity (relative risk [RR] = 1.4, 95% CI = 1.2-1.7) compared with those aged 16-24 years in 2007. In 2020-22, the proportion of Australians who had experienced suicidal ideation, suicide plans and suicide attempts in the past 12 months was 3.3%, 1.1% and 0.3%. Under half (46.5% 95% CI 44.1-48.8) of adults with a 12-month mental disorder sought treatment. Mental disorders remain an endemic feature of Australia's overall health landscape and appear to be increasing, especially in younger cohorts. While service use rates have improved over time, there is still some way to go. Epidemiological surveys such as the 2020-22 NSMHWB are important for understanding changing prevalence and the population not accessing services. Innovative prevention and treatment strategies will be needed to address the increasing rates of disorders in younger Australian adults. Equally innovative and bold policy responses will be essential.

Objective: On 15 March 2019, a white supremacist terrorist carried out sequential attacks on two mosques in Christchurch, New Zealand during Friday prayers. This resulted in the loss of 51 lives, 40 others sustained gunshot injuries, and there were approximately 250 survivors. This study aimed to evaluate the impacts on community members, assess clinical needs, facilitate access to appropriate interventions and provide insights into working with a traumatised and diverse population.

Methods: This cross-sectional study used semi-structured clinical interviews and self-report measures to assess social and demographic factors, mental health disorders and well-being for adult Muslims 11-32 months post-attack.

Results: A total of 189 participants completed assessments. The sample was diverse, representing 34 different ethnicities and participant proximity to the attack was complex, with personal and familial exposures. Elevated levels of psychological distress and psychopathology were found with 38% of participants reporting moderate/severe psychological distress on the Kessler-10, 39% reporting post-traumatic stress disorder on the post-traumatic stress disorder checklist-5, and 40% reporting poor well-being or possible depression on the World Health Organization-5 Well Being Index. Secondary stressors were also documented, as well as high scores for post-traumatic growth and the importance of faith.

Conclusion: This study provides valuable insights into the repercussions of the Christchurch mosque attack on the affected community, describing the complexity of exposure and the substantial burden of morbidity experienced. It also highlights the high levels of social connectedness and the role of faith in promoting positive outcomes in the recovery process for this population.

Objectives: Indigenous people experience poorer mental health compared to the general population. Socioeconomic gaps partly explain these disparities. However, there is variability between populations and French overseas territories are understudied. This study examines the prevalence of mental health problems among Indigenous people in New Caledonia and French Polynesia, describing and comparing it with that of their counterparts while considering associated factors.

Methods: We used the data from the cross-sectional Mental Health in the General Population survey in the only 3 sites for which information on indigenous status was available: Noumea (2006) and the 'Bush' (2008) in New Caledonia, and French Polynesia (2015-2017). Current mental health issues were screened using the Mini-International Neuropsychiatric Interview. In multivariable analyses, we considered the following factors: gender, age, education level, marital status, occupational activity and monthly income.

Results: Overall, 2294 participants were analysed. Among the 1379 indigenous participants, 52.3% had at least one mental health issue. The prevalence of depressive disorder (18.0% vs 11.7%), alcohol use disorder (16.7% vs 11.7%) and suicide risk (22.3% vs 16.7%) were higher among indigenous participants compared to non-indigenous participants. After adjustment, the association between indigenous status and these mental health issues did not persist, except for alcohol use disorder.

Conclusion: We found higher prevalence of depressive disorder, alcohol use disorder and suicide risk among indigenous people of French Polynesia and New Caledonia compared to their counterparts. These differences seemed largely explained by socioeconomic disparities. Future studies could explore the use of and access to healthcare by indigenous populations.

Background: People experiencing psychosis are at greater risk of physical health conditions and premature mortality. It is likely that Indigenous Māori youth, who experience additional systemic inequities caused by settler-colonisation, face even greater physical health and mortality risks following a diagnosis of first-episode psychosis.

Objective: Compare Māori and non-Māori for risk of hospitalisation and mortality for up to 15 years following first-episode psychosis diagnosis.

Methods: A cohort (N = 14,122) of young people (16-24 years) with first-episode psychosis diagnosis between 2001 and 2019 were identified. Using crude Kaplan-Meier and adjusted Cox proportional hazards models, Māori (n = 5211) and non-Māori (n = 8911) were compared on hospitalisation and mortality outcomes for up to 15 years.

Results: In the 15 years following first-episode psychosis diagnosis, Māori had higher adjusted risk of all-cause mortality (hazard ratio = 1.21, 95% confidence interval = [1.01, 1.45]), hospitalisation with diabetes (hazard ratio = 1.44, 95% confidence interval = [1.15, 1.79]), injury/poisoning (hazard ratio = 1.11, 95% confidence interval = [1.05, 1.16]), general physical health conditions (hazard ratio = 1.07, 95% confidence interval = [1.02, 1.13]) and also appeared to be at greater risk of cardiovascular hospitalisations (hazard ratio = 1.34, 95% confidence interval = [0.97, 1.86]). Kaplan-Meier plots show hospitalisation and mortality inequities emerging approximately 4-7 years following first-episode psychosis diagnosis.

Conclusions: Māori are at greater risk for hospitalisation and premature mortality outcomes following first-episode psychosis. Early screening and intervention, facilitated by culturally safe health service delivery, is needed to target these inequities early.