Australian and New Zealand Journal of Psychiatry最新文献

Objective: The objective was to examine response rates, types of callers and their probability of being answered, prevalence of at-risk callers, and to calculate national call rates.

Methods: Data on all calls to the Danish, national telephone helpline for suicide prevention during July 2019 to December 2022 were analysed. A measure of unique calls was developed to account for repeat calls not being answered. We examined the probability of calls being answered by caller types using logistic regression and calculated national call rates for individuals aged ⩾15 years.

Results: Overall, 526,533 calls were made by 31,317 individuals, and 131,621 unique calls were identified, of which 48.9% were answered. First-time callers (95.1%) accounted for 5.7% of calls. We found that 0.1% of callers accounted for 61.8% of all calls. This group of daily callers (>1000 calls each year) consisted of 8-12 unique callers and was more likely to be answered (odds ratio = 24, 95% confidence interval = [23, 25] vs first-time callers), often hung up (49.1% vs first-time callers: 4.4%), and received 33.0% of the total counselling time. The yearly national call and caller rates were 893 calls and 212 unique callers per 100,000 inhabitants, respectively.

Conclusions: Correcting for repeated unanswered calls provided an informative estimate of the response rate. The call distribution was highly skewed; a small group of daily callers accounted for most calls and were more likely to be answered. These callers frequently hung up before a conversation was initiated. National call rates facilitate cross-country comparisons.

Background: Australia has a high mental illness burden, especially among young women. It is known that people in urban areas, with more education and higher incomes are more likely to use Better Access services (mental health treatment plans and psychological treatments), while those in rural areas, or with lower education or incomes, disproportionately use antidepressants. During the COVID-19 period, the Australian government increased access to mental health care. Our aim was to investigate how rurality, education level and perceived ability to manage with income influenced young women's use of mental health treatment plans, psychological treatments and antidepressants separately or in various combinations (2019-2022).

Methods: Survey and linked administrative data from 7642 women from the Australian Longitudinal Study on Women's Health were used. Relative risk ratios and 95% confidence intervals for associations between sociodemographic factors and use of mental health treatment plans and treatments were estimated using multinomial logistic regression.

Results: Women in rural/remote areas (vs metropolitan areas) were less likely to have a mental health treatment plan (with/without antidepressants), difficulty managing with available income (vs not too bad/easy) was associated with having a mental health treatment plan and using antidepressants. High school-educated women (vs university-educated) were more likely to use antidepressants only (relative risk ratio = 1.60; 95% confidence interval = [1.24, 2.07]). Among women with mental health treatment plans (n = 3525), those in rural/remote areas (relative risk ratio = 2.00; 95% confidence interval = [1.13, 3.53]) and women not university-educated were more likely to use antidepressants without psychological treatment.

Conclusion: Sociodemographically disadvantaged young women disproportionately used antidepressants without Better Access services. Evidence-based interventions to reduce these inequities should be a priority.

Objective: There is concern that suicides in Australia have been increasing, especially among young women. Our aim was to describe the long-term trends in suicide rates, identifying any change points among all suicides and among age-sex population groups.

Method: We extracted annual Australian suicide data from 2000 to 2022 from the General Record of Incidence of Mortality. We used join point regression to model change points in age-standardised suicide rates over time for the total population, males, females and for eight age-sex strata.

Results: Age-standardised population suicide rates declined by 4.4% per year (95% confidence interval: -6.1 to -2.6) between 2000 and 2005 and then rose by 2.0% per year until 2018 (95% confidence interval: 1.4 to 2.5). No change was observed after this. Similar patterns were observed for males and females. When disaggregated by age and sex, a more complex picture emerged. Suicides declined in the early part of the century for some groups but not others. Most age-sex groups experienced an increase in suicides from the mid-to-late 2000s. Suicides declined between 2020 and 2022 for 15- to 24-year-old men by 16.0% per year (95% confidence interval: -24.0 to -7.4). In all other age-sex groups, suicides either plateaued or continued to rise.

Conclusion: The broad trends in suicides observed in the total population and in males and females mask more complex patterns occurring in some age and sex groups. Understanding these long-term patterns is critical to informing interventions to reduce suicide.

Objective: Non-adherence is an important factor in clinical trials, which has not been investigated in people at ultra-high risk (UHR) of developing a first episode of psychosis.

Methods: Exploratory analysis of data from NEURAPRO, a multicenter, placebo-controlled trial of long-chain omega-3 polyunsaturated fatty acids (omega-3 PUFAs) in 304 individuals at UHR. We examined correlates of non-adherence with study medication (omega-3 PUFAs or placebo), including patient, illness and treatment factors, plus transition to psychosis. Non-adherence was defined as <75% study medication intake over 6 months and, post hoc, by the number of returned pills.

Results: Of 285 randomized participants with baseline fatty acid data, 163 (57.2%) were non-adherent. In univariate analyses, non-adherence was associated with baseline omega-3 index, pre-baseline duration of untreated symptoms, smoking, cannabis use, lower baseline Social and Occupational Functioning Assessment Scale, Global Functioning: Social and Role Scale scores and transition to psychosis. Transition to psychosis risk was significantly lower in the adherent than non-adherent group (4.2%, 95% CI = 0.7-7.7% vs 17.3%, 95% CI = 10.4-24.2%), Kaplan-Meier Log-rank test, chi-square = 10.675, p = 0.001), independent of omega-3 PUFA treatment status. Similarly, Cox regression analysis, covarying for the aforementioned factors significantly associated with non-adherence, also revealed non-adherence as an independent predictor of transition to psychosis (B = 1.452, p = 0.005). Finally, non-adherence was also significantly associated with transition to psychosis, even when defining non-adherence by number of returned pills.

Conclusion: Non-adherence predicted a higher risk of progressing to psychosis in UHR individuals. Further studies are needed to better understand factors contributing to non-adherence and how non-adherence is related to transition to psychosis.

Objective: To provide critical feedback to public mental health services, Australian governments developed and implemented the Your Experience of Service survey to capture consumers' experiences of mental health care. The grey literature reports several domain structures of the survey, but these neither used data collected during routine service delivery nor have been peer-reviewed. This study sought to confirm a widely used six-domain structure of the Your Experience of Service and examine for other structures, including one informed by the CHIME five-domain framework based on the concept of personal recovery. Personal recovery is considered best mental health service practice.

Methods: Consumer-reported Your Experience of Service data for years 2019-21 were obtained from Queensland (n = 8564) and South Australia (n = 2536) Health Departments. Exploratory and confirmatory factor analyses on subsets of data were conducted to determine the best fit domain structure. Means, Cronbach's alphas and correlations were used to examine structure and reliability of the measured factors.

Results: The four factors, respectful environment, making a difference, providing information and support and supporting active participation of consumers, carers and family, were found to statistically best represent the data sets. The original six domains were partly supported within the four domains however the hypothesised five-factor CHIME personal recovery structure was not supported by the analyses.

Conclusion: The findings highlight that a four-domain structure be reported in future and illustrate opportunities to improve the Your Experience of Service survey's ability to more accurately measure consumers' experiences with mental health services, including items measuring personal recovery, and therefore maximise its value and utilisation in practice.

Objective: This study aimed to estimate the proportions of Australians aged 16-85 years who consulted health professionals for mental health in 2020-2022, and changes since 2007.

Methods: Secondary analysis of merged data from the National Study of Mental Health and Wellbeing in 2020-2022 (N = 15,893) and its 2007 predecessor (N = 8841).

Results: In 2020-2022, 17.4% of Australians aged 16-85 years had consulted a health professional (including overnight hospital admission) for their mental health in the past year (vs 11.9% in 2007). The largest increases between the surveys were in use of psychologists (123%), other (non-medical) mental health professionals (64%), and general practitioners (53%). Of adults with a 12-month mental disorder, 46.6% consulted a health professional in 2020-2022 (vs 37.5% in 2007), increasing with severity (mild 22.9%, moderate 48.4% and severe 68.8%). Multivariate regression models showed that consulting a health professional was positively associated with age < 65 years, female sex, being unmarried, disorder severity, and affective or anxiety disorder; these patterns held for consultations with most types of professionals. Socioeconomic and geographical characteristics were associated with consulting particular professionals: lower income (consulting a psychiatrist), high income and living in a major city (psychologist), living in a less disadvantaged area (general practitioner). Increases in consulting were not experienced by all groups (e.g. the likelihood of consulting increased for people aged 16-45 years, but not for older age groups).

Conclusion: Consultation with health professionals for mental health improved between 2007 and 2020-2022 but remains below national targets. Some changes may reflect recent service reforms; however, gaps in access persist.