Australian and New Zealand Journal of Psychiatry最新文献

Objective: To identify the barriers accessing health (including mental health) services by Indigenous people in Victoria, Australia, and putative solutions, through yarns with 44 members of the Victorian Aboriginal community.

Methods: This paper systematically explores grassroots barriers and potential solutions for Indigenous young people to engage and use health (including mental health) services. Elder-governed yarns were conducted via Zoom with 44 representative Victorian Aboriginal Elders, Healers, Senior and Junior people involved in the health and wellbeing of the Victorian Aboriginal community. These yarns were analyzed through an innovative, constructivist, multi-perspectival discursive grounded theory method.

Results: Five pre-eminent themes emerged: the socio-economic barriers to services, the ongoing effects of colonization, disconnection and isolation from community and Country, pressures in society of living in two worlds and lack of cultural safety and racism. Detailed and rich day-to-day barriers and possible grassroots solutions were proffered.

Conclusions: The analyzed yarns provide important detail about everyday barriers Indigenous peoples face in healthcare services and potential ways forward to improve the situation for Indigenous young people and their kinship networks. This paper can help shape future policy and its implementation. In particular, Aboriginal Community Controlled Health Organizations running traditional Indigenous healing programmes alongside Western health management, ensuring formal processes predominate and are monitored for their day-to-day effectiveness.

Objective: The prevalence of common mental disorders (CMDs, depression/anxiety) among Australian adolescents is increasing. Evidence is needed to inform how prevention efforts can be focused for greatest impact. This study used a compartmental model to estimate how investments could be optimally allocated across interventions to prevent CMDs in adolescents, and the corresponding health and economic benefits.

Methods: The Australian 0- to 19-year-old population was disaggregated by age (0-9, 10-14, 15-19), sex (male, female) and CMD experience (never, currently, previously). Twelve prevention interventions were included following targeted reviews. The model was calibrated to Australian population survey data and included sociodemographic risk factors from the literature that were relevant for included interventions (bullying, financial stress, poor school connectedness, racial discrimination, child maltreatment). An optimisation estimated how an additional AUD$50 million-AUD$1 billion per annum over 2024-2050 could be allocated across interventions to maximise the number of adolescents turning 20 without a lifetime experience of CMD.

Results: The benefit-cost ratios of interventions varied widely depending on whether they impacted CMDs directly or indirectly by reducing a risk factor, and also whether CMD was their primary purpose or not (e.g. poverty interventions). Optimally investing AUD$50 million-AUD$1 billion p.a. over 2024-2050 could lead to 144,577-791,277 fewer adolescents experiencing a CMD by age 20 (AUD$5064-AUD$18,507/lifetime CMD experience averted), with lower bound benefit-cost ratios ranging from 5.0 to 19.2. Optimally, budget allocations should include combinations of interventions targeting different age groups, sub-populations and risk factors.

Conclusions: Investing in evidence-based prevention interventions for adolescent mental health is likely to have a favourable return-on-investment.

Each year in Australia, tens of thousands of people living with mental illness die from preventable physical health conditions. Australia is yet to meet its 2008 commitment to provide equal healthcare for people with disabilities (Article 25, United Nations Convention on the Rights of Persons with Disabilities). In May 2024, a national forum of 240 delegates called for urgent action to address the life expectancy gap for people living with mental illness. This article presents perspectives of forum delegates about: (1) where we need to be, (2) critical reform elements and (3) foundational components to address this health inequity. Attendees overwhelmingly expressed the need for lived experience leadership and human rights to underpin the health system. Foundational components included respectful and inclusive practices, co-learning and co-production, a strong and integrated lived experience workforce, strategic support for reform, and societal shifts in values. Recommendations for government, advocacy bodies, services and individuals were provided, including conducting analyses of mental health legislation to align with Article 25 of the United Nations Convention on the Rights of Persons with Disabilities; establishing strategic lived experience leadership positions; providing workforce training on the increased risk of premature death and human rights approaches to improving healthcare equity; and taking every opportunity to advocate for physical health equality for people with mental illness. Urgent public health action is needed to incentivise and instil accountability for change, ensuring that reform efforts add power to the voices of those most impacted by mental illness and the services designed to support them.

Background: Impulsivity, the tendency to act quickly without careful consideration, is a known risk factor and correlate of substance use and addictive disorders, including International Classification of Diseases (ICD)-11 gaming disorder (GD). The aim of this meta-analytic review was to critically evaluate associations between GD symptoms and trait impulsivity and its subtypes.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 33 studies (N = 24,818) met inclusion criteria, including being published between 2019 and 2024 (i.e. to focus on studies in ICD-11 era) and reporting data on problem gaming and trait impulsivity using psychometrically validated tools. Pooled effect sizes were calculated using reported correlations or means and standard deviations. Sources of heterogeneity, such as sample type, age, gender, region, assessment tool and impulsivity subtype, were examined using subgroup and moderator analyses.

Results: The pooled association between GD and impulsivity was r = 0.29 (95% confidence interval [CI] = [0.24, 0.34]). Significant between-study heterogeneity was detected based on study region, with larger correlations in Asian studies compared to European and Western studies. Larger correlations were reported in studies employing the YIAT and IGDS9-SF and in studies employing the Barratt Impulsiveness Scale (BIS)-11 compared to other impulsivity tools.

Conclusion: This meta-analytic review identified a consistent moderate association between trait impulsivity and GD. The result suggests that clinical evaluation and monitoring of GD should consider the influence of impulsivity on risk and recovery. Moreover, assessing specific subtype patterns of impulsivity may inform the implementation of tailored treatment. Future research should examine the relative influence of impulsivity subtypes in the initiation, maintenance and relapse of problematic gaming behaviour.

Objective: This study aimed to estimate the population prevalence of exposure to potentially traumatic events (e.g. serious accidents, physical or sexual violence and natural disasters) during childhood among Australians and examine associations between childhood potentially traumatic events and mental disorders, suicide and long-term physical health conditions.

Methods: Survey data from the 2020 to 2022 National Survey of Mental Health and Wellbeing were analysed, which included a nationally representative household sample of Australians aged 16-85 years (n = 15,893).

Results: Up to 42% of Australians (approx. 8,250,948) have been exposed to a potentially traumatic event prior to the age of 18 years. The more common types of potentially traumatic events experienced prior to 18 years were unexpected death of a loved one (27.5%), witnessing domestic violence (21.1%), sexual assault (21.0%) and witnessing serious injury or death (20.0%). Australians exposed to childhood potentially traumatic events had significantly higher odds of any lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mental disorders compared to those who had not experienced potentially traumatic events (adjusted odds ratio: 1.51, 95% confidence interval: 1.32-1.74). They also had higher odds of suicidal thoughts (adjusted odds ratio: 1.57, 95% confidence interval: 1.28-1.92), plans (adjusted odds ratio: 1.60, 95% confidence interval: 1.17-2.19) and attempts (adjusted odds ratio: 2.04, 95% confidence interval: 1.40-2.98) and higher odds of asthma, arthritis, cancer and kidney disease compared to those who had not experienced potentially traumatic events in their lifetime.

Conclusion: Childhood potentially traumatic events are prevalent in the Australian general population and associated with serious mental and physical health conditions. These findings have important implications for early detection and intervention, trauma-informed healthcare approaches, and for policy and practice across health, education and social service systems.

This paper examines the legal meaning and clinical impact of the different harm to self and others criteria as they appear in the provisions permitting involuntary inpatient treatment in each of Australia's mental health acts. The wording of each criterion is reviewed along with relevant Court decisions, explanatory memoranda, second reading speeches and advice published by governments. Each jurisdiction's harm criterion is set out along with: the breadth of scope of the harms envisaged; how severe any harm must be to trigger the criterion; and how likely it must be that the envisaged harm will arise. The paper is designed so that readers from each jurisdiction may focus on advice relevant to their jurisdiction. In most clinical encounters where involuntary hospitalisation is proposed, the most salient harms for consideration are serious psychological harms and harms to relationships, alongside physical harm to self or others where relevant. The harm criterion sets the minimum level of harm that must be anticipated before clinicians have legal authority to provide involuntary treatment. Where a patient refuses treatment without decision-making capacity, anticipated harms must be 'serious', but only so serious as to justify overriding the patient's refusal, taking into account the harms involuntary treatment itself may cause. In such cases, whether a person can be detained and treated will hinge largely on each jurisdiction's least restrictive criterion.