Australian and New Zealand Journal of Psychiatry最新文献

Objective: This study was conducted as part of an evaluation of the Better Access initiative. It examined (1) pathways into Better Access treatment; (2) the proportion of Better Access treatment users who are 'new'; (3) patterns of use and non-use of Better Access treatment services in relation to need; and (4) socioeconomic differences in Better Access treatment service use.

Methods: We used linked administrative and survey data available through the Person-Level Integrated Data Asset (PLIDA). More specifically, we used Medicare Benefits Schedule (MBS) data, Pharmaceutical Benefits Scheme (PBS) data, 2016 Census data, and data from the 2017/18 National Health Survey.

Results: About two-thirds of individuals who have had a mental health treatment plan prepared for them receive Better Access treatment services (albeit often after a considerable wait), but one-third do not. Although Better Access is reaching those with high levels of need, access is not equitable. It is harder for new users to access the programme than it was previously, as the number of continuing users and the number of treatment sessions provided to them have increased. People on low incomes are less likely to receive psychological treatment through Better Access (and more likely to be prescribed antidepressant or anxiolytic medication), and if they do receive Better Access services, they typically wait longer than their high-income counterparts to see a provider.

Conclusion: Better Access appears to be responsive to need, but there are equity issues regarding its accessibility. These equity issues should be addressed as Better Access continues.

This paper provides an overview of the mixed-methods evaluation of the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative (Better Access) that we conducted in 2021-2022. It is the first of 10 papers in this special issue of the Australian and New Zealand Journal of Psychiatry; the other nine report on individual studies that were components of the evaluation. This paper summarises the key findings, highlighting that although many of those who use Better Access achieve positive improvements in symptoms, levels of functioning and quality of life, there are inequities in access to the programme. Based on our findings, we made 16 recommendations relating to: complementary service delivery models; workforce capacity, composition and distribution; therapies available through Better Access; referring people to the most appropriate care; fostering communication and collaboration between providers; affordability; session numbers; session modality; services for people in residential aged care facilities and routinely assessing outcomes. We report on the Australian Government's response to these recommendations.

Background: In Australia, harms associated with bushfires are expected to increase as the severity and frequency of bushfires increase with climate change. Bushfire harm includes negative impacts on mental health, particularly for adolescents. Evidence suggests that elevated incidence of mental illness can persist long-term after bushfire harm. This study extends our team's earlier cross-sectional analysis within the same cohort. It examines effects of the Black Summer bushfires (2019-2020) on adolescents' mental health measured prospectively and explores risk and protective factors associated with sustained mental health problems following bushfire harm.

Methods: A broadly representative sample of 2967 Australian adolescents was recruited in 2019-2022 at age 13-14 and followed for 24 months. Bushfire exposure and harm, and symptoms of depression, anxiety, psychological distress, insomnia, and suicidality were measured. Linear regression models examined the effects of bushfires over time; logistic regression identified predictors of these effects.

Results: 167 (5.4%) participants reported bushfire harm. Bushfire harm was not a significant predictor of any mental health outcomes at 24 months. Baseline symptoms were most strongly associated with 24-month outcomes. Participants who were gender or sexuality diverse, reported adverse childhood experiences, or had a history of mental health problems had increased risk of symptoms of depression, anxiety, distress and insomnia at 24-month follow-up compared to those who did not have these risk factors.

Conclusions: Bushfire-harmed adolescents did not show significantly elevated mental health symptoms compared to unexposed peers 24 months later. This finding is encouraging, though its underlying causes are unclear and require further research.

Objectives: This systematic review and meta-analysis aimed to investigate the impacts of screen time and screen behaviours on suicidality and non-suicidal self-injury (NSSI) in children and young people.

Methods: A systematic search was conducted of the following databases: CINAHL, PubMed, Embase, PsycARTICLES, PsycINFO, Scopus, and Web of Science. The search identified 61 eligible studies comprising 338,472 participants aged up to 18 years, drawn from 16 countries. A random-effects meta-analysis of odds ratios was conducted across 15 studies.

Results: A meta-analysis revealed that screen time was measured inconsistently across studies, yet frequent screen use - particularly nocturnal smartphone use - was significantly associated with increased odds of NSSI and suicidal behaviours. Internet addiction (IA) showed strong links to suicidal behaviours, often mediated by insomnia, depression, or anxiety. Internet gaming disorder (IGD) also predicted suicidality and NSSI, while mobile phone and social media addiction demonstrated weaker but significant associations. IA was positively associated with NSSI across all seven relevant studies. Structural models identified depression, loneliness, and interpersonal problems as key mediators. Some gender disparities emerged, with females reporting higher NSSI and suicidality, and males showing higher rates of digital addiction.

Conclusion: While these findings highlight concerning associations between excessive screen time and suicidality, they are limited by methodological heterogeneity and inconsistency, raising questions about directionality, whether excessive screen time contributes to poor mental health, or pre-existing vulnerabilities drive increased screen use.

Objective: This study aimed to provide a picture of who uses Better Access treatment services, how they do so and what the benefits are.

Methods: We conducted an observational prospective study involving independent cohorts from the Australian Longitudinal Study on Male Health (Ten to Men [TTM]) and the Australian Longitudinal Study of Women's Health (ALSWH). We used data from two pairs of baseline (T0) and follow-up (T1) waves for those aged ⩾ 18 in TTM and those in the 1989-1995, 1973-1978 and 1946-1951 cohorts in ALSWH. Using survey data and linked Medicare Benefits Schedule (MBS) claims data, we identified participants with 'mental health need' at T0 who had and had not used Better Access treatment services between T0 and T1.

Results: Proportions of Better Access users varied across study cohorts and analyses, with 45% being the highest. Those who used Better Access treatment services typically accessed 5-6 sessions, usually from clinical psychologists and/or psychologists. Between half and three-quarters paid out-of-pocket costs (usually $80-$100/session). Typically, around half of those who used Better Access had better mental health at T1 than T0. Severity of mental health problems at baseline was strongly predictive of both Better Access use and improvements in mental health.

Conclusion: Australian adults with mental health need make varying use of Better Access treatment services, but the programme appears to serve those with high levels of need relatively well.

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.

Objective: To describe characteristics, service use and clinical changes among people who received treatment through Australia's Better Access programme.

Methods: We re-analysed data from the usual care arms of two randomised controlled trials of tailored care approaches for depression and anxiety in primary care (Target-D, 2016-2019; Link-me, 2017-2019). Participants completed measures of depression and anxiety symptoms, quality of life and days out of role due to psychological distress over 12 months. They reported the use of mental health services from different providers/settings; from this, we classified a subset as likely Better Access treatment users.

Results: Of 394 Target-D and 547 Link-me participants, one-third were classified as having used Better Access treatment sessions over 12 months. They used five to seven Better Access sessions on average; half to two-thirds paid out-of-pocket costs (median $78-$89 per session). The number of Better Access sessions and other mental health services they used increased with severity of mental health problems. At baseline, Better Access treatment users reported more severe symptoms and more days out of role than those who used other or no mental health services, and poorer quality of life than those who used no services. Approximately half (43-55%) of Better Access treatment users showed improvements in mental health over 12 months. Among those with severe problems, improvements in depression and anxiety symptoms were associated with using 5+ Better Access sessions.

Conclusions: Better Access treatment is used by people with different levels of mental health need. Many experience improvements in their mental health and functioning.

Objective: Australia's Better Access initiative enables Australians with mental disorders to receive sessions of evidence-based psychological treatment following referral from an eligible provider (usually a general practitioner), subsidised through Medicare. As part of a commissioned evaluation, we examined patterns of Better Access treatment.

Methods: We sourced aggregated Medicare Benefits Schedule data from Services Australia on Better Access services delivered from 1 January 2018 to 30 June 2022. From this, we developed profiles of Better Access treatment over time and according to key consumer characteristics.

Results: In 2021, over 1.3 million Australians received at least one treatment session subsidised through Better Access (up by 0.9% per year since 2018). People living in medium/high socioeconomic status areas within major cities, females and young adults were more likely to receive Better Access treatment compared to other groups. Consumers made an out-of-pocket payment for two-thirds (64.8%) of treatment sessions in 2021 (vs 52.7% in 2018). The median out-of-pocket payment per session was constant between 2018 and 2021 ($74) but increased to $90 in the first half of 2022. In 2021, 29.9% of fees charged for all treatment sessions nationally came from consumer out-of-pocket payments (vs 24.5% in 2018). Fewer people accessed treatment following referral in 2021 than in 2018 (58.8% vs 66.9%), and those who did waited longer until their first session (median 22 days in 2021 vs 18 days in 2018).

Conclusion: Better Access enables many Australians to receive psychological treatment. Efforts are required to address gaps in access and increased wait time and consumer costs.