Australian and New Zealand Journal of Psychiatry最新文献

Purpose: The aim of the present study was to undertake a retrospective analysis of national data on psychostimulant prescription for attention-deficit hyperactivity disorder for youths aged 5 to 17 years in Australia for the period 2003 to 2022.

Method: An area-based national data set (including number of individuals and total dispensing) was used to analyse: (1) total prescription patterns over the period; (2) geographical variation in prescription by state/territory; and (3) socioeconomic variation of prescriptions by postcode.

Findings: Four major findings were observed over the period: (1) prescriptions per thousand rose sixfold; (2) variance of standardised prescription levels by state and territory are narrowing around the national average; (3) standardised prescription levels vary by socioeconomics of postcode but variance is narrowing around the national average; and (4) the highest socioeconomic decile has lifted from the lowest standardised prescription ratio to the highest between census years 2006 to 2021.

Conclusions: Standardised prescription levels in Australia are narrowing around the national average. Findings for both individual prescriptions and total dispensing are similar, providing little evidence for large quantum of drug use. Youth from lower socioeconomic regions are slightly more likely to be prescribed medication. Youth from the highest socioeconomic decile are now much more likely to be prescribed medication. The was an increase in prescription levels across the first 2 years of COVID-19. The drivers behind these changes are worthy of further research.

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.

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: 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.

Background: Clozapine is the most effective therapy for treatment-resistant schizophrenia, yet adverse drug reactions (ADRs) limit its use. The concurrent ADR burden in outpatients and its relation to psychotropic polypharmacy, tobacco smoking and measured clozapine exposure has not been well characterised.

Method: We conducted a retrospective, cross-sectional review of medical records for 360 adults receiving maintenance clozapine at a dedicated outpatient clinic. Adverse drug reactions (ADRs) were ascertained using a standardised patient checklist alongside clinical measures. We used multivariate logistic regression to estimate the association between antipsychotic polypharmacy and the presence of ADRs, and negative binomial regression to quantify its association with ADR burden. We conducted a log-linear model to evaluate dose-concentration compensation in tobacco smokers.

Results: At the clinic visit, 89.6% had ⩾1 symptomatic ADR. The most prevalent were metabolic syndrome (71.8%), hypersalivation (64.7%) and tachycardia (61.2%). Antipsychotic augmentation (51.4%) was independently associated with ADRs (adjusted odds ratios [aOR] = 3.38, 95% confidence interval [CI] = 1.41-8.06) and a 28% higher ADR count per person (incidence-rate ratio [IRR] = 1.28, 95% CI = 1.11-1.48). Smokers received higher doses yet had lower plasma concentrations, suggesting incomplete dose compensation for CYP1A2 induction and had higher odds of antipsychotic augmentation (odds ratio [OR] = 2.50, 95% CI = 1.53-4.10).

Conclusion: In maintenance clozapine care, persistent ADRs were common and were more frequent in patients receiving antipsychotic augmentation. Smokers were under-exposed to clozapine and were more likely to receive antipsychotic augmentation. Services should implement structured ADR surveillance and prioritise therapeutic drug monitoring-guided dose optimisation, particularly in smokers, before considering antipsychotic augmentation.

Objective: The Neuropsychiatry Unit Cognitive Assessment is a valid and reliable screening tool used in detecting cognitive deficits in a range of neurological and psychiatric conditions. We aimed to develop abbreviated versions of the Neuropsychiatry Unit Cognitive Assessment tool using retrospective data, and to assess their psychometric performance in distinguishing between healthy cognition and dementia.

Methods: Healthy controls (n = 132, 41%) and those with dementia (n = 191, 59%) were randomised into a 'training' cohort (n = 226, 70%) for the development and a 'testing' cohort (n = 97, 30%) for validation of the short-form versions. Receiver-operating characteristic curves were first computed for each of the 24 original Neuropsychiatry Unit Cognitive Assessment items. Items were ranked according to area under the curve values to create five-, 10- and 15-item short-form versions, which were subsequently validated.

Results: The psychometric properties of the Neuropsychiatry Unit Cognitive Assessment short-form versions were comparable with the original, with all maintaining high convergent validity and reliability. Of the three versions, the 10-item version strikes the ideal balance of breadth and brevity. With a cut-off score of 42/54, the 10-item version generated similar sensitivity, specificity and predictive values for dementia as the original Neuropsychiatry Unit Cognitive Assessment, with a sensitivity of 0.98, specificity of 0.95, and positive and negative predictive values of 0.97.

Conclusions: The 10-item Neuropsychiatry Unit Cognitive Assessment has strengths in its shorter administration time, of approximately 10 minutes, high reliability and validity, and retention of items from each cognitive domain from the original Neuropsychiatry Unit Cognitive Assessment. Future research may involve testing these short forms in non-tertiary settings, across dementia subtypes and in non-dementia groups.

Objective: The current Guidelines aim to provide evidence-based management recommendations for treatment of people living with schizophrenia in Australia and Aotearoa New Zealand.

Methods: The Australian and New Zealand Journal of Psychiatry (ANZJP) commissioned a panel of experts to establish these Guidelines. The existing literature was reviewed to address key health questions. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, and the strength of the recommendation was determined by the panel.

Results: The ANZJP GRADE Guidelines examined the current evidence base for a range of areas relevant to treatment for people with schizophrenia including: initial physical health assessment; pharmacological treatment; psychological and psychosocial interventions; family, whānau and carers; psychiatric comorbidities; physical health and lifestyle interventions; and special populations.

Conclusions: It is hoped that the current Guidelines provide useful recommendations in important aspects of care for people living with schizophrenia and their family, whānau and carers in Australia and Aotearoa New Zealand, both at the individual and systemic levels.

Objectives: Clinicians rely on clinical practice guidelines to inform evidence-based management of conditions. However, the quality and availability of clinical practice guidelines for mental health conditions in children and adolescents vary. This systematic review aimed to assess the quality of existing clinical practice guidelines and identify gaps to inform future guideline development in child and adolescent mental health.

Methods: A systematic literature search was conducted to identify clinical practice guidelines for mental health conditions in children and adolescents published between April 2019 and April 2025. Using the Appraisal of Guidelines for Research and Evaluation II tool, identified clinical practice guidelines were assessed for rigour of development (n = 85) using a 70% cut-off. Gaps in the literature were identified by categorising guidelines based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.), ensuring comprehensive coverage while considering feasibility in guideline development.

Results: Nine of the 22 Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.) categories were represented among the 20 clinical practice guidelines extracted. Literature gaps were identified for bipolar and related disorders, trauma and stressor-related disorders, sleep-wake disorders and neurocognitive disorders. In addition, gaps persisted in 13 categories where high-quality guidance was not identified. While methodological quality varied (M = 5.6/7 ± 0.7), guidelines that met threshold were identified for depressive disorders, attention deficit/hyperactivity disorder, autism spectrum disorder, anxiety disorders, feeding and eating disorders, and suicidal behaviours and non-suicidal self-injury.

Conclusion: There is a high degree of variability in the quality of available clinical practice guidelines for child and adolescent mental health conditions, emphasising the need for more rigorous development and implementation standards. While some disorders have sufficient guidance, there are major gaps, necessitating the development of high-quality resources to enhance clinical impact.