Australian and New Zealand Journal of Psychiatry最新文献

Background: There is a paucity of quality appraisal tools specific to determine cultural validity. Cultural validity measures the appropriateness and applicability of a construct for a specific cultural group. It is often discussed in reference to determining if a construct developed in one cultural group is applicable, meaningful and equivalent in another cultural group. First Nations people conceptualise mental ill-health in vastly different ways than the biomedical models most used. Thus, research that does not consider cultural validity can have harmful effects. A specific tool to assess cultural validity in First Nations communities is required to address this significant gap in the literature.

Method: The First Nations Cultural Validity Assessment Tool was developed to assess cultural validity in a meaningful way for First Nations people in Australia. The tool was designed by First Nations researchers with guidance from cultural and lived experience experts and pilot-tested by clinicians and researchers.

Results: The First Nations Cultural Validity Assessment Tool includes 10 criteria within three overarching factors (Psychometric properties, Cultural Psychometric properties and Cultural competency of staff/ethics). The First Nations Cultural Validity Assessment Tool is scored from 0 to 15, with higher scores indicating greater cultural validity. Pilot testing demonstrated excellent inter-rater reliability between scorers.

Conclusion: This is the first tool to assess the cultural validity of measurement tools from the perspective of First Nations frameworks. The First Nations Cultural Validity Assessment Tool prioritises First Nations research values using a methodological approach that is acceptable within both non-Indigenous and Indigenous research practices.

Objectives: Data from a longitudinal national cohort study was used to test associations between young caregiving and self-harming and suicidal behaviours.

Methods: We used data from Waves 6-8 (2014-2018) of the Longitudinal Study of Australian Children to assess the effect of 'core' caregiving activities (e.g. personal care, assistance moving around) on suicidal and self-harming behaviours. Care activities at 16-17 years were classified as core caregiving, non-core caregiving and no caregiving. Five self-harming and suicidal measures, collected at age 18/19 years, were used to form two outcomes: thoughts (of self-harm or suicide, or plan to suicide) and behaviours (self-harm, suicide attempt), operationalised as binary variables. Analyses were carried out using augmented inverse probability treatment weighting, adjusting for potential confounders, on complete case data.

Results: Core caregiving was associated with higher levels of suicidal and self-harming behaviours compared no caregiving, with an average treatment effect (ATE) of 0.07 (95% confidence interval [CI] = 0.02, 0.12), equating to a risk ratio of 1.86 (95% CI = [1.21, 2.45]). The ATE of core caregiving on thoughts of suicide or self-harm (compared to non-caregiving) was 0.05 (95% CI = [-0.00, 0.11]), equating to a risk ratio of 1.26 (95% CI = [0.97, 1.56]). There was no evidence of an association between non-core care and any outcomes tested. Sensitivity analyses confirmed main findings.

Discussion: Core caregiving is associated with elevated risks of self-harm among young carers, underlining the crucial need to better identify and support young carers to mitigate these adverse outcomes.

One of the key concerns of recent national mental health policy has been to lift the rate of population access to mental health services.

Ketamine has emerged as a rapid-acting intervention for treatment-resistant psychiatric disorders, generating both enthusiasm and unease. While evidence demonstrates robust antidepressant, anxiolytic and anti-suicidal effects, ketamine also carries risks, including dissociation, dependence and uncertain long-term safety. Its reputation as a recreational drug further complicates clinical adoption, fostering stigma and regulatory caution. In this article, we consider ketamine's psychiatric use through the lens of medical ethics, structured around the principles of autonomy, beneficence, non-maleficence and justice. We argue that while ketamine should be embraced as a legitimate psychiatric therapy, its application must be grounded in rigorous ethical practice, supported by regulation and research, and shielded from both undue dismissal and premature over-promotion.

Objective: To estimate the proportions and correlates of Australian young people who consulted with health professionals or used services via digital technologies for their mental health in 2020-2022.

Methods: Data from 16- to 24-year-olds (N = 1620) in the 2020-2022 Australian National Survey of Mental Health and Wellbeing were analysed to estimate proportions, population counts and unadjusted odds ratios of past-year health professional consultations and use of services via digital technology for mental health within geographic regions. Logistic regression models explored socio-economic, psychosocial and clinically meaningful correlates of past-year consultation in the full sample, metro subgroup and regional, rural and remote subgroup.

Results: In total, 24.2% of Australian young people consulted with a health professional for their mental health in the past year. Of those with a probable 12-month Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) mental health condition, 46.3% consulted a health professional. This proportion differed by sex (male: 34.2%, female: 55.6%) and symptom severity (mild: 20.0%, moderate: 47.8%, severe: 66.0%) but did not vary by geographic region. One-in-ten (9.9%) young people used other services via digital technologies for their mental health in the past year, doubling among those with a probable 12-month mental health condition (18.8%), and increasing with severity (mild or moderate: 14.2%, severe: 33.6%). Different factors were associated with service use in different regions.

Conclusion: Experiences of young people accessing mental health care in Australia differ by geographic region of residence, neighbourhood disadvantage, sex and disorder class. Australia's mental health care system must facilitate diverse pathways to care that are responsive to young people's needs and preferences.

Introduction: Effective management of mental health crises is a growing global concern, significantly impacting emergency services. In New Zealand the New Zealand Police have begun reducing their involvement in mental health emergencies. This shift positions paramedics as primary responders in pre-hospital mental health crisis management. This current study conducts a comparative analysis of mental health legislation in New Zealand, Australian jurisdictions and the United Kingdom to assess how laws empower paramedics in mental health crises.

Methods: A structured framework was employed to evaluate 12 key domains relevant to pre-hospital mental health interventions. These domains include criteria for involuntary detention, emergency detention and transportation powers, integration of services and legal protections for paramedics.

Results: The analysis reveals that New Zealand's Mental Health Bill (as introduced in 2024) emphasises reducing coercion and promoting culturally appropriate care but lacks provisions granting paramedics the authority to manage crises in isolation. In contrast, jurisdictions like the Northern Territory, Western Australia and Queensland empower paramedics with greater legal authority and more integrated roles in mental health emergencies.

Discussion: The absence of health-based legal tools and insufficient integration with mental health services in New Zealand may limit paramedics' effectiveness in crisis management, potentially increasing reliance on police and delaying interventions. Recommendations include expanding paramedic authority in line with other jurisdictions and improving integration with mental health services. By adopting models from leading Australian jurisdictions, New Zealand paramedics will be better placed to manage mental health responses and support a reduction in police involvement.

Objective: To determine the mental healthcare use of women with a police-recorded history of perpetrating intimate partner abuse, focusing on general population comparisons and characteristics of past victimisation and perpetration associated with specific service use.

Methods: Population-level Victorian mental health databases were linked to women with a police-recorded history of perpetrating intimate partner abuse (N = 145). Rates of mental health service use were compared to same-aged women in the general population between 2016 and 2019. Patterns of mental health service use were examined using descriptive statistics and logistic regression models, controlling for age.

Results: Compared to women in the general population, women who perpetrated intimate partner abuse had substantially higher rates of acute and outpatient public mental health service use both across the lifetime and during the 4-year incidence period of study. Women with multiple reports of perpetrating family violence had significantly more mental health service use than women with only a single report. Prior family violence victimisation, despite being present in almost three quarters of our sample, did not significantly increase the odds of lifetime mental health service use beyond the effects of perpetrating intimate partner abuse.

Conclusion: Women who perpetrate intimate partner abuse may have more severe and incapacitating mental health needs than women in the general population, and acute mental health needs appear to increase as frequency of perpetration increases. Future research should examine if and to what extent addressing mental health needs may play a role in reducing women's intimate partner abuse perpetration.