Australian and New Zealand Journal of Psychiatry最新文献

Background: Suicide and self-harm are significant issues globally. Accurate, efficient and comprehensive data are required to identify people who present to Emergency Departments due to self-harm to receive current accepted interventions and to develop effective health policies and responses. Current methods for identifying people presenting with these behaviors can be time- and labor-intensive or can underestimate the true figure.

Methods: This study investigated the use of a novel machine learning-based Natural Language Processing program developed to quantify the number of Emergency Department presentations which were related to suicidal or self-harm ideation or behavior. The program identifies these presentations based on Emergency Department triage notes. We compared the Natural Language Processing program with alternative methods for identifying suicide or self-harm related presentations, including International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification coding and keyword searching.

Results: Using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification codes included with the dataset, 10,399 Emergency Department presentations related to suicide or self-harm were identified for the period July 2015 to June 2022, while the Natural Language Processing program found 27,298 presentations over the same period with a precision of 0.89 and a recall of 0.94. All methods were evaluated by comparing their identifications with a set of manually identified presentations. Natural Language Processing identification was the most appropriate for providing an accurate, comprehensive and efficient quantification.

Conclusion: This study revealed that less than 40% of Emergency Department presentations related to suicide or self-harm are identified using existing methods in the Australian Capital Territory. By providing an improved identification method, this study enables more accurate analysis and understanding of the issues of suicide and self-harm.

Objective: To determine the prevalence and predictors of persistent antidepressant use among Australian children and adolescents.

Methods: A population-based cohort study was conducted, including children and adolescents aged from 5 to 18 years who initiated an antidepressant between 2014 and 2022, using 10% randoms sample of Pharmaceutical Benefits Scheme (PBS) dispensing data. We measured persistence at 1 and 2 years after initiation, as defined by continuous supply of any antidepressant with no gaps of more than 90 days between dispensings.

Results: A total of 44,366 children and adolescents initiated on antidepressants during the study period. Approximately one-quarter (23.1%) received only a single antidepressant dispensing, with a further 33.0% considered persistent users after 1 year and 19.8% considered persistent users after 2 years. Persistence at 1 year was significantly higher in females (adjusted odds ratios (aOR) 1.13 [1.09-1.18]) than males, and in concurrent users of antipsychotics (aOR 1.37 [1.22-1.54]) or psychostimulants (aOR 1.60 [1.49-1.71]) than non-users. The likelihood of persistent antidepressant use at 1 year was lower in individuals with a concession card (aOR 0.81 [0.78-0.85]) than general beneficiaries and in those who initiated with serotonin and norepinephrine reuptake inhibitors (aOR 0.60 [0.54-0.67]) or mirtazapine (aOR 0.45 [0.34-0.51]) compared with selective serotonin reuptake inhibitors. Findings were similar for persistent antidepressant use at 2 years.

Conclusion: Persistent antidepressant use beyond 1 or 2 years is common among children and adolescents and shows an increasing trend over time. The reasons for and appropriateness of prolonged treatment with antidepressants in this population warrant further investigation.

Background: People with mental health problems often report that they are avoided and discriminated against. However, less is known about the occurrence of supportive actions. This study aimed to investigate the prevalence in Australian adults of actions recommended by expert consensus mental health first aid guidelines, as well as actions not recommended.

Methods: A national survey was carried out with 6045 Australians aged 18+ who were members of the Life in Australia probability-based online panel. Participants were asked about actions they intended to take to support a person with a mental health problem or in a mental health crisis. Those who had actually provided support to someone in the past 12 months were asked about what supportive actions they took, while those who had personally had a mental health problem were asked what support they had received.

Results: Respondents more frequently reported providing actions that were recommended in mental health first aid guidelines than those not recommended (medians across actions of 88.2% vs 37.8%). However, people who had a mental health problem in the past 12 months reported actually receiving recommended actions less frequently (median across actions of 65.5%). Actions to support a person at suicide risk were particularly in need of improvement, with only 41.8% of suicidal persons being asked about suicidal thoughts.

Conclusion: The findings show a need to further upskill Australian adults on how best to support people with mental health problems or in a mental health crisis, particularly those at suicide risk.

Body dysmorphic disorder (BDD) is a persistently under-recognised psychiatric condition. Evidence suggests a degree of shared cognitive dysfunction and clinical presentation of BDD with autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). The current study is the first to investigate the co-occurrence of BDD, ASD and ADHD in a large online community sample. Utilising data from an online survey, we investigated the comorbidity frequency of BDD, ASD and ADHD, as well as the presence of possible undiagnosed BDD in these neurodevelopmental populations (N = 6844). Individuals with BDD did not report a higher frequency of ASD or ADHD comorbidity than those without BDD. However, individuals with neurodevelopmental diagnoses were significantly more likely to have possible undiagnosed BDD than those without a neurodevelopmental diagnosis (ASD adjusted odds ratio [AOR] = 3.55, ADHD AOR = 2.45). These preliminary findings cautiously suggest that elevated body image concern and possible BDD in ASD and ADHD are potentially missed or misattributed to individuals' neurodevelopmental diagnoses without further investigation.

Objectives: There is a well-established trend of increasing prevalence of mental health disorders among children and young people. Understanding patterns across diagnostic categories and predicting future changes is crucial for effective interventions and service planning.

Methods: We employed advanced time series analysis techniques, autoregressive integrated moving average-based time series modelling and forecasting, to analyse two decades of routinely collected data from the Western Australian Child and Adolescent Mental Health Services system. The large-scale dataset, with consistent sampling intervals, enabled robust time series analyses to account for secular, seasonal and random fluctuations. Models estimated both historical and forecasted future trends in mental health presentations at Western Australian Child and Adolescent Mental Health Services.

Results: Modelling of historical data from 2004 to 2024 shows significant increases for anxiety disorders, mood disorders, personality disorders, sleep disorders, attention deficit hyperactivity disorder (ADHD) and autism and eating disorders. Forecasting to 2044 suggests that while anxiety disorders will decrease, ADHD, autism, eating disorders and sleep disorders will continue to increase.

Conclusions: We have established autoregressive integrated moving average modelling and forecasting as a robust, sophisticated and useful statistical approach to characterising historical and future trends in youth mental health. The ability to forecast into the future with confidence means we can identify what services are most needed and where gaps exist in current service provision or fund distribution permitting strategic allocation of finite resources and supporting complex funding decisions. Importantly, our findings encourage other health care services, locally and internationally, to use autoregressive integrated moving average modelling and forecasting to capitalize on routine health data to support proactive service planning initiatives.

Aims: To examine self-perceived need for mental health care in the Australian adult population between 2007 and 2021.

Methods: The Perceived Need for Care Questionnaire in the 2007 and 2021 National Study of Mental Health and Wellbeing captures types of help needed in five mental health care categories: medication, information, counselling, social interventions and skills training. Needs are rated as unmet, partially met, or fully met. Twelve-month affective, anxiety and substance use disorders are assessed using WHO's Composite International Diagnostic Interview.

Results: Demand for mental health care (composite of need categories) among adult Australians increased from 14% (2007) to 20% (2021). It also increased in those with common disorders (43.3-58.9%) and without (6.5-9.9%). Highest 2021 demand was in those with affective (76%), followed by anxiety (61%) and substance use (43%) disorders. Rates of demands being fully met remained stable (45% in 2007; 48% in 2021), with rates among those with substance use (24% in 2021), affective or anxiety (38%) disorders, and those without a common disorder (63%). In 2021, needed supports were counselling (16%), information (11%), medication (10%), skills training (6%) and social interventions (5%). Fully met needs were highest for medication (81%), then counselling (57%), information (54%), skills training (41%) and social interventions (15%).

Conclusions: Despite service expansion, less than half of people with demand had fully met needs. Attention is needed on the causes, population-level prevention as well as treatment strategies to address this burgeoning mental health crisis.

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.