Australian and New Zealand Journal of Psychiatry最新文献

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.

Background: Diversionary approaches seek to address criminal legal system involvement among people with psychosis and other mental illness. There is limited evidence examining health characteristics of people with psychosis in Australian criminal legal systems and how these vary with court outcomes, including diversion.

Methods: We conducted a data-linkage study of 21,229 adults hospitalised with psychosis in New South Wales (June 2001 to December 2019) with a subsequent offence finalised in the New South Wales Local Court. We described psychosis types, co-occurring conditions and prior health service use and examined their associations with court outcome (diversion vs conviction) using logistic regression, adjusting for sociodemographic and legal factors.

Results: A total of 70.8% of participants had a schizophrenia spectrum disorder (substance-induced psychosis 22.6%; affective psychosis 6.6%). Co-occurring conditions were common (lifetime substance-related harm 84.8%; personality disorder 41.3%; neurodevelopmental disorder 17.5%; physical condition 25.6%), and 76.3% used mental health services in the year before the index offence. Affective and substance-induced psychoses were negatively associated with diversion vs schizophrenia spectrum disorders (adjusted odds ratios = 0.64 [95% confidence interval = 0.54-0.74] and 0.29 [95% confidence interval = 0.26-0.33], respectively). Duration of psychosis admissions and past-year mental health service use were positively associated with diversion, while in those with schizophrenia spectrum disorders, lifetime substance-related harm was negatively associated.

Conclusion: Court defendants with psychosis have a complex health profile. Although people with schizophrenia spectrum disorders are more likely to be diverted than those with other psychosis types, substance use may inhibit diversion. Health and criminal legal system collaboration is needed to facilitate diversion and treatment for this group.

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.