Australian and New Zealand Journal of Psychiatry最新文献

Objective: This study aimed to estimate the population prevalence of exposure to potentially traumatic events (e.g. serious accidents, physical or sexual violence and natural disasters) during childhood among Australians and examine associations between childhood potentially traumatic events and mental disorders, suicide and long-term physical health conditions.

Methods: Survey data from the 2020 to 2022 National Survey of Mental Health and Wellbeing were analysed, which included a nationally representative household sample of Australians aged 16-85 years (n = 15,893).

Results: Up to 42% of Australians (approx. 8,250,948) have been exposed to a potentially traumatic event prior to the age of 18 years. The more common types of potentially traumatic events experienced prior to 18 years were unexpected death of a loved one (27.5%), witnessing domestic violence (21.1%), sexual assault (21.0%) and witnessing serious injury or death (20.0%). Australians exposed to childhood potentially traumatic events had significantly higher odds of any lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mental disorders compared to those who had not experienced potentially traumatic events (adjusted odds ratio: 1.51, 95% confidence interval: 1.32-1.74). They also had higher odds of suicidal thoughts (adjusted odds ratio: 1.57, 95% confidence interval: 1.28-1.92), plans (adjusted odds ratio: 1.60, 95% confidence interval: 1.17-2.19) and attempts (adjusted odds ratio: 2.04, 95% confidence interval: 1.40-2.98) and higher odds of asthma, arthritis, cancer and kidney disease compared to those who had not experienced potentially traumatic events in their lifetime.

Conclusion: Childhood potentially traumatic events are prevalent in the Australian general population and associated with serious mental and physical health conditions. These findings have important implications for early detection and intervention, trauma-informed healthcare approaches, and for policy and practice across health, education and social service systems.

This paper examines the legal meaning and clinical impact of the different harm to self and others criteria as they appear in the provisions permitting involuntary inpatient treatment in each of Australia's mental health acts. The wording of each criterion is reviewed along with relevant Court decisions, explanatory memoranda, second reading speeches and advice published by governments. Each jurisdiction's harm criterion is set out along with: the breadth of scope of the harms envisaged; how severe any harm must be to trigger the criterion; and how likely it must be that the envisaged harm will arise. The paper is designed so that readers from each jurisdiction may focus on advice relevant to their jurisdiction. In most clinical encounters where involuntary hospitalisation is proposed, the most salient harms for consideration are serious psychological harms and harms to relationships, alongside physical harm to self or others where relevant. The harm criterion sets the minimum level of harm that must be anticipated before clinicians have legal authority to provide involuntary treatment. Where a patient refuses treatment without decision-making capacity, anticipated harms must be 'serious', but only so serious as to justify overriding the patient's refusal, taking into account the harms involuntary treatment itself may cause. In such cases, whether a person can be detained and treated will hinge largely on each jurisdiction's least restrictive criterion.

Objective: This study presents estimates of the prevalence, severity and correlates of mental health conditions in Australian emerging adults within geographic regions.

Methods: We analysed data from 16- to 24-year-olds (N = 1620) of the 2020-2022 Australian National Study of Mental Health and Wellbeing, a national cross-sectional household survey. Estimated prevalence, population counts and unadjusted odds ratios of the 12-month Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) mental and substance use disorders (mental health conditions) are presented for Modified Monash Model categories (geographic region). Multivariable logistic regression models explored correlates of any mental health condition in the full sample, metro subgroup and regional, rural and remote subgroup.

Results: Over one-third of emerging adults met criteria for a mental health condition. Anxiety disorders were most prevalent (29.2%), then mood disorders (13.7%) and substance use disorders (7.8%). Prevalence was high across metro areas (36.1%); regional centres (35.4%); large rural towns (38.4%) and medium rural towns, small rural towns and remote communities (38.1%). Lifetime exposure to suicide or sexual assault was associated with mental health condition in all regions. In metro but not regional, rural and remote areas, female sex, neighbourhood disadvantage, household financial hardship, no engagement with education/employment, lifetime physical domestic or family violence, less social support and bodily pain were associated with mental health condition.

Conclusion: Mental health conditions are prevalent among Australian emerging adults in metro, regional, rural and remote regions. Equitable solutions bringing together the full continuum of care in mental health, suicide prevention, sexual violence and bodily pain are needed to reduce their significant impact.

The Early Psychosis Prevention and Intervention Centre model has significantly shaped early intervention strategies for psychotic disorders, setting a benchmark for effective care and influencing practices globally. The model's effectiveness has been demonstrated through various trials and systematic reviews, highlighting its benefits in symptomatic relief, functional improvement and reduced hospitalisation. This paper explores and proposes advancements to the current model of care for early psychosis, incorporating recent developments and emerging evidence in the field. We highlight several areas to further enhance the Early Psychosis Prevention and Intervention Centre model. This includes highlighting the importance of interventions to reduce duration of untreated psychosis, maximising pharmacological and cognitive interventions, incorporating digital technologies for real-time feedback and personalised care, and access to physical health interventions to prevent unwanted long-term physical outcomes. In addition, the growing role of trauma-informed care, and more recently, peer support, as well as approaches and interventions for culturally diverse and high-risk populations, underscores the need for more inclusive and tailored interventions. Future directions also need to concentrate especially on the long-term outcome, which are less favourable and equity of access to high-quality services. The development of national and international collaborative research platforms, including Australia's new clinical quality registry and clinical trials network, also represents a significant step forward in generating robust evidence and refining care models. We suggest that to further progress the early psychosis field a personalised, data-informed approach is needed and that we find ways to harness technological innovations and collaborative networks to enhance care and subsequent treatment outcomes.