Australian and New Zealand Journal of Psychiatry最新文献

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.

Introduction: There is mounting evidence for the use of ketamine/esketamine in the treatment of depression. This paper examines how comorbid borderline personality disorder, or traits, may impact the efficacy of ketamine/esketamine in the treatment of depressive disorders.

Aims: To evaluate the efficacy of ketamine/esketamine in the treatment of depression where there are comorbid borderline personality disorder/traits.

Method: MEDLINE, Embase, APA PsycInfo, CINAHL and Scopus databases were searched for English language journal articles focusing on the use of ketamine/esketamine to treat depression in patients with comorbid borderline personality disorder/traits. Analysis included study design and intervention, efficacy statistics relating to the treatment of depression, as well as study limitations.

Results: Nine studies (n = 281) were included. Ultimately, patients with depression and comorbid borderline personality disorder/traits were equally likely to respond to ketamine/esketamine as those with depression but without borderline personality disorder/traits.

Conclusion: This is the first systematic review to assess the effectiveness of ketamine/esketamine in this cohort. Our findings suggest that ketamine/esketamine may be useful in improving symptoms of depression, in those with comorbid borderline personality disorder. Limited study data are available; however, given case reports of suicidal ideation and self-harm following treatment cessation, as well as indications of a higher risk of acute dissociation in individuals with borderline personality disorder, clinicians should exercise caution when using ketamine to treat depression in this population. More data are required including a larger randomised control trial to assess the efficacy and side effects of ketamine/esketamine in this study population. Clinicians should, where available and appropriate, consider offering ketamine/esketamine to patients in this cohort.

Objective: In the context of escalating impacts of climate change, bushfires have emerged as a natural disaster that may significantly impact a population's mental health. Adolescents typically residing in rural and regional areas present unique challenges in the aftermath of bushfires.

Method: Adhering to the PRISMA framework, a literature search was conducted to identify studies assessing the impact of bushfires on mental health in adolescent populations. Extracted information included demographic characteristics, bushfire location, timeframe post-bushfire, study design and relevant mental wellbeing outcomes.

Results: Nineteen studies were included within the review, which examined the impact of nine separate bushfire events across six countries. There are consistent findings suggesting that exposure to bushfire is associated with adolescent mental disorders, particularly post-traumatic stress disorder and depressive symptoms. Consistent predictors of poor mental health findings in adolescents include the subjective feeling of threat during the bushfire, property loss, housing adversity and injury to oneself or a family member. There is also replicated evidence that in adolescent populations, subjective or perceived life threat has a greater impact on post-traumatic stress disorder symptoms than objective or actual life threat.

Conclusion: All studies showed that exposure to bushfires impacts adolescent mental health, with some symptoms worsening at follow-up. Adolescents require sustained psychosocial supports and targeted interventions within impacted regional and rural communities. Future research should further explore long-term impacts and strategies to effectively manage the impact of bushfire.

Objective: Rates of suicide, suicidal ideation and self-harm are higher in regional and remote areas of Australia. This study aimed to examine the regional co-occurrence of adolescent suicidal ideation/self-harm and adverse childhood experiences, with consideration of area-based indices of socio-economic disadvantage and remoteness and the availability of mental healthcare professionals in New South Wales (NSW).

Methods: Participants were 73,883 young people, born between 2002 and 2005, represented in the NSW Child Development Study (NSW-CDS) - a record-linkage study utilising Commonwealth and State government records. Aggregated longitudinal data according to statistical areas of residence were used to geographically map adolescent suicidal ideation/self-harm against prior adverse childhood experiences, socio-economic disadvantage, geographical remoteness and the number of mental healthcare professionals per region.

Results: The average number of adverse childhood experiences and the proportion of children residing in areas of socio-economic disadvantage and geographical remoteness were strongly associated with the regional incidence of suicidal ideation/self-harm. Associations between the incidence of suicidal ideation/self-harm and the number of mental healthcare professionals in each region were not significant in adjusted models. Young people growing up in regions outside of Greater Sydney, particularly those in north-west NSW, had the greatest exposure to early adverse childhood experiences, the highest proportion residing in socio-economic disadvantaged and geographically remote areas and the highest incidence of adolescent suicidal ideation/self-harm.

Discussion: These findings have policy implications for the geographic allocation of resources to prevent self-harm and suicide in young people. Early-life interventions should be aimed at reducing adverse childhood experiences.

Background: Personality disorder is often underdiagnosed or misdiagnosed in secondary care settings. This can lead to challenges in accessing appropriate care for patients, and the allocation of resources in these services.

Objectives: The primary objective was to estimate the rate of personality disorder in a cohort of individuals presenting to a typical urban secondary care mental health service in Australia. The secondary objective was to compare this to the recorded rate of personality disorder diagnosis in this setting.

Methods: A retrospective chart review was completed for 376 patients (52.7% female, M = 47.26, SD = 16.99, 16-94 years). Data collected included the Standardised Assessment of Personality - Abbreviated Scale (SAPAS), a standardised screening tool for Personality Disorder. Demographic and clinical data included participant age, gender, location, presenting problem, diagnosis, and mortality. Statistical analyses included univariate analyses and the χ² test of independence.

Results: Of the entire sample, 289 participants (76.86%) completed the screening tool, with 214 participants (56.91%) meeting caseness for personality disorder. Comparatively, only 13 participants (3.46%) had a personality disorder diagnosis listed on their electronic medical records. The estimated rate of personality disorder was 16.46 times greater than the recorded rate of personality disorder diagnosis.

Conclusion: Estimated rate of personality disorder using a brief screening tool was found to be very high in a large urban Australian secondary care mental health service. However, the recorded rate in the same service was found to be very low. The discrepancy found between estimated and recorded rates have potential implications for access to appropriate care and resource allocation in this setting. The results suggest health professionals may benefit from further education and training in the identification and clinical assessment of personality disorder.

Background: People with intellectual disability are disproportionately affected by mental illness, including serious mental illness. While the prevalence of mental illness in this population is well-documented, the factors associated with the onset of any mental illness and serious mental illness lack comprehensive investigation. This study aims to identify demographic, service-related and disability-related factors associated with the onset of any mental illness and serious mental illness in people with intellectual disability using a large, linked dataset in New South Wales, Australia.

Methods: A retrospective cohort study was conducted using linked administrative data for 47,330 individuals with intellectual disability aged 13-80 years. Data from 2004 to 2018 were used to track first recorded contact with mental health services for any mental illness and serious mental illness. Flexible parametric survival analysis was employed to account for time-varying factors and estimate hazard ratios for the risk of developing any mental illness or serious mental illness.

Results: Nearly half of the cohort (48.9%) experienced any mental illness, and 11.7% experienced serious mental illness. Factors associated with any mental illness included attention-deficit/hyperactivity disorder, learning disorders, physical comorbidities, and living in areas of greater socioeconomic disadvantage. Serious mental illness onset was associated with living in outer regional, remote or very remote areas, attention-deficit/hyperactivity disorder, learning disorders, male sex, and a history of any mental illness.

Conclusion: This study identified factors associated with the onset of any mental illness and serious mental illness in people with intellectual disability. These findings emphasise the need for early identification and targeted interventions to improve mental health outcomes in this high-risk population.

Objective: Eating disorders impact physical, psychological, and social well-being, and often need complex health care. Understanding changes in healthcare utilization is essential for policy and planning. This research evaluates healthcare utilization by people with eating disorders by linking person-level data across health settings to provide a system-wide description of eating disorder care.

Methods: This retrospective cohort study evaluates health service use by people with eating disorders aged 6 years or older in the three most populous states in Australia; New South Wales, Queensland, and Victoria, for a 10-year period, 2010-2019, by linking data for hospital admissions (public and private), emergency department presentations and public outpatient mental health. Population rates and Average Annual Percent Change (AAPC) by age groups are reported.

Results: Service use increased significantly over the decade in all states, in all healthcare settings, and was highest for young people. Public outpatient service contacts doubled in VIC, almost tripled in NSW, and increased 5-fold in QLD. Public hospital admissions doubled in NSW and VIC and tripled in QLD. Hospital admissions for males increased at a higher rate than for females in NSW and QLD, and public hospital admissions for males in QLD increased 6-fold over the study period. Presentations to emergency departments doubled in all states. Population rates and AAPC show increases were greatest in 16- and 17-year-olds.

Conclusions: This study covering three-quarters of the Australian population demonstrates substantial increases in rates of health service use for people with eating disorders between 2010 and 2019.