Australian and New Zealand Journal of Psychiatry最新文献

Psychiatry currently faces the following four intersecting challenges: technological disruption through artificial intelligence (AI); the loss of exclusive prescribing authority; escalating systemic constraints within public psychiatry, and market-driven models in private practice. Together, these forces challenge the specialty's traditional identity, narrowing its scope towards containment rather than recovery and meaning-making, and risk diminishing the specialty's relevance if left unaddressed. To respond, we propose a structured approach based on three concentric domains of action, the circles of control, influence, and concern, to differentiate what psychiatry can act on directly, shape through collaboration, or advocate for systemically. Within the circle of control, the AIMS framework (Assessment, Intervention, Monitoring, Step-Up/Step-Down) offers a practical structure to refocus care on relational depth, ethical decision-making, and contextual continuity. The circle of influence is addressed through reform in training and interdisciplinary culture, equipping psychiatrists to lead reflectively and integrate technology wisely. Reclaiming psychiatry's biopsychosocial identity lies at the centre of this renewal, combining biological sophistication, psychological fluency, and social awareness to restore the discipline's integrative purpose. Rather than competing with AI, psychiatry must redefine its value through those capacities that cannot be automated: empathy, interpretation, and ethical discernment. The specialty's future will be secured not by speed or compliance, but by its ability to hold complexity, foster recovery, and sustain human connection in an increasingly algorithmic world.

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.

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.

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.