Australian and New Zealand Journal of Psychiatry最新文献

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.

Objective: The onset of youth suicidal ideation and behaviour is a critical predictor of future mental health. This study examines generational differences in the prevalence and age of onset for suicidal ideation, plans, self-harm, and suicide attempts by age 25 in a nationally representative Australian cohort.

Method: A retrospective analysis using data from the Australian Bureau of Statistics National Study of Mental Health and Wellbeing, 2020-22. Respondents were grouped into Generation Z (16-25 years), Millennials (26-41 years), Generation X (42-57 years), and Baby Boomers (58-76 years). Cox proportional hazards models assessed the impact of demographic, childhood adversities, and mental health factors across generations.

Results: Of the 14,753 respondents, 16.1% were Generation Z, 31.3% Millennials, and around one-quarter were from either Generation X or the Baby Boomer generation. Generation Z had the highest hazards for youth suicidal ideation, planning, self-harm, and suicide attempts, with the youngest age of onset. Adverse childhood experiences and lifetime mental health diagnoses were consistent risk factors across generations, but generational differences in their impact were evident. Sexual abuse before 19 was less strongly associated with earlier onset in Generation Z, while witnessing parental violence and exposure to suicide in others had stronger associations with younger onset in Generation Z. Mental disorders were linked to earlier onset, particularly in Baby Boomers.

Conclusions: Generational differences in the prevalence and age of onset of suicidal ideation and behaviours in Australia are evident, emphasising the need for a tailored, multi-sectorial suicide prevention strategy to address these evolving risks.

Introduction: People diagnosed with borderline personality disorder experience persistent functional impairment despite current evidence-based treatment. Domains of daily living functioning, such as establishing a routine, household management and self-care, can be important goals for rehabilitation. This review aimed to scope and synthesise programmes that address the daily living functioning of people diagnosed with borderline personality disorder.

Methods: This review followed the PRISMA Extension for Scoping Reviews Checklist and the Joanna Briggs Institute scoping review methodological guidance. Eight databases (Medline, PsycINFO, ASSIA, CINAHL, Embase, Emcare, ProQuest Dissertations & Theses Global and Scopus) and grey literature were searched.

Results: Forty-four records were found spanning 12 countries, from 1987 to 2025, comprising research studies, educational materials and programme summaries. Programmes included independent living skills development, residential facilities, outpatient treatment and occupational therapy, with rehabilitation and recovery the most frequently used approaches. The domains of daily living functioning were health (n = 189), relational (n = 84), responsibility (n = 67), personal (n = 61), leisure (n = 53), routine (n = 42) and household (n = 30). Measures used to describe changes in functioning varied considerably.

Conclusions: Programmes supporting the daily living functioning of people diagnosed with borderline personality disorder exist. However, the evidence base is currently disparate. No single programme addressed all identified domains of daily living functioning. Comprehensive, evidence-based rehabilitation programmes addressing all domains of daily living functioning are needed to enable functional recovery for people diagnosed with borderline personality disorder.

Objective: Cognitive difficulties are a core feature of psychotic disorders such as schizophrenia; however, the prevalence of cognitive impairment among Australians with schizophrenia is unclear. This review aimed to estimate the prevalence of cognitive impairment associated with schizophrenia in Australia and to describe methodological approaches to assessing cognition and defining cognitive impairment in the Australian schizophrenia research literature.

Methods: Systematic searches were conducted across MEDLINE Complete, APA PsycINFO, Embase and Scopus to identify studies reporting cognitive assessment outcomes among Australians diagnosed with schizophrenia or schizoaffective disorder. A particular focus was given to studies of naturalistic cohorts (those studied in real-world environments without manipulation or experimental intervention); however, clinical trial cohorts were also included. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement and Synthesis Without Meta-analysis guidelines.

Results: Findings were synthesised from 198 studies comprising approximately 23,755 individuals. There was substantial heterogeneity in cognitive assessment approaches and definitions of cognitive impairment. Over 100 different cognitive tests and test batteries were used across the included studies. Only 11 studies described naturalistic cohorts, with reported prevalence estimates of cognitive impairment of between 14.5% and 90%. Given insufficient quantitative data and substantial methodological differences across studies, meta-analysis was not conducted.

Conclusion: Although a pooled prevalence estimate could not be calculated, cognitive impairment likely poses a substantial burden to Australians with schizophrenia. Reducing this burden requires a multifaceted approach, including improved access to cognitive assessments as part of routine clinical care, and improved availability of evidence-based cognition-focused treatment options.

Objectives: People with psychotic disorders face significant functional impairments, high levels of disability, multimorbidity and physical health challenges. Despite unique health benefits, resistance training remains underexplored in this population and rarely implemented in real-world mental health settings.

Methods: This randomised controlled trial comparing resistance training with aerobic interval training in people with psychotic disorders accessing psychiatric rehabilitation. Supervised exercise sessions by exercise physiologists were conducted 3 times per week over 8 weeks. Primary outcomes were feasibility, acceptability and adverse events. Secondary outcomes were psychiatric symptoms, global and physical functioning and the effect of randomisation to exercise type on participation rates.

Results: In total, 54 participants (median age 31 years, 71.6% male, 75% diagnosed with schizophrenia/schizoaffective disorder, 55.5% with ⩾3 health conditions) were enrolled. Resistance training met predetermined feasibility and acceptability thresholds and showed comparable results to aerobic interval training with no significant exercise-related adverse events. Within-group analysis revealed significant increases in muscle strength following resistance training. Post-intervention, resistance training participants reported more total weekly minutes of physical activity compared to aerobic interval training, though no other significant between-group differences were observed. Randomisation to exercise type did not influence participation.

Conclusion: In conclusion, resistance training was feasible and acceptable to people with psychotic disorders, with no serious adverse events and comparable to aerobic interval training. Resistance training was successfully implemented in rehabilitation settings with promising improvements in muscle strength and self-reported physical activity. In future, larger longer-term trials comparing resistance training with aerobic interval training, and in comparison with other psychosocial therapies are warranted. Further exploration of participant preference for exercise type on outcomes is recommended.