Australian and New Zealand Journal of Psychiatry最新文献

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.

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.