Australian and New Zealand Journal of Psychiatry最新文献

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.

Background: Universal screening of all perinatal women using the Edinburgh Postnatal Depression Scale is currently recommended in Australian National Guidelines, yet Australian validation studies of this measure are limited and with mixed findings. This study aims to address a current gap using the largest Australian sample to include both antenatal and postpartum periods to evaluate the performance screening for Major Depression.

Method: Data from 887 women is drawn from the Mercy Pregnancy and Emotional Wellbeing Study, a prospective cohort, in Melbourne, Perth and regional and rural Western Australia. Participants completed an Edinburgh Postnatal Depression Scale and Structured Clinical Interview for DSM diagnostic interview between weeks 12 and 20 of pregnancy and then again at 6 months postpartum. Data are compared to report internal validity and receiver operator characteristics including area under the curve, sensitivity, specificity, positive predictive value, negative predictive value and optimal cutoffs for the Edinburgh Postnatal Depression Scale.

Results: Internal consistency was good. With recommended Edinburgh Postnatal Depression Scale cutoffs of 13 or above in the postpartum and 15 and above antenatally the Edinburgh Postnatal Depression Scale was found to have a positive predictive value of 52% and 58%, respectively. Overall, the receiver operator characteristic analysis suggests fair to poor performance of the Edinburgh Postnatal Depression Scale for detecting Major Depression in both the antenatal and postpartum periods.

Conclusions: Clinicians and researchers using recommended Edinburgh Postnatal Depression Scale cutoffs may expect to have one in two of those women screening positive later receive a diagnosis of Major Depression, and one in five who screen negative representing missed cases. Clinical implications and recommendations are discussed.

Objective: On March 15, 2019, a white supremacist attacked two mosques in Christchurch, New Zealand causing 51 deaths. The March 15 study was initiated to evaluate the mental health and wellbeing of the affected Muslim community. Given participants shared faith and reported growth through adversity, an evaluation of post-traumatic growth and religious coping was included.

Methods: The March 15 study assessed sociodemographic and clinical factors 11-32 months after the shootings. The Post-Traumatic Growth Inventory and the Religious Coping Scale were administered. Descriptive statistics were used to report the presence of moderate-high post-traumatic growth. Bivariable analyses between Post-Traumatic Growth Inventory and potential predictor variables were undertaken. Measures that were significantly (p < 0.05) or marginally (p < 0.10) associated with post-traumatic growth were included in a multivariable regression model.

Results: Data for 187 participants were analysed. Fifty-eight percent of the participants met criteria for moderate-to-high post-traumatic growth. Being present at a mosque during the shootings (p = 0.011) and use of a life coach after the shootings (p = 0.02) were positively associated with post-traumatic growth. Family tensions and holding a university degree were negatively associated with post-traumatic growth (p = 0.035, 0.011). When the Religious Coping Scale was included in the multivariable model, it explained a large proportion of the variance associated with post-traumatic growth (p < 0.001).

Conclusion: The participants experienced relatively high levels of post-traumatic growth. The dominance of religious coping in the multivariable model suggests that the Post-Traumatic Growth Inventory and Religious Coping Scale assessed similar qualities for Muslims impacted by the March 15 shootings. Qualitative research is required to broaden understanding of the underpinnings to post-traumatic growth.

Aims: The aim of the study was to examine the interplay between income inequality, psychological distress, medication use and access to psychologist consultations in Australia.

Methods: Hypothesis-driven secondary data analysis was conducted using nationally representative data from the 2011-2012, 2014-2015 and 2017-2018 Australian National Health Surveys. Approximately 12,000 working-age participants (18-64 years) were analysed per survey year, with subgroup interaction effects (p < 0.1) explored.

Results: Overall, 16% of participants reported taking medications, and 5% consulted a psychologist in the past year. About 14% experienced high distress, and 5% had very-high distress in the past month. Lower-income individuals were more likely to experience high psychological distress and use mental health medications. Specifically, 30% of adults in the lowest income quintile used medications, and 14% reported very-high distress, compared to 10% and 2% in the highest income group. More low-income individuals (9%) consulted a psychologist compared to high-income individuals (4%). Interaction analyses revealed that lower-income individuals who used medication or saw a psychologist exhibited up to four times higher distress than those in higher-income groups.

Conclusions: The findings reveal a concerning disparity when combined with other national data: individuals in the lowest income quintile face higher mental health symptoms, greater medication use, and are more likely to consult a psychologist, yet receive fewer consultations. This exploratory work deepens understanding of the complex relationship between income inequality, mental health symptoms, medications and healthcare utilisation in well-resourced countries like Australia. With mental ill-health rising globally, understanding these dynamics is crucial for designing equitable mental health policies.