Western Australian adolescent emotional wellbeing during the COVID-19 pandemic in 2020

BACKGROUND

The impacts of the COVID-19 pandemic have been vast and are not limited to physical health. Many adolescents have experienced disruptions to daily life, including changes in their school routine and family's financial or emotional security, potentially impacting their emotional wellbeing. In low COVID-19 prevalence settings, the impact of isolation has been mitigated for most young people through continued face-to-face schooling, yet there may still be significant impacts on their wellbeing that could be attributed to the pandemic.

METHODS

We report on data from 32,849 surveys from Year 7-12 students in 40 schools over two 2020 survey cycles (June/July: 19,240; October: 13,609), drawn from a study of 79 primary and secondary schools across Western Australia, Australia. The Child Health Utility Index (CHU9D) was used to measure difficulties and distress in responding secondary school students only. Using comparable Australian data collected six years prior to the pandemic, the CHU9D was calibrated against the Kessler-10 to establish a reliable threshold for CHU9D-rated distress.

RESULTS

Compared to 14% of responding 12-18-year-olds in 2013/2014, in both 2020 survey cycles almost 40% of secondary students returned a CHU9D score above a threshold indicative of elevated difficulties and distress. Student distress increased significantly between June and October 2020. Female students, those in older Grades, those with few friendships or perceived poor quality friendships, and those with poor connectedness to school were more likely to score above the threshold.

CONCLUSIONS

In a large dataset collected during the first year of the COVID-19 pandemic, the proportion of secondary school students with scores indicative of difficulties and distress was substantially higher than a 2013/2014 benchmark, and distress increased as the pandemic progressed, despite the low local prevalence of COVID-19. This may indicate a general decline in social and emotional wellbeing exacerbated by the events of the pandemic.

TRIAL REGISTRATION

ANZCTRN (ACTRN12620000922976). Retrospectively registered 17/08/2020. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380429&isReview=true .

Development and validation of the Australian Aboriginal racial identity and self-esteem survey for 8-12 year old children (IRISE_C)

INTRODUCTION

In Australia, there is little empirical research of the racial identity of Indigenous children and youth as the majority of the current literature focuses on adults. Furthermore, there are no instruments developed with cultural appropriateness when exploring the identity and self-esteem of the Australian Aboriginal population, especially children. The IRISE_C (Racial Identity and Self-Esteem of children) inventory was developed to explore the elements of racial identity and self-esteem of urban, rural and regional Aboriginal children. This paper describes the development and validation of the IRISE_C instrument with over 250 Aboriginal children aged 8 to 12 years.

METHODS

A pilot of the IRISE C instrument was combined with individual interviews and was undertaken with 35 urban Aboriginal children aged 8-12 years. An exploratory factor analysis was performed to refine the survey and reduce redundant items in readiness for the main study. In the main study, the IRISE C was employed to 229 Aboriginal children aged 6-13 years across three sites (rural, regional and urban) in Western Australia. An exploratory factor analysis using Principal axis factoring was used to assess the fit of items and survey structure. A confirmatory factor analysis was then employed using LISREL (diagonally weighted least squares) to assess factor structures across domains. Internal consistency and reliability of subscales were assessed using Cronbach's co-efficient alpha.

RESULTS

The pilot testing identified two key concepts - children's knowledge of issues related to their racial identity, and the importance, or salience, that they attach to these issues. In the main study, factor analyses showed two clear factors relating to: Aboriginal culture and traditions; and a sense of belonging to an Aboriginal community. Principal Axis Factoring of the Knowledge items supported a 2-factor solution, which explained 38.7% of variance. Factor One (Aboriginal culture) had a Cronbach's alpha of 0.835; Factor 2 (racial identity) had a Cronbach's alpha of 0.800, thus demonstrating high internal reliability of the scales.

CONCLUSION

The IRISE_C has been shown to be a valid instrument useful of exploring the development of racial identity of Australian Aboriginal children across the 8-12 year old age range and across urban, rural and regional geographical locations.

Severity and persistence of asthma and mental health: a birth cohort study

BACKGROUND

The goal of the current study was to investigate asthma and mental health among youth in the community, and to consider the role of asthma severity and persistence in this link. Method Data were drawn from the Raine Study, a population-based birth cohort study in Western Australia. Logistic regression models and generalized estimating equations were used to examine the relationship between asthma at age 5 years and the range of internalizing and externalizing mental health problems at ages 5-17 years. Analyses were stratified by asthma severity and persistence, and adjusted for a range of potential confounders.

RESULTS

More severe and persistent asthma at age 5 was associated with significantly increased odds of affective, anxiety, somatic, oppositional defiant and conduct problems at ages 5-17. Mild asthma and remitted asthma were not associated with heightened vulnerability to mental disorders.

CONCLUSIONS

Our results suggest that youth with symptomatic asthma are more likely to suffer from a wide range of mental health problems, and that the likelihood of mental health problems appears to increase as a function of asthma severity. Youth with poorly controlled and/or more severe and persistent asthma may be considered a vulnerable group who might benefit from mental health screening in clinical, school and community settings.

Associations between aggressive behaviour scores and cardiovascular risk factors in childhood

OBJECTIVE

To examine the influence of aggressive behaviour scores on cardiovascular disease (CVD) risk factors throughout childhood.

METHODS

This study utilized cross-sectional and longitudinal data from the Western Australian Pregnancy Cohort (Raine) Study (n = 2900). Aggressive behaviour scores were derived from the Child Behavior Checklist/4-18(CBCL), Youth Self-Report/11-18 (YSR) and Teacher Report Form/6-18 (TRF). CVD risk factors included body mass index (BMI), blood pressure, fasting lipids and homeostasis model of insulin resistance (HOMA-IR).

RESULTS

Girls with higher aggressive behaviour scores had higher BMI from 10 years of age (P ≤ 0.001), higher BMI trajectories throughout childhood (P = 0.0003) and at 14 years higher HOMA-IR (P = 0.008). At the 14-year survey, this equated to a difference of 1.7 kg/m2 in the predicted BMI between the extreme CBCL scores in girls (top 5% (CBCL ≥ 17) vs. CBCL score = 0). Boys with higher aggressive behaviour scores had higher BMI at 5 years (P = 0.002), lower diastolic pressure at 14 years (P = 0.002) and lower systolic blood pressure trajectories throughout childhood (P = 0.016).

CONCLUSION

Aggressive behaviour influences BMI from early childhood in girls but not boys. If this association is causal, childhood offers the opportunity for early behavioural intervention for obesity prevention.

Early mental health morbidity and later smoking at age 17 years

BACKGROUND

We examined the relationship between the onset and pattern of childhood mental health disorders and subsequent current smoking status at age 17 years.

METHOD

Data were from a prospective cohort study of 2868 births of which 1064 supplied information about their current smoking at 17 years of age. The association between the onset and pattern of clinically significant mental health disorders in the child and subsequent smoking at age 17 years was estimated via multivariable logistic regression.

RESULTS

Relative to 17 year olds who never had an externalizing disorder, 17-year-olds who had an externalizing disorder at age 5, 8 or 14 years were, respectively, 2.0 times [95% confidence interval (CI) 1.24-3.25], 1.9 (95% CI 1.00-3.65) or 3.9 times (95% CI 1.73-8.72) more likely to be a current smoker. Children with an ongoing pattern of externalizing disorder were 3.0 times (95% CI 1.89-4.84) more likely to be smokers at the age of 17 years and those whose mothers reported daily consumption of 6-10 cigarettes at 18 weeks' gestation were 2.5 times (OR 2.46, 95% CI 1.26-4.83) more likely to report smoking at 17 years of age. Associations with early anxiety and depression in the child were not found.

CONCLUSIONS

Current smoking in 17-year-olds may be underpinned by early emergent, and then, ongoing, externalizing disorder that commenced as young as age 5 years as well as exposure to early prenatal maternal smoking. The associations documented in adults and adolescents that link tobacco smoking and mental health are likely to be in play at these early points in development.

Maternal death and the onward psychosocial circumstances of Australian Aboriginal children and young people

BACKGROUND

This study sought to determine the social and emotional impact of maternal loss on Aboriginal children and young people using data from the Western Australian Aboriginal Child Health Survey (WAACHS).

METHOD

Data were from a population-based random sample of 5289 Aboriginal children aged under 18 years. Interview data about the children were gathered from primary carers and from their school teachers. Probabilistic record linkage to death registrations was used to ascertain deaths. Association between maternal death and subsequent psychosocial outcomes was assessed using univariate analyses and logistic regression.

RESULTS

Of the 5289 Aboriginal children, 57 had experienced the death of their birth mother prior to the survey. Multi-variable adjustment accounting for age and gender found that, relative to children who were living with their birth mother, children whose birth mother had died were at higher risk for sniffing glue or other substances [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.3-8.7], using other drugs (OR 2.8, 95% CI 1.2-6.8), talking about suicide (OR 2.6, 95% CI 1.2-5.7) and attempting suicide (OR 7.0, 95% CI 1.6-31.1).

CONCLUSIONS

Although the death of a birth mother is relatively rare and the vast majority of Aboriginal children with adverse developmental outcomes live in families and are cared for by their birth mother, the findings here suggest that the loss of a birth mother and the circumstances arising from this impart a level of onward developmental risk for mental health morbidity in Australian Aboriginal children.

Frequent nocturnal awakening in early life is associated with nonatopic asthma in children

Sleep deprivation has become a common phenomenon of the Western world and is associated with a variety of medical problems in children. This retrospective longitudinal analysis of a community-based birth cohort was undertaken to determine whether frequent nocturnal awakening during early life was associated with the development of childhood asthma. 2,398 children born to mothers recruited from the antenatal clinics of a single hospital in Perth, Australia during 1989-1991 were followed up at years 1, 2, 3, 6, 8, 10 and 14. Parent-completed questionnaires were analysed. The odds ratio for asthma at age 6 and 14 yrs in children with frequent nocturnal awakening during the first 3 yrs after birth was determined from multiple logistic regression. Following adjustment for asthma risk factors, co-sleeping and family stress, persistent nocturnal awakening was associated with nonatopic asthma at age 6 and 14 yrs (at age 14 yrs: OR 2.18, 95% CI 1.15-4.13) but not with atopic asthma. We found an increased risk of nonatopic asthma in children following frequent nocturnal awakening during the first 3 yrs of life. These hypothesis-generating data suggest the need for further systematic study of the effects of disordered sleep in early life on the development of asthma.

A new method of prenatal alcohol classification accounting for dose, pattern and timing of exposure: improving our ability to examine fetal effects from low to moderate alcohol

BACKGROUND

When examining the association between prenatal alcohol exposure and fetal effects, the timing and intensity of exposure have been ignored in epidemiological studies. The effect of using dose, pattern and timing of consumption ("composite" method) was investigated in this study, to examine the association between prenatal alcohol exposure and fetal effects.

METHODS

The composite method resulted in six categories of exposure (abstinent, low, moderate, binge <weekly, binge 1-2×/week and heavy). The odds of language delay and child behaviour problems were calculated for the composite method and then compared with an analysis using averaged estimates of <1 and 1+ drinks per day and with stratification by quantity ignoring dose per occasion. Data used for the analyses were from a 10% random sample of non-Indigenous women delivering a live infant in Western Australia (1995-1997). Participants from the 1995-1996 cohort were invited to participate in an 8 year longitudinal survey (78% response rate n=2224; 85% were followed-up at 2 years, 73% at 5 years and 61% at 8 years).

RESULTS

The effect of moderate and binge levels of exposure was only evident with the composite method; anxiety/depression following first-trimester moderate exposure (OR 2.24, 95% CI 1.16 to 4.34), and following late pregnancy moderate (aggressive behaviour OR 1.93, 95% CI 0.91 to 4.09) and binge (language delay OR 3.00, 95% CI 0.90 to 9.93) exposures. Results for heavy levels of exposure were similar with each method. The estimates for late pregnancy were imprecise due to small numbers. Conclusion The composite method of classification more closely reflects real-life drinking patterns and better discriminates maternal drinking than the other methods, particularly low, moderate and binge levels.

The association between information and communication technology exposure and physical activity, musculoskeletal and visual symptoms and socio-economic status in 5-year-olds

BACKGROUND

Increasing use of computers by children has raised concerns over the potential impact on their cognitive, social, educational, visual and physical development. Despite this concern, there are no large-scale studies relating the use of computers to specific health indicators in children as they reach school age.

METHODS

A cross-sectional analysis of 1600 5-year-old Western Australian children participating in a longitudinal cohort study was conducted to ascertain their computer use, other activities (watching television and videos, playing electronic games, reading and looking at books, drawing on paper and moderate to vigorous physical activity), and specific health indicators.

RESULTS

More than half (56%) of the children used computers each week. Computer use was significantly related to TV viewing (OR 1.97 weekday) and electronic game use (console games OR 2.48 weekday, 1.81 weekend; hand-held games OR 1.88 weekend) and negatively associated with vigorous physical activity on weekends (OR 0.72). Computer use was also significantly related to socio-economic indicators such as the mother being older (40+ years, OR 1.70 weekend, 1.73 weekday), tertiary educated (OR 1.63 weekend) and studying (OR 1.52 weekend, 1.41 weekday). Almost 1% children were reported to have complained of tired or sore muscles, and 2.2% had complained of tired or sore eyes, after watching television or using a computer.

CONCLUSION

A substantial proportion of 5-year-old Western Australian children are using computers. Computer use was related to other sedentary activities and less vigorous activity. While musculoskeletal and vision problems are not widespread, their presence and the sedentary nature of computer use is of public health concern.

The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well-being

OBJECTIVE

To identify the prevalence of three mental disorders (Depressive Disorder, Conduct Disorder and Attention-Deficit/Hyperactivity Disorder), the prevalence of mental health problems, the health-related quality of life of those with problems, and patterns of service utilisation of those with and without mental health problems, among 4-17-year-olds in Australia. To identify rates of health-risk behaviours among adolescents with mental health problems.

METHOD

The mental disorders were assessed using the parent-version of the Diagnostic Interview Schedule for Children Version IV. Parents completed the Child Behaviour Checklist to identify mental health problems and standard questionnaires to assess health-related quality of life and service use. The Youth Risk Behaviour Questionnaire completed by adolescents was employed to identify health-risk behaviours.

RESULTS

Fourteen percent of children and adolescents were identified as having mental health problems. Many of those with mental health problems had problems in other areas of their lives and were at increased risk for suicidal behaviour. Only 25% of those with mental health problems had attended a professional service during the six months prior to the survey.

CONCLUSION

Child and adolescent mental health problems are an important public health problem in Australia. The appropriate balance between funding provided for clinical interventions focusing on individual children and families and funding for interventions that focus on populations, requires careful study. The latter are an essential component of any strategy to reduce mental health problems as the high prevalence of problems makes it unlikely that individual care will ever be available for all those needing help. Clinical and population health interventions must take into account the comorbid problems experienced by children with mental disorders.

What do children with cystic fibrosis and their parents know about nutrition and pancreatic enzymes?

OBJECTIVE

To describe the development and validation of questionnaires designed to assess nutrition and pancreatic enzyme replacement therapy knowledge and cystic fibrosis self-management skills, and the results obtained when the questionnaires were used.

DESIGN

A cross-sectional study using validated questionnaires to interview the respondents. The outcome measures were scores for knowledge, appropriate and inappropriate self-management, and Socioeconomic Index.

SUBJECTS

Forty-two children with cystic fibrosis aged 6 to 11 years and 55 caregivers of 2 to 11-year-old patients of the Princess Margaret Hospital Cystic Fibrosis Clinic, Perth, Australia.

STATISTICAL ANALYSES

Descriptive statistics and correlations between scores were used for statistical analyses. Associations between knowledge scores were examined using Pearson's correlation coefficient. Spearman's rank correlation was used to examine the associations between knowledge and self-management scores and socioeconomic index.

RESULTS

Children's and caregivers' mean knowledge scores were 63% and 85%, respectively. Mean appropriate and inappropriate self-management scores for children were 55% and 21%, respectively, and for the caregivers were 74% and 32%, respectively. There was a statistically significant (P < .05) positive association between caregivers' and children's knowledge (r = 0.32), and children's knowledge and appropriate self-management scores (r = 0.41); and a statistically significant negative association between caregivers' knowledge and inappropriate self-management scores (r = -0.35); and no statistically significant associations between Socioeconomic Index and children's and caregivers' knowledge and self-management scores.

APPLICATIONS

This study identified areas in which the nutrition knowledge of children with cystic fibrosis and their caregivers needs to be enhanced to increase the likelihood that optimum dietary and pancreatic enzyme therapy is achieved. The questionnaires that were developed for the study could be refined and used in the clinical setting to identify knowledge and self-management deficits. Alternatively, the questionnaires could become valuable research tools for assessing the type of intervention required and in planning and evaluating programs.

Mental health disorders in children and young people: scope, cause and prevention

OBJECTIVE

To review the scope and characteristics of mental health disorders in children and young people in Australia; detail some emerging concepts of the causal pathways of mental health disorders in children and young people; and discuss aspects of the prevention of mental health disorders and the promotion of mental health in children and young people.

METHOD

An integrated review of selected literature.

RESULTS

(i) While as many as one in five Australian children aged from four to 17 have significant mental health problems there remains a need for prevalence estimates in subsections of the population, notably children and young people of Aboriginal and Torres Strait Islander descent; (ii) appropriate studies of gene-environment interaction will require better measurement and developmental exposition of those risk exposures that are known to be on the causal pathway to mental health disorder; and (iii) universal, selective and indicated prevention trials and evaluations directed at anxiety, depression and conduct disorder are needed.

CONCLUSION

Preventive intervention and promotion in mental health must entail effective collaboration at national, state and local levels between health, welfare and education sectors. These sectors must be informed by high quality epidemiology and a knowledge of the causal pathways of mental health disorders. Such intervention must also improve the movement of scientific knowledge to political policy on one hand and to praxis on the other. This will require a clear and persistent vision of the urgency, costs and consequences of mental health disorders in children and young people coupled with effective leadership and political resolve.

Population screening for cystic fibrosis in Western Australia: community response

We measured acceptance of carrier testing for cystic fibrosis in the community when offered in a primary care setting, determined variables influencing acceptance, and assessed knowledge of cystic fibrosis 3-6 months later. A total of 5,102 individuals age 18-50 years attending general practices or a family planning clinic in Western Australia completed questionnaires about knowledge of cystic fibrosis and the State Anxiety Inventory. Testing for the delta F508 gene was offered. After 3-6 months, carriers, a sample of consenting participants who were not tested, and a sample of test-negative participants were sent a further questionnaire; 43.5% of participants chose to be tested for cystic fibrosis carrier status. Women, younger people, people with higher education, people without children, and people planning to have children were more likely to be tested. After 3-6 months, carriers gave correct responses to questions about cystic fibrosis more frequently than those who tested negative or were not tested; 82.2% of carriers knew that they were definitely a carrier and 31.1% of test-negative individuals believed they were definitely not carriers. Thus, population carrier screening for cystic fibrosis offered in a community setting in Western Australia was acceptable to almost half of those offered testing, particularly younger people and those planning to have children, for whom knowledge of carrier status could be useful in making reproductive decisions. There was evidence that tested individuals recalled information in a way that minimised their risk of being a carrier.

The National Survey of Mental Health and Wellbeing: the child and adolescent component

OBJECTIVE

This paper describes the Child and Adolescent Component of the National Survey of Mental Health and Wellbeing.

METHOD

The aims of the study, critical decisions in planning for the study, progress to date and key issues which influenced the course of the study are described.

RESULTS

The Child and Adolescent Component of the National Survey of Mental Health and Wellbeing is the largest study of child and adolescent mental health conducted in Australia and one of the few national studies to be conducted in the world. Results from the study will provide the first national picture of child and adolescent mental health in Australia.

CONCLUSIONS

Large-scale epidemiological studies have the potential to provide considerable information about the mental health of children and adolescents. However, having a clear set of aims, ensuring that the scope of the study remains within manageable proportions and paying careful attention to the details of fieldwork are essential to ensure that high-quality data is obtained in such studies.

Fetal growth and subsequent mental health problems in children aged 4 to 13 years

To test the hypothesis that children with suboptimal fetal growth have significantly poorer mental health outcomes than those with optimal growth, a population random sample survey of children aged 4 to 16 years in Western Australia in 1993 was conducted. The Child Behavior Checklist (Achenbach 1991a) and the Teacher Report Form (Achenbach 1991b) were used to define mental health morbidity. Survey data for 1775 children aged 4 to 13 years were available for linkage with original birth information. The percentage of expected birthweight (PEBW) was used as the measure of fetal growth. Children below the 2nd centile of PEBW who had achieved only 57% to 72% of their expected birthweight given their gestation at delivery were at significant risk of a mental health morbidity (OR 2.9, 95% CI 1.18, 7.12). In addition, they were more likely to be rated as academically impaired (OR 6.0, 95% CI 2.25, 16.06) and to have poor general health (OR 5.1, 95% CI 1.69, 15.52).

Environmental factors and asthma and allergy in schoolchildren from Western Australia

The association of environmental factors with atopic disease in children remains poorly understood. The aim of this study was to investigate the relationship between socio-environmental factors and symptoms of asthma and atopy in 6-7-yr-old children assessed as an adjunct to Phase I of the International Study of Asthma and Allergy in Childhood in Perth, Western Australia. Parental questionnaire responses were obtained for 2,193 children (73.6%) in 34 randomly selected primary schools in the Perth metropolitan area. Children born in Australia had a significantly increased risk of current asthma (odds ratio (OR) 237, p = 0.001). Having a mother born in Australia was the only factor independently associated with an increased risk of current hay fever (OR 1.56, p = 0.005). Increasing numbers of people living in the home were significantly associated with a multiplicative decrease in risk of current asthma (OR 0.88, p = 0.03) and eczema (OR 0.82, p = 0.01). Houses made of fibrocement (OR 2.40, p = 0.02) and the presence of mats on less than half of the floor area in the "main bedroom" (relative to wall-to-wall carpet) (OR 3.50, p = 0.003) were associated with an increased risk of current eczema. All reported associations were independent of socioeconomic status (categorized by school), age and sex. This study suggests that household and country-specific environmental factors are associated with asthma, hay fever and eczema risk in 6-7-yr-old schoolchildren, and may have substantially contributed to the increased prevalence of these diseases in Australia.

The Western Australian child health survey: a pilot study

A pilot survey of 200 households was undertaken to field test the survey instruments and trial the validation and calibration procedures for the Western Australian Child Health Survey (WACHS) conducted in 1992. This paper describes the background to the WACHS, the development of the instrumentation and the conduct of the pilot study. This survey aims to replicate and extend previous epidemiological surveys conducted in other countries, and to provide Australian norms for mental health morbidity in 4 to 16 year old children. The measurement of mental health was undertaken through the use of the Child Behaviour Checklist (CBCL). This screening instrument provided data on the prevalence of mental health morbidity and of specific mental disorders in 4 to 16 year olds. Its reliability and validity as a diagnostic indicator were checked through a clinical calibration technique. The pilot survey also permitted an examination of the sampling strategy adopted to ensure that the sample selected reflected "normality" in terms of expected trends and results. Modifications to the content of the questionnaires are described in light of both psychometric qualities of the data and comments from field interviewers and professionals who have examined the instrument. Finally, changes to data collection strategies are discussed.

The role of life events in different categories of preterm birth in a group of women with previous poor pregnancy outcome

The aim of the present study was to determine whether mothers reporting more life events experience more preterm births following both complicated and uncomplicated pregnancies. A Life Events Inventory was administered prospectively to women at high risk for poor obstetric and neonatal outcomes who took part in the Pregnancy Home Visiting Program (PHVP), a randomized controlled trial of the effect of a programme of antenatal home visits by midwives on the incidence of preterm birth. This study took place in Western Australia in the years 1984-1987. All women in the study had had a previous poor pregnancy outcome. The women were classified into two groups--those with complicated and those with uncomplicated pregnancies. Pregnancies classified as 'complicated' were defined as a pregnancy in which there was antenatal hospital admission(s) for hypertension, antepartum haemorrhage or other medical reason except for preterm birth. Pregnancies classified as 'uncomplicated' refer to all pregnancies without these complications. No significant association was found between life events and preterm birth although the total stress score for women with uncomplicated pregnancies almost reached significance, as did the number of life events for both women with complicated and women with uncomplicated pregnancies considered together. Life events were not shown to have a predictive relationship to preterm birth even when stratified by etiologically different groups. However, although stress was not an important predictor of preterm birth in this group of women at biological risk it may yet be so in a group at social risk.

Blood alcohol levels in suicide cases

STUDY OBJECTIVE

The aim was to investigate the relationship between alcohol consumption prior to suicide and the act of suicide.

DESIGN

This was a retrospective total ascertainment survey of a three year cohort of suicides in Western Australia.

SETTING

Coroner's records of suicide in Western Australia between 1986 and 1988 inclusive.

PARTICIPANTS

The study involved 515 consecutive suicides: 414 males and 101 females.

MAIN RESULTS

Information on blood alcohol levels at time of death, presence of other drugs at time of death, drug and alcohol abuse history, psychiatric history, life events prior to death and method of suicide were collected. It was found that 35.8% of cases had a positive blood alcohol reading. Those who had been drinking alcohol prior to suicide were younger, more likely to be male, more likely to have chosen carbon monoxide as the method of suicide, more likely to have experienced a break up of a relationship and less likely to have sought professional help than those who had not been drinking.

CONCLUSIONS

Data from the present study do not provide evidence for a causal relationship between alcohol consumption and suicide. Differences between those who had consumed alcohol and those who had not are suggestive of a contributory role of alcohol to a decision to commit suicide in a subset of suicide cases.

Are children and adolescents who have suicidal thoughts different from those who attempt suicide?

In this study we inquire whether children and adolescents with suicidal ideation can be differentiated from children who attempt suicide on the basis of clinical symptoms or social grounds. From a total of 2181 consecutive outpatient referrals to a child and adolescent psychiatry service, 258 young persons who exhibited suicidal ideation are compared with 82 who had actually attempted suicide. We were unable to differentiate children with suicidal thoughts from those who attempted suicide on the basis of clinical symptoms alone. Both groups had similar high levels of symptoms of depression, anxiety, sleep disorder, and irritability. Conduct disorders were less common in both groups but 22% of the attempters abused illicit drugs or alcohol. Suicide attempts were more likely to be associated with chronic family discord and substance abuse. For boys, the odds of suicidal attempts were substantially increased if the subject had experienced loss. Results are discussed with reference to antecedents that may increase the odds of suicidal attempt and suggestions for future research are outlined.

Hidden handicap in school-age children who received neonatal intensive care

A group of 347 children who had been classed as 'at risk' in the neonatal period were examined by means of academic attainment tests and teacher ratings at the end of their first year in primary school. Matched classroom controls were also examined to estimate the prevalence of reading, spelling and mathematics difficulties. Preterm birth and low birthweight appeared to be significant antecedents of poorer outcome in all three subjects. The attributable risk of low birthweight to academic handicap was estimated to be 29 per cent. There was no additional effect of time to spontaneous respiration (short and long) on academic outcome for the preterm low-birthweight group. In contrast, poor outcome for the low-birthweight children who had not been preterm was associated with longer time to spontaneous respiration. Graduates of neonatal intensive care with normal birthweights performed comparably with their low-risk controls. These results are discussed in relation to other longitudinal studies of the outcome for 'at-risk' infants.

Can localised brain impairment be simulated on neuropsychological test profiles?

We asked 28 registered nurses with varying degrees of experience in working with neurological and neurosurgical patients to fake results on 10 neuropsychological tests in such a way as to be congruent with a history of trauma to the left fronto-temporal cortex. We compared these data to those obtained from 21 patients who had been referred with verified cerebral injury and who had a diagnosis of left fronto-temporal dysfunction. The overall hit rate of classification for the two groups was 85.7% and 89.8%, depending on the way in which test scores were combined. Results showed that a knowledgeable group of informed fakers had great difficulty reproducing the test performance of individuals with left fronto-temporal impairment.

Early sensory-perceptual changes in Huntington's disease

Forty-four patients at risk for Huntington's disease and seventeen diagnosed as having the disease were studied longitudinally over a nine-year period to assess the evolution of cognitive impairment. Results showed that there were measurable changes in sensory-perceptual functions well in advance of the emergence of the movement disorder. Discrimination between patients with Huntington's disease and those at risk for the disease based on tests of sensory-perceptual functioning resulted in a correct classification rate of 95.1%. Subjects who had changed from being at risk to having the disease nearly all had discriminant scores from their first test sequence lying in either the disease range or the pre-symptomatic disease range. The present organic model of Huntington's disease is discussed in light of these findings and implications of the mathematical model underlying prediction are discussed.

Smooth pursuit eye movements in normal and dyslexic children

This paper describes a detailed study of horizontal eye movements associated with visual tracking of a smoothly moving target. Essentially all children, even at target velocities as low as 5 degrees/sec., show some saccadic eye movements superimposed on smooth tracking movements. Detailed analysis of pursuit eye-movements from a group of 26 poor readers and 34 normal controls (8 to 13 yr.) showed that about 25% of poor readers have an abnormally raised saccadic component in smooth pursuit. This suggests that studies of eye movements during tracking of smoothly moving targets at low velocity, combined with a quantitative approach to data analysis, may be useful for early detection of a significant proportion of poor-reading children.

Dyslexia: saccadic eye movements

This paper describes an extensive study of the parameters of saccadic eye movement in a group of 28 poor-reading children and a comparative normally reading group of 31 children. Ages ranged from 6.0 to 16.9 yr. Poor readers had normal intelligence but were lagging by at least two years in reading ability as compared to their peer age group. Parameters studied in refixation eye movements included saccadic latency, accuracy, velocity, and acceleration, as well as differences in latency for abduct and adduct movements. Shapes of saccades were also studied. It was shown that eye-movement performance in simple saccadic refixation was not distinguishably different for poor readers and normal readers, even though in reading, which requires higher processing, eye-movement characteristics are quite different. Maturational changes for various saccadic eye-movement parameters were also examined for the normal and poor reading groups.

Impact of a drug bulletin on prescribing oral analgesics in a teaching hospital

The impact of a drug bulletin on prescribing oral analgesics in a teaching hospital was studied. Using an abbreviated time-series design, prescriptions for oral analgesics for all inpatients were surveyed one, three, and five weeks before and one, three, five, and seven weeks after the distribution of one of the hospital's regular drug bulletins. This bulletin contained guidelines for the treatment of minor, moderate, and severe pain. The 493 patients included in the study were classified by drug category, pain severity, and timer period. The drug categories were: (1) propoxyphene, (2) aspirin or acetaminophen alone or with codeine 8 mg or less, and (3) codeine alone or in combination products with more than codeine 8 mg, or other oral narcotic drugs. Each patient's pain severity was determined by interviewing attendant nursing staff; the validity of this approach was confirmed by correlating nurse and physician perception of pain at one time point. Multivariate contingency table analysis revealed that the drug bulletin significantly (p less than or equal to 0.05) reduced the prescribing of propoxyphene hydrochloride across both the minor and moderate pain categories. An increased use of aspirin and acetaminophen was significant three weeks after the release of the drug bulletin. This effect, however, was not significant at other time points. Drug bulletins can be used to achieve a temporary change in physician prescribing patterns of oral analgesics. For a sustained effect, alternative strategies are needed.