1
|
Kisely S, Herrman H, Chamoli S, Hemachandra D, Lawn S, Bajurny L, Wright N, Mellsop G. Determining the future role of clinical practice guidelines: The experience of Australia and New Zealand. Aust N Z J Psychiatry 2024:48674241253475. [PMID: 38761089 DOI: 10.1177/00048674241253475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
There has been recent discussion in Australia and New Zealand concerning the utility of Clinical Practice Guidelines (CPGs) and the role of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) in their development. The College Board therefore established a Steering Group (SG) to oversee an exploration of options and produce recommendations about contemporary approaches to the development of high-quality evidence-based clinical practice guidance for psychiatry. This paper outlines the SG's conclusions and recommendations, as well as the underlying methods and reasoning. In particular, we discuss best practice and recent developments in the synthesis of research evidence. Account has been taken of the opportunities offered by digital technologies, the proliferation of clinical evidence and awareness of the gains to be made by increased inclusion of lived-experience perspectives. It is recommended that the broader concept of best practice resources (BPRs) as now emphasised in so many fields of service is the most appropriate starting point for the College's role in this area especially as the expertise of the College and its fellows lends itself to the development of a range of BPRs. In conclusion, contemporary guidance needs to be tailored to the requirements of the practitioners seeking it, to articulate the real-world needs and experiences of patients, and to be delivered in a contemporary format that is responsive to rapidly emerging evidence. The experience in Australia and New Zealand may have implications elsewhere for the development of CPGs and BPRs more broadly.
Collapse
Affiliation(s)
- S Kisely
- The Princess Alexandra Hospital Southside Clinical Unit, Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia
| | - H Herrman
- Orygen, Parkville, VIC, Australia
- The Centre for Youth Mental Health, the University of Melbourne, Melbourne, VIC, Australia
| | - S Chamoli
- Bi-national Faculty of Adult Psychiatry Committee, The Royal Australian & New Zealand College of Psychiatrists (RANZCP), Melbourne, VIC, Australia
| | - D Hemachandra
- Department of Psychiatry, Canberra Health Services, Canberra, ACT, Australia
| | - S Lawn
- Lived Experience Australia, Adelaide, SA, Australia
| | - L Bajurny
- Policy, Practice, and Research, The Royal Australian & New Zealand College of Psychiatrists (RANZCP), Melbourne, VIC, Australia
| | - N Wright
- Policy, Practice, and Research, The Royal Australian & New Zealand College of Psychiatrists (RANZCP), Melbourne, VIC, Australia
| | - G Mellsop
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| |
Collapse
|
2
|
Kisely S, Zirnsak T, Corderoy A, Ryan CJ, Brophy L. The benefits and harms of community treatment orders for people diagnosed with psychiatric illnesses: A rapid umbrella review of systematic reviews and meta-analyses. Aust N Z J Psychiatry 2024:48674241246436. [PMID: 38650311 DOI: 10.1177/00048674241246436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
AIMS Community treatment orders have been introduced in many jurisdictions with increasing use over time. We conducted a rapid umbrella review to synthesise the quantitative and qualitative evidence from systematic reviews and/or meta-analyses of their potential harms and benefits. METHODS A systematic search of Medline, PubMed, Embase and PsycINFO for relevant systematic reviews and/or meta-analyses. Where available, participants on community treatment orders were compared with controls receiving voluntary psychiatric treatment. This review is registered with PROSPERO (CRD42023398767) and the Open Science Framework (https://osf.io/zeq35). RESULTS In all, 17 publications from 14 studies met the inclusion criteria. Quantitative synthesis of data from different systematic reviews was not possible. There were mixed findings on the effects of community treatment orders on health service use, and clinical, psychosocial or forensic outcomes. Whereas uncontrolled evidence suggested benefits, results were more equivocal from controlled studies and randomised controlled trials showed no effect. Any changes in health service use took several years to become apparent. There was evidence that better targeting of community treatment order use led to improved outcomes. Although there were other benefits, such as in mortality, findings were mostly rated as suggestive using predetermined and standardised criteria. Qualitative findings suggested that family members and clinicians were generally positive about the effect of community treatment orders but those subjected to them were more ambivalent. Any possible harms were under-researched, particularly in quantitative designs. CONCLUSIONS The evidence for the benefits of community treatment orders remains inconclusive. At the very least, use should be better targeted to people most likely to benefit. More quantitative research on harms is indicated.
Collapse
Affiliation(s)
- Steve Kisely
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia
- Griffith Criminology Institute (GCI), Griffith University, Mount Gravatt, QLD, Australia
- Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Tessa Zirnsak
- Social Work and Social Policy, Department of Community and Clinical Health, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Amy Corderoy
- Discipline of Psychiatry & Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Christopher James Ryan
- Discipline of Psychiatry & Mental Health, University of New South Wales, Sydney, NSW, Australia
- Specialty of Psychiatry, University of Sydney, Sydney, NSW, Australia
- Department of Psychiatry, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Lisa Brophy
- Social Work and Social Policy, Department of Community and Clinical Health, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| |
Collapse
|
3
|
Bull C, Trott M, Najman JM, Arnautovska U, Siskind D, Warren N, Kisely S. Associations between child maltreatment and hospital admissions for alcohol and other substance use-related disorders up to 40 years of age: Results from the Childhood Adversity and Lifetime Morbidity study. Addiction 2024. [PMID: 38634806 DOI: 10.1111/add.16479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/15/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND AND AIMS Evidence on the associations between child maltreatment (CM), alcohol use disorders (AUDs) and other substance use disorders (SUDs) comes largely from retrospective studies. These rely on self-reported data, which may be impacted by recall bias. Using prospective CM reports to statutory agencies, we measured associations between CM notifications and inpatient admissions for AUDs and SUDs up to 40 years of age. DESIGN, SETTING AND PARTICIPANTS Observational study linking administrative health data from Queensland, Australia to prospective birth cohort data comprising both agency-reported and substantiated notifications of CM. MEASUREMENTS Outcomes were inpatient admissions for AUDs and SUDs based on ICD-10-Australian modification (AM)-coded primary diagnoses. Unadjusted and adjusted logistic regression analyses were undertaken. FINDINGS Ten per cent (n = 609) of the cohort had a history of agency-reported or substantiated CM notifications before age 15. These individuals had higher adjusted odds of being admitted for AUDs and SUDs. For AUDs, the adjusted odds of inpatient admission were 2.86 [95% confidence interval (CI) = 1.73-4.74] greater where there was any previous agency-reported CM and 3.38 (95% CI = 1.94-5.89) greater where there was any previous substantiated CM. For SUDs, the adjusted odds of inpatient admission were 3.34 (95% CI = 2.42-4.61) greater where there was any previous agency-reported CM and 2.98 (95% CI = 2.04-4.36) greater where there was any previous substantiated CM. CONCLUSIONS People with a history of child maltreatment appear to have significantly higher odds of inpatient admissions for alcohol use disorders and other substance use disorders up to 40 years of age compared to people with no history of child maltreatment.
Collapse
Affiliation(s)
- Claudia Bull
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- The ALIVE National Centre for Mental Health Research Translation, The University of Queensland, Woolloongabba, QLD, Australia
- Queensland Centre for Mental Health Research, The University of Queensland, Woolloongabba, QLD, Australia
| | - Mike Trott
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Queensland Centre for Mental Health Research, The University of Queensland, Woolloongabba, QLD, Australia
| | - Jake Moses Najman
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- School of Social Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Urska Arnautovska
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Queensland Centre for Mental Health Research, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - Dan Siskind
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Queensland Centre for Mental Health Research, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - Nicola Warren
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - Steve Kisely
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- The ALIVE National Centre for Mental Health Research Translation, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
- Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
4
|
Kisely S, Bull C, Trott M, Arnautovska U, Siskind D, Warren N, Najman JM. Emergency department presentations for deliberate self-harm and suicidal ideation in 25-39 year olds following agency-notified child maltreatment: results from the Childhood Adversity and Lifetime Morbidity (CALM) study - CORRIGENDUM. Epidemiol Psychiatr Sci 2024; 33:e23. [PMID: 38604777 PMCID: PMC11022252 DOI: 10.1017/s204579602400026x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
|
5
|
Thaker P, Gartner C, Kisely S, Plever S. Systematic review of tobacco smoking prevalence among young people in treatment for first-episode psychosis. Int J Ment Health Nurs 2024. [PMID: 38606655 DOI: 10.1111/inm.13332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/28/2024] [Accepted: 03/27/2024] [Indexed: 04/13/2024]
Abstract
To determine whether smoking prevalence in first-episode psychosis (FEP) is different than in people with established psychosis in long-term treatment. A systematic review of cross-sectional, case-control and cohort studies identified from searches of PubMed, Embase, CINAHL and PsycINFO up to 12 August 2023. 20 studies out of 2773 screened titles were included. There was no clear pattern of smoking by diagnosis as smoking rates in people with FEP ranged from 43% to 78%, while in those with established psychosis, it ranged from 19% to 76%. The wide range of smoking levels in both populations precluded conclusions as to whether smoking rates are different between people with FEP and established psychosis suggesting that factors other than the time course of the illness influence smoking levels.
Collapse
Affiliation(s)
- Parth Thaker
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Coral Gartner
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, Queensland, Australia
| | - Steve Kisely
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| | - Sally Plever
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, Queensland, Australia
- Metro North Mental Health, Brisbane, Queensland, Australia
| |
Collapse
|
6
|
Kisely S, Arnautovska U, Siskind D, Warren N, Najman JM. Admissions for psychosis following agency-notified child maltreatment at 40-year-follow-up: Results from the Childhood Adversity and Lifetime Morbidity (CALM) cohort. Schizophr Res 2024; 267:247-253. [PMID: 38581827 DOI: 10.1016/j.schres.2024.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
There is substantial evidence of an association between self-reported child maltreatment (CM) and subsequent psychosis in retrospective data. Such findings may be affected by recall bias. Prospective studies of notifications to statutory agencies address recall bias but are less common and subject to attrition bias. These studies may therefore be underpowered to detect significant associations for some CM types such as sexual abuse. This study therefore linked administrative health data to a large birth cohort that included notifications to child protection agencies. We assessed psychiatric outcomes of CM as measured by inpatient admissions for non-affective psychoses (ICD10 codes F20-F29) to both public and private hospitals in Brisbane, Australia. Follow-up was up to 40 years old. There were 6087 cohort participants whose data could be linked to the administrative health data. Of these, 10.1 % had been the subject of a CM notification. Seventy-two participants (1.2 %) had been admitted for non-affective psychosis by 40-year follow-up. On adjusted analysis, all notified and substantiated types of CM were associated with admissions for non-affective psychosis. This included neglect, physical, sexual or emotional abuse, as well as notifications for multiple CM types. For instance, there was a 2.72-fold increase in admissions following any agency notification (95 % CI = 1.53-4.85). All maltreatment types therefore show a significant association with subsequent admissions for psychosis up to the age of 40. Screening for CM in individuals who present with psychosis is, therefore, indicated, as well as greater awareness that survivors of CM may be at higher risk of developing psychotic symptoms.
Collapse
Affiliation(s)
- Steve Kisely
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba 4102, Queensland, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada; Metro South Addiction and Mental Health Service, Brisbane, Australia.
| | - Urska Arnautovska
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba 4102, Queensland, Australia; Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Dan Siskind
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba 4102, Queensland, Australia; Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Nicola Warren
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba 4102, Queensland, Australia; Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Jake Moses Najman
- School of Public Health, The University of Queensland, Public Health Building, Herston 4006, Queensland, Australia; School of Social Sciences, The University of Queensland, St Lucia 4072, Queensland, Australia
| |
Collapse
|
7
|
Hayter CM, Allison S, Bastiampillai T, Kisely S, Looi JCL. The changing psychiatry workforce in Australia: Still lacking in rural and remote regions. Aust J Rural Health 2024; 32:332-342. [PMID: 38419201 DOI: 10.1111/ajr.13092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION There is a long standing and worsening shortage of psychiatrists in Australia particularly in rural areas. The majority of psychiatrists work in major cities. OBJECTIVE To identify recent trends in the Australian rural psychiatrist workforce compared with the metropolitan workforce. DESIGN We descriptively analysed population-level data from the National Health Workforce Data Set (NHWDS), the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS). A descriptive analysis of the numbers (count) and gender of psychiatrists from 1995 to 2022 working in Australia was conducted. For the period 2013 to 2022, we analysed for rurality, gender, years' experience, hours worked, Medicare-subsidised services provided and proportions of Specialist International Medical Graduates (SIMG) by sex, with a focus on the rural workforce. For international comparison, psychiatrist numbers were obtained for other OECD countries. The number of psychiatrists working in Australia, as per NHWDS and AIHW, was quantified. We analysed trends in demographics, hours worked and rurality of psychiatrists working in Australia in a serial cross-sectional design. FINDINGS Most psychiatrists are maldistributed to major cities, while outer regional and remote areas have few resident psychiatrists. Outer regional New South Wales (NSW) and South Australia (SA) have the lowest numbers of psychiatrists per capita. The full-time equivalent (FTE) of psychiatrists per 100 000 has increased from 12.6 in 2000 to 15.2 in 2022. However, the average hours worked by psychiatrists has declined. In total, available psychiatrist hours worked per 100 000 population has increased by 6.1% since the beginning of the millennium. DISCUSSION Rural areas in NSW and SA have the greatest shortage of psychiatrists. Specialist International Medical Graduates and females (43% of the overall workforce) are the predominant workforce in rural areas. Although Medicare-subsidised services per 1000 people have increased in rural areas, they remain lower than for those living in major cities. CONCLUSION There remains an acute shortage of psychiatrists in many regional and remote areas of Australia, with an increasing proportion of SIMGs and females working in these areas, in the context of future increased demand.
Collapse
Affiliation(s)
- Catherine Mary Hayter
- Mental Health, Justice Health, Alcohol and Drug Services, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Stephen Allison
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, Australian Capital Territory, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, Australian Capital Territory, Australia
- Discipline of Psychiatry, Monash University, Melbourne, Victoria, Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, Australian Capital Territory, Australia
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, Queensland, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| | - Jeffrey C L Looi
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, Australian Capital Territory, Australia
- Academic Unit of Psychiatry and Addiction Medicine, Canberra Hospital, The Australian National University School of Medicine and Psychology, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
8
|
Looi JC, Amos A, Loi S, Bastiampillai T, Reutens S, Woon L, Maguire PA, Kisely S, Miller E, Benipal A, Wilkes F. Australasian psychiatry - for the art and science of psychiatry. Australas Psychiatry 2024; 32:113-117. [PMID: 38342996 DOI: 10.1177/10398562241232749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia; Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Andrew Amos
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Samantha Loi
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia; Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Department of Psychiatry, Monash University, Clayton, VIC, Australia
| | - Sharon Reutens
- Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Luke Woon
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia; Department of Psychiatry, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia; Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; School of Medicine, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Edward Miller
- Division of Psychological Medicine, Faculty of Medical & Health Science, University of Auckland, Auckland, New Zealand
| | | | - Fiona Wilkes
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia
| |
Collapse
|
9
|
Kisely S, Bull C, Trott M, Arnautovska U, Siskind D, Warren N, Najman JM. Emergency department presentations for deliberate self-harm and suicidal ideation in 25-39 years olds following agency-notified child maltreatment: results from the Childhood Adversity and Lifetime Morbidity (CALM) study. Epidemiol Psychiatr Sci 2024; 33:e18. [PMID: 38532726 PMCID: PMC11022258 DOI: 10.1017/s2045796024000192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 03/28/2024] Open
Abstract
AIMS To compare prospective reports of child maltreatment (CM) with emergency department (ED) presentations for deliberate self-harm (DSH) and suicidal ideation in individuals aged between 25 and 39 years old. METHODS Linked records between the Mater-University of Queensland Study of Pregnancy birth cohort and Queensland administrative health data were used, which included notifications to child protection agencies for CM. ED presentations for individuals aged between 25 and 39 years of age for suicidal ideation, suicidal behaviour or poisoning by paracetamol or psychotropic medications where the intention was unclear were examined using logistic regression analyses. RESULTS A total of 609 (10.1%) individuals were the subject of one or more CM notifications for neglect or physical, sexual or emotional abuse before the age of 15 years. Of these, 250 (4.1%) presented at least once to ED for DSH and/or suicidal ideation between 25 and 39 years of age. In adjusted analysis, any notification of CM was associated with significantly increased odds of presenting to ED for these reasons (aOR = 2.80; 95% CI = 2.04-3.84). In sensitivity analyses, any notification of CM increased the odds of the combined outcome of DSH and suicidal ideation by 275% (aOR = 2.75; 95% CI = 1.96-4.06) and increased the odds of DSH alone by 269% (aOR = 2.69; 95% CI = 1.65-4.41). CONCLUSIONS All CM types (including emotional abuse and neglect) were associated with ED presentations for DSH and suicidal ideation in individuals between 25 and 39 years of age. These findings have important implications for the prevention of DSH, suicidal ideation and other health outcomes. They also underscore the importance of trauma-informed care in ED for all individuals presenting with DSH and suicidal ideation.
Collapse
Affiliation(s)
- S. Kisely
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - C. Bull
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - M. Trott
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - U. Arnautovska
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - D. Siskind
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - N. Warren
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - J. Moses Najman
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- School of Social Sciences, The University of Queensland, St Lucia, QLD, Australia
| |
Collapse
|
10
|
Woon LSC, Allison S, Bastiampillai T, Kisely S, Maguire P, Pring W, Reay R, Looi JC. Comparison of the out-of-pocket costs of Medicare-funded telepsychiatry and face-to-face consultations: A descriptive study. Australas Psychiatry 2024:10398562241237128. [PMID: 38438122 DOI: 10.1177/10398562241237128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE Telepsychiatry items in the Australian Medicare Benefits Schedule (MBS) were expanded following the COVID-19 pandemic. However, their out-of-pocket costs have not been examined. We describe and compare patient out-of-pocket payments for face-to-face and telepsychiatry (videoconferencing and telephone) MBS items for outpatient psychiatric services to understand the differential out-of-pocket cost burden for patients across these modalities. METHODS out-of-pocket cost information was obtained from the Medical Costs Finder website, which extracted data from Services Australia's Medicare claims data in 2021-2022. Cost information for corresponding face-to-face, video, and telephone MBS items for outpatient psychiatric services was compared, including (1) Median specialist fees; (2) Median out-of-pocket payments; (3) Medicare reimbursement amounts; and (4) Proportions of patients subject to out-of-pocket fees. RESULTS Medicare reimbursements are identical for all comparable face-to-face and telepsychiatry items. Specialist fees for comparable items varied across face-to-face to telehealth options, with resulting differences in out-of-pocket costs. For video items, higher proportions of patients were not bulk-billed, with greater out-of-pocket costs than face-to-face items. However, the opposite was true for telephone items compared with face-to-face items. CONCLUSIONS Initial cost analyses of MBS telepsychiatry items indicate that telephone consultations incur the lowest out-of-pocket costs, followed by face-to-face and video consultations.
Collapse
Affiliation(s)
- Luke S-C Woon
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine and Psychology, Canberra Hospital, The Australian National University Medical, Canberra, ACT, Australia; and
- Department of Psychiatry, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; and
- Department of Psychiatry, Monash University, Clayton, VIC, Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
- School of Medicine, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia; and
- Departments of Psychiatry, Community Health and Epidemiology, Dalhouise University, Halifax, NS, Canada
| | - Paul Maguire
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine and Psychology, Canberra Hospital, The Australian National University Medical, Canberra, ACT, Australia; and
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - William Pring
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
- Centre for Mental Health Education and Research at Delmont Private Hospital, Melbourne, VIC, Australia; and
- Egmont Terrace Specialist Rooms, Private Psychiatrist, Melbourne, VIC, Australia
| | - Rebecca Reay
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine and Psychology, Canberra Hospital, The Australian National University Medical, Canberra, ACT, Australia
| | - Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine and Psychology, Canberra Hospital, The Australian National University Medical, Canberra, ACT, Australia; and
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| |
Collapse
|
11
|
Betts KS, Kisely S, Alati R. Exploring the relationships between pathogen-specific prenatal infections requiring inpatient admission and domains of offspring behaviour at age 5. J Child Psychol Psychiatry 2024. [PMID: 38385623 DOI: 10.1111/jcpp.13964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Research exploring the relationship between prenatal infection and child behavioural outcomes would benefit from further studies utilising full-population samples with the scale to investigate specific infections and to employ robust designs. We tested the association among several common infections requiring inpatient admission during and after pregnancy with a range of childhood behavioural outcomes, to determine whether any negative impact was specific to the period of foetal development. METHODS The sample included all mother-offspring pairs from the Australian state of New South Wales (NSW) for whom the child commenced their first year of full-time schooling in 2009 (~age 5 years; n = 77,302 offspring), with records linked across four health administrative data sets including the NSW perinatal data collection (PDC), the NSW admitted patient data collection (APDC) and the NSW component of the 2009 Australian Early Development Census (AEDC). Multivariable linear regression was used to test associations between a number of infections requiring inpatient admission during and after pregnancy with a range of teacher assessed behavioural outcomes. RESULTS Associations specific to the prenatal period were only found for streptococcus A although this would need to be reproduced in external samples given the low prevalence. Otherwise, 12 out of 15 selected infections either showed no association prenatally or also demonstrated associations in the 12 months after pregnancy. For example, prenatal hepatitis C, influenza and urinary E. coli infections were associated with lower scores of several domains of childhood behaviour, but even stronger associations were found when these same maternal infections occurred after pregnancy. CONCLUSIONS The prenatal infections we tested appeared not to impact childhood behaviour by altering foetal neurodevelopment. Rather, the strong associations we found among infections occurring during and after pregnancy point to either residual socioeconomic/lifestyle factors or a shared familial/genetic liability between infections and behavioural problems.
Collapse
Affiliation(s)
- Kim Steven Betts
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Rosa Alati
- School of Population Health, Curtin University, Perth, WA, Australia
| |
Collapse
|
12
|
Kisely S, Strathearn L, Najman JM. Self-Reported and Agency-Notified Child Abuse as Contributors to Suicidal Behaviour in a Population-Based Birth Cohort Study at 30-Year-Follow-Up. Child Maltreat 2024; 29:155-164. [PMID: 36127307 DOI: 10.1177/10775595221127923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This was a record-linkage analysis of a birth cohort to examine the association between self-reported self-harm in adulthood and childhood maltreatment (CM) as prospectively notified to authorities and self-reported on the Child Trauma Questionnaire. There were 2507 participants at 30-year follow-up with data on both CM and self-reported self-harm including an intent to die. Of the participants, 304 (12.1%) had self-harmed at some time in their lives while 150 (4.2%) had wanted to die. The prevalence of self- and agency-reported maltreatment was 513 (20.5%) and 143 (5.7%) respectively. On adjusted analyses, CM irrespective of reporting source showed significant associations with both suicidal outcomes. Physical and emotional abuse showed the strongest associations while findings for neglect were mixed. The only association for sexual abuse was for self-reported maltreatment and intent to die but numbers may have been under-powered.
Collapse
Affiliation(s)
- Steve Kisely
- School of Medicine, University of Queensland, Princess Alexandra Hospital, Woolloongabb, Queensland, Australia
- Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada
| | - Lane Strathearn
- Stead Family Department of Paediatrics, Developmental and Behavioural Paediatrics, University of Iowa, Iowa, USA
- Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Jake Moses Najman
- School of Public Health, The University of Queensland, Public Health Building, Herston, , Queensland, Australia
| |
Collapse
|
13
|
Looi JCL, Allison S, Bastiampillai T, Maguire PA, Kisely S, Looi RCH. Mitigating the consequences of electronic health record data breaches for patients and healthcare workers. AUST HEALTH REV 2024; 48:4-7. [PMID: 38109886 DOI: 10.1071/ah23258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023]
Abstract
Electronic health records (EHRs) have been widely adopted in Australian public sector healthcare and will remain an ongoing, essential data system. However, recent substantial data breaches from hacked business data systems in Australian enterprises, as well as international healthcare providers, mean that EHR data breaches are increasingly likely in Australia. Risks include medical identity theft and extortion attempts based on threats to release sensitive patient information. Hacking is now a foreseeable additional risk of medical treatment. Risk mitigation for the consequences of data breaches needs to be considered, as well as support for patients (and families) and healthcare workers. This includes identity theft protection services, cybersecurity insurance, and psychological support.
Collapse
Affiliation(s)
- Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine and Psychology, The Australian National University, Canberra Hospital, Building 4, Level 2, PO Box 11, Garran, Canberra, ACT 2605, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; and Department of Psychiatry, Monash University, Wellington Road, Clayton, Vic., Australia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine and Psychology, The Australian National University, Canberra Hospital, Building 4, Level 2, PO Box 11, Garran, Canberra, ACT 2605, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | | |
Collapse
|
14
|
Looi JCL, Allison S, Bastiampillai T, Kisely S, Pring W. Medicare Benefits Schedule (MBS) Review Advisory Committee post-implementation review of MBS telehealth items: abolition of initial telehealth consultations for non-general practitioner specialists. AUST HEALTH REV 2024; 48:34-36. [PMID: 38245912 DOI: 10.1071/ah23237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024]
Abstract
In 2022, the Australian Federal Minister for Health and Aged Care commissioned the Medicare Benefits Schedule (MBS) Review Advisory Committee (MRAC) to conduct a post-implementation review of MBS telehealth services, including settings of video and telephone consultations. The MRAC has made a series of administrative recommendations for telehealth practice that appear at cross-purposes to the evidence-base on medical consultations and that would limit patient access to medical specialist assessment in Australia. These recommendations particularly underestimate the role of telehealth in rural and remote Australia and did not take into account high patient satisfaction with telehealth assessment and treatment during the ongoing coronavirus disease 2019 (COVID-19) pandemic. They also appear to contradict the Medical Board of Australia's guidance on telehealth. On this basis, the recommendations for telehealth principles and abolition of reimbursement for telehealth for all initial non-general practitioner medical specialist consultations should be withdrawn.
Collapse
Affiliation(s)
- Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Building 4, Level 2, PO Box 11, Garran, Canberra, ACT 2605, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; and Department of Psychiatry, Monash University, Wellington Road, Clayton, Vic., Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - William Pring
- Delmont Private Hospital, Glen Iris, Vic., Australia; and Department of Psychiatry, Monash University, Clayton, Vic., Australia
| |
Collapse
|
15
|
Forbes M, Stuckey S, Kisely S. Concerns Regarding Strength of Conclusions in Systematic Review and Meta-Analysis of Neuroradiological Abnormalities in First-Episode Psychosis. JAMA Psychiatry 2024; 81:107. [PMID: 37966810 DOI: 10.1001/jamapsychiatry.2023.4390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- Malcolm Forbes
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
| | - Stephen Stuckey
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
16
|
Northwood K, Myles N, Clark SR, Every-Palmer S, Myles H, Kisely S, Warren N, Siskind D. Evaluating the epidemiology of clozapine-associated neutropenia among people on clozapine across Australia and Aotearoa New Zealand: a retrospective cohort study. Lancet Psychiatry 2024; 11:27-35. [PMID: 38040009 DOI: 10.1016/s2215-0366(23)00343-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Clozapine is associated with the risk of serious neutropenia. However, this risk might decrease over time, meaning that indefinite absolute neutrophil count (ANC) monitoring could be unnecessary. We aimed to determine the epidemiology and timing of clozapine-associated neutropenia outcomes, to investigate variables that might contribute to the odds of neutropenia, and to determine risk of competing neutropenic events during clozapine treatment. METHODS We performed a retrospective analysis of the Australian and New Zealand Viatris Pharmacovigilance system (one of two monitoring databases for these two countries) between June 6, 1990, and Oct 25, 2022. Patients were excluded from analysis if they commenced clozapine before 1990, did not have a haematology test within 2 weeks of commencement date, or had no follow-up. We measured minor neutropenia (ANC 1·0-1·5 × 109 per L) and serious neutropenia (ANC <1·0 × 109 per L) leading to cessation of clozapine within 6 weeks of the neutropenic event. We determined the rates of minor and serious neutropenia and calculated odds ratios (ORs) for the likelihood of neutropenia leading to cessation. For serious neutropenia leading to cessation, we used time-to-event to calculate rolling weekly averages and to perform competing risk analysis of outcomes using Cox proportional hazards models and a Fine-Gray subdistribution hazards regression model. For the subset of data where information on previous clozapine use was available, we did an analysis for participants who did and did not have previous clozapine exposure. FINDINGS We included 26 630 people, with 2·6 million ANC values. Within the total cohort, 17 585 people (66%) were male, 9025 (33·9%) female, and 20 (0·1%) other gender, and the mean age was 36·1 years (SD 13·7). We did not have data on race or ethnicity. Of the 26 630 people taking clozapine, 1146 (4·3%) had minor neutropenia, 313 (1·2%) had serious neutropenia leading to cessation, and 223 (0·8%) had serious neutropenia unrelated to clozapine without cessation. In people with no previous exposure to clozapine (n=15 973), the cumulative incidence of serious neutropenia leading to cessation was 0·9% at 18 weeks and 1·4% at 2 years; the weekly incidence rate for serious neutropenia leading to cessation peaked at 9 weeks (0·128%) and fell to a rolling average weekly incidence of 0·001% by 2 years. For minor neutropenia, the cumulative incidence was 1·7% at 18 weeks and 3·5% at 2 years; the weekly incidence rate peaked at 9 weeks (0·218%) and fell to a stable rolling average of 0·01%. The median time to a serious neutropenic event leading to cessation was 17 weeks (IQR 9·96-102). Previous clozapine exposure reduced the risk of serious neutropenia leading to cessation (OR 0·19, 95% CI 0·12-0·31; p <0·0001). INTERPRETATION Most serious neutropenia leading to clozapine cessation occurs within 18 weeks of treatment and becomes negligible after 2 years. Weekly haematological monitoring after the first 18 weeks could be safely reduced to once every 4 weeks and ceased after 2 years unless clinically indicated. Clozapine retrial after interruption with 2 cumulative years of unremarkable testing might not require further haematological monitoring. A serious neutropenia ANC threshold of ≤1·0 × 109 per L could be used in more jurisdictions. FUNDING None.
Collapse
Affiliation(s)
- Korinne Northwood
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Metro South Addiction and Mental Health Service, Metro South Health, Brisbane, QLD, Australia; Physical and Mental Health Stream, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Nicholas Myles
- Discipline of Psychiatry, Adelaide University, Adelaide, SA, Australia
| | - Scott R Clark
- Discipline of Psychiatry, Adelaide University, Adelaide, SA, Australia
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Hannah Myles
- Northern Adelaide Health Network, Adelaide, SA, Australia
| | - Steve Kisely
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Metro South Addiction and Mental Health Service, Metro South Health, Brisbane, QLD, Australia; Physical and Mental Health Stream, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Nicola Warren
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Metro South Addiction and Mental Health Service, Metro South Health, Brisbane, QLD, Australia
| | - Dan Siskind
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Metro South Addiction and Mental Health Service, Metro South Health, Brisbane, QLD, Australia; Physical and Mental Health Stream, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia.
| |
Collapse
|
17
|
Najman JM, Kisely S, Scott JG, Ushula TW, Williams GM, Clavarino AM, McGee TR, Mamun AA, Wang WYS. Gender differences in cardiovascular disease risk: Adolescence to young adulthood. Nutr Metab Cardiovasc Dis 2024; 34:98-106. [PMID: 38016890 DOI: 10.1016/j.numecd.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND AND AIMS Gender differences in cardiovascular disease (CVD) have been well documented but rarely for young adults and the extent to which gender related lifestyle differences may contribute to gender differences in CVD risk experienced by young adults have not been reported. METHODS AND RESULTS Data are from a long-running cohort study, the Mater-University of Queensland Study of Pregnancy (MUSP). We track gender differences in CVD related behaviours at 21 and 30 years (consumption of a Western Diet/Health-Oriented Diet, cigarette smoking, vigorous physical exercise, heavy alcohol consumption). At 30 years we compare males and females for CVD risk, and the extent to which lifestyle behaviours at 21 and 30 years contribute to CVD risk. At both 21 and 30 years of age, males more frequently consume a Western Diet and less often a Health Oriented Diet. By contrast, males are also much more likely to report engaging in vigorous physical activity. On most CVD markers, males exhibit much higher levels of risk than do females at both 21 and 30 years. At 30 years of age males have about five times the odds of being at high risk of CVD. Some lifestyle behaviours contribute to this additional risk. CONCLUSION Young adult males much more frequently engage in most CVD related risk behaviours and males have a higher level of CVD risk. Gender differences in CVD risk remain high even after adjustment for CVD lifestyles, though dietary factors independently contribute to CVD risk at 30 years.
Collapse
Affiliation(s)
- Jake M Najman
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Road, Herston, Qld 4006, Australia.
| | - Steve Kisely
- Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Qld 4102, Australia
| | - James G Scott
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia; Child and Youth Mental Health Service, Children's Health Queensland, South Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Wacol, QLD, Australia
| | - Tolassa W Ushula
- UQ Poche Centre for Indigenous Health, The University of Queensland, 74 High Street, Toowong, Qld 4066, Australia
| | - Gail M Williams
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Road, Herston, Qld 4006, Australia
| | - Alexandra M Clavarino
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Road, Herston, Qld 4006, Australia
| | - Tara R McGee
- School of Criminology and Criminal Justice, Griffith University, 176 Messines Ridge Road, Mount Gravatt, Qld 4122, Australia
| | - Abdullah A Mamun
- School of Criminology and Criminal Justice, Griffith University, 176 Messines Ridge Road, Mount Gravatt, Qld 4122, Australia
| | - William Y S Wang
- Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Qld 4102, Australia
| |
Collapse
|
18
|
Looi JCL, Kisely S, Allison S, Bastiampillai T, Maguire PA. The unfulfilled promises of electronic health records. AUST HEALTH REV 2023; 47:744-746. [PMID: 37866822 DOI: 10.1071/ah23192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
We provide a brief update on the current evidence on electronic health records' benefits, risks, and potential harms through a rapid narrative review. Many of the promised benefits of electronic health records have not yet been realised. Electronic health records are often not user-friendly. To enhance their potential, electronic health record platforms should be continuously evaluated and enhanced by carefully considering feedback from all stakeholders.
Collapse
Affiliation(s)
- Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Building 4, Level 2, PO Box 11, Canberra, ACT 2605, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; and Department of Psychiatry, Monash University, Wellington Road, Clayton, Vic., Australia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Building 4, Level 2, PO Box 11, Canberra, ACT 2605, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| |
Collapse
|
19
|
Allison S, Bastiampillai T, Kisely S, Looi JCL. Deterioration of mild anxiety and depression with Better Access treatment: implications for scaling up psychotherapy worldwide. AUST HEALTH REV 2023; 47:741-743. [PMID: 37844607 DOI: 10.1071/ah23163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
The Australian Medicare Better Access initiative in mental health reached one in every 10 Australians in 2021 (more than 2.6 million people) with interventions targeted at mild-to-moderate anxiety and depression, provided by general practitioners, allied health professionals, and/or psychiatrists, at a cost of AUD1.2 billion. However, the overall mental health of the Australian population has not improved since the introduction of Better Access. The benefits of population-scale mental health interventions (medications and psychotherapies) might have been overestimated for milder conditions, and the iatrogenic potential underestimated. A recent evaluation of Better Access found that mild anxiety and depressive symptoms were threefold more likely to worsen (32%) rather than improve (10%). Better Access might be targeted more cost-effectively towards severe and complex conditions, for which treatment appears to have superior risk-benefit ratios. These findings have implications for similar initiatives worldwide, such as those proposed by the World Health Organization.
Collapse
Affiliation(s)
- Stephen Allison
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA 5042, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Tarun Bastiampillai
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA 5042, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and Department of Psychiatry, Monash University, Wellington Road, Clayton, Vic., Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Jeffrey C L Looi
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia
| |
Collapse
|
20
|
Looi JCL, Allison S, Bastiampillai T, Kisely S. What have been the clinical outcomes of the Project Synergy/InnoWell digital health platform? AUST HEALTH REV 2023; 47:747-749. [PMID: 37814472 DOI: 10.1071/ah23159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023]
Abstract
Project Synergy is a digital mental health tool for assessment, referral and follow-up of people with mental health problems. The Australian federal government Department of Health entered an AUD33 million formal funding arrangement with InnoWell, a proprietary company vehicle (primarily the consultancy firm PwC and University of Sydney) to continue development of Project Synergy. This followed an initial federal National Health and Medical Research Council grant of AUD5.5 million over the previous 3 years. However, based on the assessment of peer-reviewed research data, the Project Synergy/InnoWell platform does not seem to have demonstrated clinical outcomes of healthcare value to date.
Collapse
Affiliation(s)
- Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; and Department of Psychiatry, Monash University, Wellington Rd, Clayton, Vic., Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
21
|
Warren N, Leske S, Arnautovska U, Northwood K, Kisely S, Siskind D. Prevalence of frailty in severe mental illness: findings from the UK Biobank. BJPsych Open 2023; 9:e185. [PMID: 37821357 PMCID: PMC10594184 DOI: 10.1192/bjo.2023.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/28/2023] [Accepted: 09/10/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Severe mental illness (SMI) is associated with significant morbidity. Frailty combines biological ageing, comorbidity and psychosocial factors and can predict adverse health outcomes. Emerging evidence indicates that frailty is higher in individuals with SMI than in the general population, although studies have been limited by sample size. AIMS To describe the prevalence of frailty in people with SMI in a large cohort using three different frailty measures and examine the impact of demographic and sociodemographic variables. METHOD The UK Biobank survey data, which included individuals aged 37-73 years from England, Scotland and Wales from 2006 to 2010, with linked in-patient hospital episodes, were utilised. The prevalence of frailty in individuals with and without SMI was assessed through three frailty measures: frailty index, physical frailty phenotype (PFP) and Hospital Frailty Risk Score (HFRS). Stratified analysis and dichotomous logistic regression were conducted. RESULTS A frailty index could be calculated for 99.5% of the 502 412 UK Biobank participants and demonstrated greater prevalence of frailty in women and an increase with age. The prevalence of frailty for those with SMI was 3.19% (95% CI 3.0-3.4), 4.2% (95% CI 3.8-4.7) and 18% (95% CI 15-23) using the frailty index, PFP and HFRS respectively. The prevalence ratio was between 3 and 18 times higher than in those without SMI. CONCLUSIONS As a measure, frailty captures the known increase in morbidity associated with SMI and may potentially allow for earlier identification of those who will benefit from targeted interventions.
Collapse
Affiliation(s)
- Nicola Warren
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; and Metro South Addiction and Mental Health Service, Metro South Health, Brisbane, Australia
| | - Stuart Leske
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Urska Arnautovska
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; and Metro South Addiction and Mental Health Service, Metro South Health, Brisbane, Australia
| | - Korinne Northwood
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; and Metro South Addiction and Mental Health Service, Metro South Health, Brisbane, Australia
| | - Steve Kisely
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; and Metro South Addiction and Mental Health Service, Metro South Health, Brisbane, Australia
| | - Dan Siskind
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; and Metro South Addiction and Mental Health Service, Metro South Health, Brisbane, Australia
| |
Collapse
|
22
|
Plever S, Kisely S, Bonevski B, McCarthy I, Emmerson B, Ballard E, Anzolin M, Siskind D, Allan J, Gartner C. Can improvement in delivery of smoking cessation care be sustained in psychiatry inpatient settings through a system change intervention? An analysis of statewide administrative health data. Aust N Z J Psychiatry 2023; 57:1375-1383. [PMID: 37038343 DOI: 10.1177/00048674231164566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE This study evaluated maintenance of improved delivery of smoking cessation assistance in adult acute psychiatry inpatient units 3 years post statewide implementation of a system change intervention through analysis of a statewide administrative health dataset. METHOD Rates of documenting smoking status and providing a brief smoking cessation intervention (the Smoking Cessation Clinical Pathway) in all eligible Queensland public adult acute psychiatry inpatient units (N = 57) during the implementation phase (October 2015-September 2017) of a system change intervention were compared to the maintenance phase (October 2017-October 2020) using interrupted time series analysis. RESULTS Across implementation and maintenance phases, the percentage of discharges from psychiatry inpatient units that had a smoking status recorded remained high with the statewide average exceeding 90% (implementation phase 93.2%, 95% confidence interval = [92.4, 93.9]; and maintenance phase 94.6%, 95% confidence interval = [94.0, 95.2]). The percentage of discharges statewide with a completed Pathway stabilised during the maintenance phase (change in slope -3.7%, 95% confidence interval = [-5.2, -2.3]; change in level 0.4%, 95% confidence interval = [-7.0, 7.9]). CONCLUSION An evidence-based smoking cessation intervention implemented with a system change intervention resulted in sustained improvement in addressing smoking in adult inpatient psychiatry units up to 3 years post implementation.
Collapse
Affiliation(s)
- Sally Plever
- The QLD Mental Health Clinical Collaborative, Metro North Mental Health, Brisbane, QLD, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, QLD, Australia
| | - Steve Kisely
- Department of Psychiatry, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - Billie Bonevski
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, QLD, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Irene McCarthy
- The QLD Mental Health Clinical Collaborative, Metro North Mental Health, Brisbane, QLD, Australia
| | - Brett Emmerson
- The QLD Mental Health Clinical Collaborative, Metro North Mental Health, Brisbane, QLD, Australia
| | - Emma Ballard
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Melissa Anzolin
- The QLD Mental Health Clinical Collaborative, Metro North Mental Health, Brisbane, QLD, Australia
| | - Dan Siskind
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, QLD, Australia
- Department of Psychiatry, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - John Allan
- Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Queensland Health, Brisbane, QLD, Australia
| | - Coral Gartner
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
23
|
Affiliation(s)
- Steve Kisely
- Metro South Mental Health, Woolloongabba, QLD, Australia
- Princess Alexandra Hospital, School of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| |
Collapse
|
24
|
Leichsenring F, Abbass A, Heim N, Keefe JR, Kisely S, Luyten P, Rabung S, Steinert C. The status of psychodynamic psychotherapy as an empirically supported treatment for common mental disorders - an umbrella review based on updated criteria. World Psychiatry 2023; 22:286-304. [PMID: 37159376 PMCID: PMC10168167 DOI: 10.1002/wps.21104] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
To assess the current status of psychodynamic therapy (PDT) as an empirically supported treatment (EST), we carried out a pre-registered systematic umbrella review addressing the evidence for PDT in common mental disorders in adults, based on an updated model for ESTs. Following this model, we focused on meta-analyses of randomized controlled trials (RCTs) published in the past two years to assess efficacy. In addition, we reviewed the evidence on effectiveness, cost-effectiveness and mechanisms of change. Meta-analyses were evaluated by at least two raters using the proposed updated criteria, i.e. effect sizes, risk of bias, inconsistency, indirectness, imprecision, publication bias, treatment fidelity, and their quality as well as that of primary studies. To assess the quality of evidence we applied the GRADE system. A systematic search identified recent meta-analyses on the efficacy of PDT in depressive, anxiety, personality and somatic symptom disorders. High quality evidence in depressive and somatic symptom disorders and moderate quality evidence in anxiety and personality disorders showed that PDT is superior to (inactive and active) control conditions in reducing target symptoms with clinically meaningful effect sizes. Moderate quality evidence suggests that PDT is as efficacious as other active therapies in these disorders. The benefits of PDT outweigh its costs and harms. Furthermore, evidence was found for long-term effects, improving functioning, effectiveness, cost-effectiveness and mechanisms of change in the aforementioned disorders. Some limitations in specific research areas exist, such as risk of bias and imprecision, which are, however, comparable to those of other evidence-based psychotherapies. Thus, according to the updated EST model, PDT proved to be an empirically-supported treatment for common mental disorders. Of the three options for recommendation provided by the updated model (i.e., "very strong", "strong" or "weak"), the new EST criteria suggest that a strong recommendation for treating the aforementioned mental disorders with PDT is the most appropriate option. In conclusion, PDT represents an evidence-based psychotherapy. This is clinically important since no single therapeutic approach fits all psychiatric patients, as shown by the limited success rates across all evidence-based treatments.
Collapse
Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | | | - Nikolas Heim
- International Psychoanalytic University, Berlin, Germany
| | - John R Keefe
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sven Rabung
- Department of Psychology, University of Klagenfurt, Klagenfurt, Austria
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- International Psychoanalytic University, Berlin, Germany
| |
Collapse
|
25
|
Ogilvie JM, Tzoumakis S, Thompson C, Allard T, Dennison S, Kisely S, Stewart A. Psychiatric illness and the risk of reoffending: recurrent event analysis for an Australian birth cohort. BMC Psychiatry 2023; 23:355. [PMID: 37221485 DOI: 10.1186/s12888-023-04839-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/03/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Psychiatric illness is a well-established risk factor for criminal justice system involvement, but less is known about the relationships between specific psychiatric illnesses and reoffending. Research typically examines reoffending as a single discrete event. We examined the relationship between different psychiatric disorders and types of reoffending while accounting for multiple reoffending events over time. METHODS Data were drawn from a population cohort of 83,039 individuals born in Queensland, Australia, in 1983 and 1984 and followed to age 29-31 years. Psychiatric diagnoses were drawn from inpatient health records and offending information was drawn from court records. Descriptive and recurrent event survival analyses were conducted to examine the association between psychiatric disorders and reoffending. RESULTS The cohort included 26,651 individuals with at least one proven offence, with 3,580 (13.4%) of these individuals also having a psychiatric disorder. Individuals with any psychiatric disorder were more likely to reoffend compared to those without a disorder (73.1% vs. 56.0%). Associations between psychiatric disorders and reoffending varied across age. Individuals with a psychiatric disorder only started to accumulate more reoffending events from ~ 27 years, which accelerated up to age 31 years. There were both specificity and common effects in the associations between different psychiatric disorders and types of reoffending. CONCLUSIONS Findings demonstrate the complexity and temporal dependency of the relationship between psychiatric illness and reoffending. These results reveal the heterogeneity present among individuals who experience psychiatric illness and contact with the justice system, with implications for intervention delivery, particularly for those with substance use disorders.
Collapse
Affiliation(s)
- James M Ogilvie
- School of Criminology and Criminal Justice, Griffith University, Mount Gravatt, QLD, Australia.
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia.
| | - Stacy Tzoumakis
- School of Criminology and Criminal Justice, Griffith University, Mount Gravatt, QLD, Australia
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia
| | - Carleen Thompson
- School of Criminology and Criminal Justice, Griffith University, Mount Gravatt, QLD, Australia
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia
| | - Troy Allard
- School of Criminology and Criminal Justice, Griffith University, Mount Gravatt, QLD, Australia
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia
| | - Susan Dennison
- School of Criminology and Criminal Justice, Griffith University, Mount Gravatt, QLD, Australia
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia
| | - Steve Kisely
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia
- School of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Anna Stewart
- School of Criminology and Criminal Justice, Griffith University, Mount Gravatt, QLD, Australia
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia
| |
Collapse
|
26
|
Kisely S, Looi JC. Latest evidence casts further doubt on the effectiveness of headspace. Med J Aust 2023. [PMID: 37182904 DOI: 10.5694/mja2.51944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/06/2023] [Accepted: 04/20/2023] [Indexed: 05/16/2023]
|
27
|
Allison S, Looi JC, Kisely S, Bastiampillai T. Could negative outcomes of psychotherapies be contributing to the lack of an overall population effect from the Australian Better Access initiative? Australas Psychiatry 2023:10398562231172417. [PMID: 37097000 DOI: 10.1177/10398562231172417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
OBJECTIVE We examine deterioration in psychotherapies, as reported in the recent evaluation of the Australian Medicare Better Access initiative. CONCLUSION A focus on patients who experience poor clinical outcomes helps programs minimise harm and improve quality of care. The Better Access evaluation found the mental health of 20-40% of patients deteriorated. This may partly explain why population distress and suicide rates were not reduced by the introduction of the Better Access initiative. Deterioration was more likely for milder conditions, and less likely for severe conditions, which also improved the most. Using severity as a criterion for priority setting and resource allocation may minimise patient risk and maximise benefits. Patients with severe conditions may require considerably more sessions than the current average for Better Access psychotherapies.
Collapse
Affiliation(s)
- Stephen Allison
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA, Australia; and
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra, ACT, Australia; and
- Consortium of Australian Academic Psychiatrists for Independent Policy Research and Analysis, Canberra, ACT, Australia
| | - Steve Kisely
- School of Medicine, University of Queensland, Woolloongabba, QLD, Australia
| | - Tarun Bastiampillai
- Psychiatry, Flinders University, Adelaide, SA, Australia; and
- Psychiatry, Monash University, Clayton, VIC, Australia
| |
Collapse
|
28
|
Kisely S, McMahon L, Siskind D. Benefits following community treatment orders have an inverse relationship with rates of use: meta-analysis and meta-regression. BJPsych Open 2023; 9:e68. [PMID: 37056174 PMCID: PMC10134313 DOI: 10.1192/bjo.2023.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Community treatment order (CTO) use in Australia and New Zealand ranges from less than 40 per 100 000 population in Western Australia and Canterbury to over 100 per 100 000 in Victoria, South Australia and Waitemata. Recent publications on CTO use now permit a meta-regression to investigate whether differences in CTO use by jurisdiction affect either the possible predictors or outcomes of CTOs. AIMS To assess whether factors associated with CTO placement or subsequent outcomes vary by rates of use. METHOD A systematic search of PubMed/Medline, Embase, CINAHL, the Cochrane Central Register of Controlled Trials and PsycINFO for any Australian or New Zealand study comparing CTO cases with controls receiving voluntary psychiatric treatment. This study was prospectively registered with PROSPERO (protocol registration number: CRD42022351500). RESULTS There were 35 articles from 16 studies identified in the search, plus unpublished data from a further study. Of these, 29 publications were included in meta-analyses. Two were from New Zealand. People who were male, single and not engaged in work, study or home duties were significantly more likely to be on CTOs. In addition, those from migrant backgrounds were 47% more likely to be on an order. On meta-regression, cases in jurisdictions with higher CTO rates had higher proportions of females or individuals with diagnoses other than non-affective psychoses. High-use jurisdictions were also less likely to show reductions in readmission rates or bed-days. CONCLUSIONS There are marked differences in the possible predictors and outcomes of CTO placement between high- and low-use jurisdictions in Australia and New Zealand. These findings may have implications elsewhere and indicate that better-targeted CTO placement might improve outcomes.
Collapse
Affiliation(s)
- Steve Kisely
- The University of Queensland School of Medicine, Queensland, Australia; Metro South Health Service, Woolloongabba, Queensland, Australia; Griffith Criminology Institute, Griffith University, Queensland, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Laura McMahon
- The University of Queensland School of Medicine, Queensland, Australia
| | - Dan Siskind
- The University of Queensland School of Medicine, Queensland, Australia; and Metro South Health Service, Woolloongabba, Queensland, Australia
| |
Collapse
|
29
|
Northwood K, Pearson E, Arnautovska U, Kisely S, Pawar M, Sharma M, Vitangcol K, Wagner E, Warren N, Siskind D. Optimising plasma clozapine levels to improve treatment response: an individual patient data meta-analysis and receiver operating characteristic curve analysis. Br J Psychiatry 2023; 222:241-245. [PMID: 36994656 DOI: 10.1192/bjp.2023.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND Although clozapine is the most efficacious medication for treatment-refractory schizophrenia, not all patients will have an adequate response. Optimising clozapine dose using therapeutic drug monitoring could therefore maximise response. AIMS Using individual patient data, we undertook a receiver operating characteristic (ROC) curve analysis to determine an optimal therapeutic range for clozapine levels to guide clinical practice. METHOD We conducted a systematic review of PubMed, PsycINFO and Embase for studies that provided individual participant level data on clozapine levels and response. These data were analysed using ROC curves to determine the prediction performance of plasma clozapine levels for treatment response. RESULTS We included data on 294 individual participants from nine studies. ROC analysis yielded an area under the curve of 0.612. The clozapine level at the point of optimal diagnostic benefit was 372 ng/mL; at this level, the response sensitivity was 57.3%, and specificity 65.7%. The interquartile range for treatment response was 223-558 ng/mL. There was no improvement in ROC performance with mixed models including patient gender, age or length of trial. Clozapine dose and clozapine concentration to dose ratio did not provide significantly meaningful prediction of response to clozapine. CONCLUSIONS Clozapine dose should be optimised based on clozapine therapeutic levels. We found that a range between 250 and 550 ng/mL could be recommended, while noting that a level of >350 ng/mL is the most optimal for response. Although some patients may not respond without clozapine levels >550 ng/mL, the benefits should be weighed against the increased risk of adverse drug reactions.
Collapse
Affiliation(s)
- Korinne Northwood
- Metro South Addiction and Mental Health Service, Metro South Health, Australia and Faculty of Medicine, University of Queensland, Australia
| | - E Pearson
- College of Medicine and Public Health, Flinders University, Australia
| | - U Arnautovska
- Metro South Addiction and Mental Health Service, Metro South Health, Australia and Faculty of Medicine, University of Queensland, Australia
| | - S Kisely
- Metro South Addiction and Mental Health Service, Metro South Health, Australia and Faculty of Medicine, University of Queensland, Australia
| | - M Pawar
- Metro South Addiction and Mental Health Service, Metro South Health, Australia
| | - M Sharma
- Department of Mental Health, Monash Health, Australia
| | - K Vitangcol
- Faculty of Medicine, University of Queensland, Australia
| | - E Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - N Warren
- Metro South Addiction and Mental Health Service, Metro South Health, Australia and Faculty of Medicine, University of Queensland, Australia
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Metro South Health, Australia and Faculty of Medicine, University of Queensland, Australia
| |
Collapse
|
30
|
Teoh CXW, Thng M, Lau S, Taing MW, Chaw SY, Siskind D, Kisely S. Dry mouth effects from drugs used for depression, anxiety, schizophrenia and bipolar mood disorder in adults: systematic review. BJPsych Open 2023; 9:e53. [PMID: 36938801 PMCID: PMC10044002 DOI: 10.1192/bjo.2023.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Poor oral health is increasingly recognised as an important comorbidity in people with psychiatric illness. One risk factor is psychotropic-induced dry mouth. AIMS To perform a systematic review of the severity of dry mouth due to psychotropic drugs in adults (CRD42021239725). Study quality was assessed using the Cochrane risk of bias tool. METHOD We searched the following databases: PubMed, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL and Web of Science. We included randomised controlled trials (RCTs) measuring the severity of drug-induced hyposalivation and xerostomia. RESULTS Eighteen RCTs with 605 participants were included. Severity of drug-induced dry mouth was compared among eight drug classes and/or against placebo. All studies were published 20 to 40 years ago and included tricyclic antidepressants (TCAs), serotonin specific reuptake inhibitors (SSRIs) and other drug classes. Meta-analysis was not feasible owing to design heterogeneity. TCAs caused more severe dry mouth, both objectively and subjectively, than placebo or other drug classes. SSRIs were generally associated with less severe symptoms. However, there was no information on antipsychotics or more recently available antidepressants, and there was minimal information on mood stabilisers. Most studies were on healthy subjects, limiting the generalisability of findings. Only one study measured both objective and subjective dry mouth, which have different clinical implications. CONCLUSIONS Psychotropic-induced dry mouth is a poorly researched area, and well-designed RCTs of newer psychotropic drugs using standardised objective and subjective measures are indicated. Given the ongoing use of TCAs for treatment-resistant depression, prescribers need to remain vigilant for xerostomia.
Collapse
Affiliation(s)
| | - Millie Thng
- School of Dentistry, University of Queensland, Herston, Queensland, Australia
| | - Serene Lau
- School of Dentistry, University of Queensland, Herston, Queensland, Australia
| | - Meng-Wong Taing
- School of Pharmacy, University of Queensland, Woolloongabba, Queensland, Australia
| | - Sarah Y Chaw
- School of Dentistry, University of Queensland, Herston, Queensland, Australia
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia; and School of Medicine, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Steve Kisely
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada
| |
Collapse
|
31
|
Betts KS, Chai K, Kisely S, Alati R. Development and validation of a machine learning-based tool to predict autism among children. Autism Res 2023; 16:941-952. [PMID: 36899450 DOI: 10.1002/aur.2912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023]
Abstract
Autism is a lifelong condition for which intervention must occur as early as possible to improve social functioning. Thus, there is great interest in improving our ability to diagnose autism as early as possible. We take a novel approach to this challenge by combining machine learning with maternal and infant health administrative data to construct a prediction model capable of predicting autism disorder (defined as ICD10 84.0) in the general population. The sample included all mother-offspring pairs from the Australian state of New South Wales (NSW) between January 2003 and December 2005 (n = 262,650 offspring), linked across three health administrative data sets including the NSW perinatal data collection (PDC); the NSW admitted patient data collection (APDC) and the NSW mental health ambulatory data collection (MHADC). Our most successful model was able to predict autism disorder with an area under the receiver operating curve of 0.73, with the strongest risk factors for diagnoses found to include offspring gender, maternal age at birth, delivery analgesia, maternal prenatal tobacco disorders, and low 5-min APGAR score. Our findings indicate that the combination of machine learning and routinely collected admin data, with further refinement and increased accuracy than achieved by us, may play a role in the early detection of autism disorders.
Collapse
Affiliation(s)
- Kim Steven Betts
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Kevin Chai
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Rosa Alati
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
32
|
Kisely S, Alotiby MKN, Protani MM, Soole R, Arnautovska U, Siskind D. Breast cancer treatment disparities in patients with severe mental illness: A systematic review and meta-analysis. Psychooncology 2023; 32:651-662. [PMID: 36892099 DOI: 10.1002/pon.6120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE The incidence and mortality rates of breast cancer in individuals with pre-existing severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major depression, are higher than in the general population. Reduced screening is one factor but there is less information on possible barriers to subsequent treatment following diagnosis. METHODS We undertook a systematic review and meta-analysis on access to guideline-appropriate care following a diagnosis of breast cancer in people with SMI including the receipt of surgery, endocrine, chemo- or radiotherapy. We searched for full-text articles indexed by PubMed, EMBASE, PsycInfo and CINAHL that compared breast cancer treatment in those with and without pre-existing SMI. Study designs included population-based cohort or case-control studies. RESULTS There were 13 studies included in the review, of which 4 contributed adjusted outcomes to the meta-analyses. People with SMI had a reduced likelihood of guideline-appropriate care (RR = 0.83, 95% CI = 0.77-0.90). Meta-analyses were not possible for the other outcomes but in adjusted results from a single study, people with SMI had longer wait-times to receiving guideline-appropriate care. The results for specific outcomes such as surgery, hormone, radio- or chemotherapy were mixed, possibly because results were largely unadjusted for age, comorbidities, or cancer stage. CONCLUSIONS People with SMI receive less and/or delayed guideline-appropriate care for breast cancer than the general population. The reasons for this disparity warrant further investigation, as does the extent to which differences in treatment access or quality contribute to excess breast cancer mortality in people with SMI.
Collapse
Affiliation(s)
- Steve Kisely
- University of Queensland, School of Clinical Medicine, Brisbane, Queensland, Australia.,Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Melinda M Protani
- University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - Rebecca Soole
- University of Queensland, School of Clinical Medicine, Brisbane, Queensland, Australia.,Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| | - Urska Arnautovska
- University of Queensland, School of Clinical Medicine, Brisbane, Queensland, Australia.,Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| | - Dan Siskind
- University of Queensland, School of Clinical Medicine, Brisbane, Queensland, Australia.,Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| |
Collapse
|
33
|
Kisely S, Leske S, Arnautovska U, Siskind D, Warren N, Northwood K, Suetani S, Najman JM. A 40-year study of child maltreatment over the early life course predicting psychiatric morbidity, using linked birth cohort and administrative health data: protocol for the Childhood Adversity and Lifetime Morbidity (CALM) study. BJPsych Open 2023; 9:e50. [PMID: 36880844 PMCID: PMC10044170 DOI: 10.1192/bjo.2023.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Child maltreatment is a major public health issue worldwide. Retrospective studies show a strong association between self-reported child maltreatment and poor mental and physical health problems. Prospective studies that use reports to statutory agencies are less common, and comparisons of self- and agency-reported abuse in the same cohort even rarer. AIMS This project will link state-wide administrative health data with prospective birth cohort data (N = 7223) from Brisbane in Queensland, Australia (including notifications to child protection agencies), to compare psychiatric outcomes in adulthood of agency- and self-reported child maltreatment while minimising attrition bias. METHOD We will compare people with all forms of self- and agency-reported child maltreatment to the rest of the cohort, adjusting for confounding in logistic, Cox or multiple regression models based on whether outcomes are categorical or continuous. Outcomes will be hospital admissions, emergency department presentations or community/out-patient contacts for ICD-10 psychiatric diagnoses, suicidal ideation and self-harm as recorded in the relevant administrative databases. CONCLUSIONS This study will track the life course outcomes of adults after having experienced child maltreatment, and so provide an evidence-based understanding of the long-term health and behavioural consequences of child maltreatment. It will also consider health outcomes that are particularly relevant for adolescents and young adults, especially in relation to prospective notifications to statutory agencies. Additionally, it will identify the overlap and differences in outcome for two different sources of child maltreatment identification in the same cohort.
Collapse
Affiliation(s)
- Steve Kisely
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada; and Addiction and Mental Health Services, Metro South Addiction and Mental Health Service, Australia
| | - Stuart Leske
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Australia
| | - Urska Arnautovska
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Australia; and Addiction and Mental Health Services, Metro South Addiction and Mental Health Service, Australia
| | - Dan Siskind
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Australia; and Addiction and Mental Health Services, Metro South Addiction and Mental Health Service, Australia
| | - Nicola Warren
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Australia; and Addiction and Mental Health Services, Metro South Addiction and Mental Health Service, Australia
| | - Korinne Northwood
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Australia; and Addiction and Mental Health Services, Metro South Addiction and Mental Health Service, Australia
| | | | - Jake Moses Najman
- School of Public Health, The University of Queensland, Australia; and School of Social Sciences, The University of Queensland, Australia
| |
Collapse
|
34
|
San Martin Porter MA, Maravilla J, Kisely S, Betts KS, Salom C, Alati R. Trends of perinatal mental health referrals and psychiatric admissions in Queensland. Aust N Z J Psychiatry 2023; 57:401-410. [PMID: 35229690 DOI: 10.1177/00048674221080405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Perinatal depression is often underdiagnosed; consequently, many women suffer perinatal depression without follow-up care. Screening for depressive symptoms during the perinatal period has been recommended in Australia to increase detection and follow-up of women suffering from depressive symptoms. Screening rates have gradually increased over the last decades in Australia. OBJECTIVE To explore trends in referrals of women to community mental health services during the perinatal period, and prenatal and postnatal admissions to psychiatric units, among those who gave birth in Queensland between 2009 and 2015. METHOD Retrospective analyses of data from three linked state-wide administrative data collections. Trend analyses using adjusted Poisson regression models examined 426,242 births. Outcome variables included referrals to specialised mental health services; women admitted with a mood disorder during the second half of their pregnancy and during the first 3 months of the postnatal period; and women admitted with non-affective psychosis disorders during the second half of their pregnancy and during the first 3 months of the postnatal period. RESULTS We found an increase in mental health referrals during the perinatal period over time (adjusted incidence rate ratio, 1.07; 95% confidence interval, [1.06, 1.08]) and a decrease in admissions with mood disorders during the first 3 months of the postnatal period (adjusted incidence rate ratio, 0.95; 95% confidence interval, [0.94, 0.98]). We did not find any changes in rates of admission for other outcomes. CONCLUSION Since the introduction of universal screening in Queensland, referrals for mental health care during the perinatal period have increased, while admissions for mood disorders in the first 3 months after delivery decreased.
Collapse
Affiliation(s)
| | - Joemer Maravilla
- Institute for Social Science Research (ISSR), The University of Queensland, Brisbane, QLD, Australia
| | - Steve Kisely
- School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Kim S Betts
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Caroline Salom
- Institute for Social Science Research (ISSR), The University of Queensland, Brisbane, QLD, Australia.,Australian Research Council Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, QLD, Australia
| | - Rosa Alati
- Institute for Social Science Research (ISSR), The University of Queensland, Brisbane, QLD, Australia.,School of Population Health, Curtin University, Perth, WA, Australia
| |
Collapse
|
35
|
Kisely S, Connor M, Somogyi AA, Siskind D. A systematic literature review and meta-analysis of the effect of psilocybin and methylenedioxymethamphetamine on mental, behavioural or developmental disorders. Aust N Z J Psychiatry 2023; 57:362-378. [PMID: 35285280 DOI: 10.1177/00048674221083868] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES There is an increasing interest in combining psilocybin or methylenedioxymethamphetamine with psychological support in treating psychiatric disorders. Although there have been several recent systematic reviews, study and participant numbers have been limited, and the field is rapidly evolving with the publication of more studies. We therefore conducted a systematic review of PubMed, MEDLINE, PsycINFO, the Cochrane Central Register of Controlled Trials, Embase, and CINAHL for randomised controlled trials of methylenedioxymethamphetamine and psilocybin with either inactive or active controls. METHODS Outcomes were psychiatric symptoms measured by standardised, validated and internationally recognised instruments at least 2 weeks following drug administration, Quality was independently assessed using the Cochrane risk of bias assessment tool and Grading of Recommendations Assessment, Development and Evaluation framework. RESULTS There were eight studies on methylenedioxymethamphetamine and six on psilocybin. Diagnoses included post-traumatic stress disorder, long-standing/treatment-resistant depression, obsessive-compulsive disorder, social anxiety in adults with autism, and anxiety or depression in life-threatening disease. The most information and strongest association was for the change in methylenedioxymethamphetamine scores compared to active controls in post-traumatic stress disorder (k = 4; standardised mean difference = -0.86; 95% confidence interval = [-1.23, -0.50]; p < 0.0001). There were also small benefits for social anxiety in adults with autism. Psilocybin was superior to wait-list but not niacin (active control) in life-threatening disease anxiety or depression. It was equally as effective as escitalopram in long-standing depression for the primary study outcome and superior for most of the secondary outcomes in analyses uncorrected for multiple comparisons. Both agents were well tolerated in supervised trials. Trial quality varied with only small proportions of potential participants included in the randomised phase. Overall certainty of evidence was low or very low using the Grading of Recommendations Assessment, Development and Evaluation framework. CONCLUSION Methylenedioxymethamphetamine and psilocybin may show promise in highly selected populations when administered in closely supervised settings and with intensive support.
Collapse
Affiliation(s)
- Steve Kisely
- School of Medicine, The University of Queensland, Woolloongabba, QLD, Australia.,Addiction and Mental Health Services, Metro South Health Service, Woolloongabba, QLD, Australia.,Departments of Psychiatry, Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Connor
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Andrew A Somogyi
- Discipline of Pharmacology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Dan Siskind
- School of Medicine, The University of Queensland, Woolloongabba, QLD, Australia.,Addiction and Mental Health Services, Metro South Health Service, Woolloongabba, QLD, Australia
| |
Collapse
|
36
|
De Monte V, Veitch A, Dark F, Meurk C, Wyder M, Wheeler M, Carney K, Parker S, Kisely S, Siskind D. Measuring recovery-oriented rehabilitation language in clinical documentation to enhance recovery-oriented practice. BJPsych Open 2023; 9:e36. [PMID: 36789776 PMCID: PMC9970174 DOI: 10.1192/bjo.2023.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Mental health services are encouraged to use language consistent with principles of recovery-oriented practice. This study presents a novel approach for identifying whether clinical documentation contains recovery-oriented rehabilitation language, and evaluates an intervention to improve the language used within a community-based rehabilitation team. AIMS This is a pilot study of training to enhance recovery-oriented rehabilitation language written in care review summaries, as measured through a text-based analysis of language used in mental health clinical documentation. METHOD Eleven case managers participated in a programme that included instruction in recovery-oriented rehabilitation principles. Outcomes were measured with automated textual analysis of clinical documentation, using a custom-built dictionary of rehabilitation-consistent, person-centred and pejorative terms. Automated analyses were run on Konstanz Information Miner (KNIME), an open-source data analytics platform. Differences in the frequency of term categories in 50 pre-training and 77 post-training documents were analysed with inferential statistics. RESULTS The average percentage of sentences with recovery-oriented rehabilitation terms increased from 37% before the intervention to 48% afterward, a relative increase of 28% (P < 0.001). There was no significant change in use of person-centred or pejorative terms, possibly because of a relatively high frequency of person-centred language (22% of sentences) and low use of pejorative language (2.3% of sentences) at baseline. CONCLUSIONS This computer-driven textual analysis method identified improvements in recovery-oriented rehabilitation language following training. Our study suggests that brief interventions can affect the language of clinical documentation, and that automated text-analysis may represent a promising approach for rapidly assessing recovery-oriented rehabilitation language in mental health services.
Collapse
Affiliation(s)
- Veronica De Monte
- Mobile Intensive Rehabilitation Team, Metro South Addiction and Mental Health Service, Woolloongabba, Queenland, Australia
| | - Angus Veitch
- Department of Media and Communications, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Frances Dark
- Mobile Intensive Rehabilitation Team, Metro South Addiction and Mental Health Service, Woolloongabba, Queenland, Australia; and Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Carla Meurk
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; and Queensland Centre for Mental Health Research, The Park, Wacol, Queensland, Australia
| | - Marianne Wyder
- Research and Learning Network, Metro South Addiction and Mental Health Service, Mt Gravatt, Queensland, Australia
| | - Maddison Wheeler
- Mobile Intensive Rehabilitation Team, Metro South Addiction and Mental Health Service, Woolloongabba, Queenland, Australia
| | - Kylie Carney
- Mobile Intensive Rehabilitation Team, Metro South Addiction and Mental Health Service, Woolloongabba, Queenland, Australia
| | - Stephen Parker
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; and Research and Learning Network, Metro South Addiction and Mental Health Service, Mt Gravatt, Queensland, Australia
| | - Steve Kisely
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; and Research and Learning Network, Metro South Addiction and Mental Health Service, Mt Gravatt, Queensland, Australia
| | - Dan Siskind
- Mobile Intensive Rehabilitation Team, Metro South Addiction and Mental Health Service, Woolloongabba, Queenland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; and Queensland Centre for Mental Health Research, The Park, Wacol, Queensland, Australia
| |
Collapse
|
37
|
Todorovic A, Lal S, Dark F, De Monte V, Kisely S, Siskind D. CBTp for people with treatment refractory schizophrenia on clozapine: a systematic review and meta-analysis. J Ment Health 2023; 32:321-328. [PMID: 33076721 DOI: 10.1080/09638237.2020.1836558] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Cognitive behavioural therapy for psychosis (CBTp), an effective treatment for people with schizophrenia, may have a role in clozapine refractory schizophrenia. AIMS A systematic-review and meta-analysis on the impact of CBTp on psychotic symptoms in people on clozapine. METHODS We searched PubMed, Embase, PsycInfo, CINAHL and Cochrane for randomised control trials of CBTp as augmentation in people with treatment-refractory schizophrenia on clozapine and conducted pair-wise meta-analyses. RESULTS Four studies met inclusion criteria. On pairwise meta-analyses, the primary outcome of total psychotic symptoms was not significantly altered by CBTp at either therapy endpoint or six to twelve months follow-up. Secondary outcomes showed that CBT improved positive symptoms at both therapy endpoint (SMD -0.33, 95%CI -0.50 to -0.16, p = 0.002, I2 = 0%) and six to twelve months follow-up (SMD -0.20, 95%CI -0.38 to -0.02, p = 0.03, I2 = 0%) though did not alter negative psychotic symptoms at either timepoint. CONCLUSIONS CBTp may lead to small benefits for positive symptoms refractory to clozapine. Given the low risks associated with CBTp, and the limited alternative options for clozapine refractory schizophrenia, this approach should be considered in this population.
Collapse
Affiliation(s)
- Aleksandar Todorovic
- Metro South Addiction and Mental Health Service, Woolloongabba, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Australia
| | - Sweta Lal
- Metro South Addiction and Mental Health Service, Woolloongabba, Australia
| | - Frances Dark
- Metro South Addiction and Mental Health Service, Woolloongabba, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Australia
| | - Veronica De Monte
- Metro South Addiction and Mental Health Service, Woolloongabba, Australia
| | - Steve Kisely
- Metro South Addiction and Mental Health Service, Woolloongabba, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Australia
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Woolloongabba, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Australia
| |
Collapse
|
38
|
Najman JM, Scott JG, Farrington DP, Clavarino AM, Williams GM, McGee TR, Kisely S. Does Childhood Maltreatment Lead to Low Life Success? Comparing Agency and Self-Reports. J Interpers Violence 2023; 38:NP1320-NP1342. [PMID: 35466762 DOI: 10.1177/08862605221090565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The long-term mental and physical health consequences of childhood maltreatment have been well documented. Less known are the longer-term consequences of childhood maltreatment, specifically the extent to which childhood maltreatment predicts adult life success. OBJECTIVES To prospectively assess the extent to which childhood experiences of physical, sexual, emotional abuse and childhood neglect predict life success at 30 years of age. PARTICIPANTS AND SETTING Data are from the Mater-University of Queensland Study of Pregnancy (MUSP), a pre-birth cohort study which follows children from conception to 30 years of age. METHODS Details of childhood maltreatment are from two sources; child safety agency notifications (and substantiations) linked to the survey data with self-reports of childhood experiences of maltreatment obtained at the 30-year follow-up using the Child Trauma Questionnaire (CTQ). Life success is a 9-item composite measure (alpha = 0.76) obtained at the 30-year follow-up. We use logistic regression models (with control for covariates) to examine the association between overall as well as specific forms of childhood maltreatment on adult life success. We further test these models using different cut-offs and propensity analyses to adjust for loss to follow-up. RESULTS Childhood maltreatment whether measured by agency report or self-report predicts overall low life success; agency substantiation OR = 1.88(1.14,3.08) & self-report OR = 2.60 (2.10,3.25). Self-report physical abuse, OR = 2.37(1.72,3.28); sexual abuse, OR = 2.85(2.05,3.96); emotional abuse, OR = 2.53(1.85,3.45) and neglect, OR = 2.36(1.83,3.03) all predict higher levels of low life success. CONCLUSIONS Our findings suggest that the long-term consequences of childhood maltreatment extend to a wide range of day-to-day circumstances and extend into mid- to later life.
Collapse
Affiliation(s)
- Jake M Najman
- School of Public Health, 1974University of Queensland, Herston, Australia
| | - James G Scott
- Mental Health Research Programme, 56362QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | | | | | - Gail M Williams
- School of Public Health, 1974University of Queensland, Herston, Australia
| | - Tara R McGee
- School of Criminology and Criminal Justice, 385727Griffith University, Mount Gravatt, QLD, Australia
| | - Steve Kisely
- School of Clinical Medicine, 1974University of Queensland, Woolloongabba, Australia
| |
Collapse
|
39
|
Abstract
The poor physical health (including oral health) of people with mental disorders is a global problem. The burden of oral diseases among this group is substantial given their high prevalence and ability to increase the personal, social, and economic impacts of mental disorders. This article summarizes causes of mental disorders and oral diseases, critically reviews current evidence on interventions to reduce the burden of oral diseases in people with mental disorders, and suggests future research directions. The relationship between mental disorders and oral diseases is complex due to the shared social determinants and bidirectional interaction mechanisms that involve interconnected social, psychological, behavioral, and biological processes. Research has, to date, failed to produce effective and scalable interventions to tackle the burden of oral diseases among people with mental disorders. Transformative research and actions informed by a dynamic involvement of biological, behavioral, and social sciences are needed to understand and tackle the complex relationship between mental disorders and oral diseases, as well as inform the design of complex interventions. Examples of future research on complex public health, health service, and social care interventions are provided. The design and testing of these interventions should be carried out in real-world settings, underpinned by the principles of coproduction and systems thinking, and conducted by a transdisciplinary team. We propose this starts with setting research priorities and developing complex intervention theory, which we report to support future research to improve oral health and hence physical and mental health in this disadvantaged group.
Collapse
Affiliation(s)
- E Joury
- Centre for Dental Public Health and Primary Care, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, The Royal London Hospital, London, UK
| | - S Kisely
- PA-Southside Clinical Unit, School of Clinical Medicine, Faculty of Medicine, the University of Queensland, Woolloongabba, QLD, Australia
| | - R G Watt
- Research Department of Epidemiology & Public Health, University College London, London, UK
| | - N Ahmed
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - A J Morris
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - F Fortune
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, London, UK
| | - K Bhui
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
| |
Collapse
|
40
|
Ogilvie JM, Allard T, Thompson C, Dennison S, Little SB, Lockwood K, Kisely S, Putland E, Stewart A. Psychiatric disorders and offending in an Australian birth cohort: Overrepresentation in the health and criminal justice systems for Indigenous Australians. Aust N Z J Psychiatry 2022; 56:1587-1601. [PMID: 34881665 DOI: 10.1177/00048674211063814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Most studies that examine psychiatric illness in people who offend have focused on incarcerated samples, with little known about the larger population of individuals with criminal justice system contact. We examine the overlap between proven offences and psychiatric diagnoses with an emphasis on experiences for Indigenous Australians. METHODS In a population-based birth cohort of 45,141 individuals born in Queensland, Australia, in 1990 (6.3% Indigenous), psychiatric diagnoses were identified from hospital admissions between ages 4/5 and 23/24 years and proven offences were identified from court records (spanning ages 10-24 years). Prevalence rates for offending, psychiatric diagnoses and their overlap were examined for Indigenous and non-Indigenous individuals. Associations between specific psychiatric diagnoses and types of offending were examined using logistic regressions. RESULTS There were 11,134 (24.7%) individuals with a finalised court appearance, 2937 (6.5%) with a diagnosed psychiatric disorder and 1556 (3.4%) with a proven offence and diagnosed psychiatric disorder, with Indigenous Australians significantly overrepresented across all outcomes. Compared with non-Indigenous Australians, Indigenous Australians were younger at their first court finalisation (Cohen's d = -0.62, 95% confidence interval = [-0.67, -0.57]), experienced a higher number of finalisations (d = 0.94, 95% confidence interval = [0.89, 1.00]) and offences (d = 0.64, 95% confidence interval = [0.59, 0.69]) and were more likely to receive custodial (d = 0.41, 95% confidence interval = [0.36, 0.46]) or supervised (d = 0.55, 95% confidence interval = [0.50, 0.60]) sentences. The overlap between offending and psychiatric illness was more pronounced for Indigenous Australians compared with non-Indigenous Australians (14.8% vs 2.7%). Substance use disorders were the most prevalent psychiatric diagnosis among individuals with a court finalisation (9.2%). CONCLUSIONS Indigenous Australians were significantly overrepresented in court finalisations and psychiatric diagnoses. Indigenous Australians with a psychiatric diagnosis were at highest risk of experiencing a court appearance, emphasising the importance of culturally appropriate mental health responses being embedded into the criminal justice system.
Collapse
Affiliation(s)
- James M Ogilvie
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia
| | - Troy Allard
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia.,School of Criminology and Criminal Justice, Griffith University, Mount Gravatt, QLD, Australia
| | - Carleen Thompson
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia.,School of Criminology and Criminal Justice, Griffith University, Mount Gravatt, QLD, Australia
| | - Susan Dennison
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia.,School of Criminology and Criminal Justice, Griffith University, Mount Gravatt, QLD, Australia
| | - Simon B Little
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia
| | - Krystal Lockwood
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia.,School of Criminology and Criminal Justice, Griffith University, Mount Gravatt, QLD, Australia
| | - Steve Kisely
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia.,School of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - Ellie Putland
- School of Applied Psychology, Griffith University, Mount Gravatt, QLD, Australia
| | - Anna Stewart
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia.,School of Criminology and Criminal Justice, Griffith University, Mount Gravatt, QLD, Australia
| |
Collapse
|
41
|
Kisely S, Looi JCL. Latest evidence casts further doubt on the effectiveness of headspace. Med J Aust 2022; 217:388-390. [PMID: 36182662 PMCID: PMC9826401 DOI: 10.5694/mja2.51700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 07/20/2022] [Accepted: 08/08/2022] [Indexed: 01/11/2023]
|
42
|
Taylor M, Dangelo-Kemp D, Liu D, Kisely S, Graham S, Hartmann J, Colman S. Antipsychotic utilisation and persistence in Australia: A nationwide 5-year study. Aust N Z J Psychiatry 2022; 56:1155-1163. [PMID: 34657454 DOI: 10.1177/00048674211051618] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the utilisation and persistence of antipsychotics for the treatment of schizophrenia in Australia. METHODS A retrospective study using the Australian Pharmaceutical Benefits Scheme database of a representative 10% sample. All adults with schizophrenia who were dispensed three or more supplies of oral (including clozapine) or long-acting injectable antipsychotics between 1 June 2015 and 31 May 2020 were included. Persistence time in treatment was evaluated using survival analysis and Cox hazard ratios. RESULTS In all, 26,847 adults with schizophrenia were studied. Oral second-generation antipsychotics were more frequently dispensed than the other antipsychotic groups studied. Median treatment persistence times were 18.3 months for second-generation antipsychotic long-acting injectables, 10.7 months for oral second-generation antipsychotics and were significantly lower for both formulations of first-generation antipsychotics at 5.2 months (long-acting injectables) and 3.7 months (oral). The median persistence time for clozapine was significantly longer than all other antipsychotics groups. CONCLUSIONS Oral second-generation antipsychotics and second-generation antipsychotic long-acting injectables accounted for over 75% and 13% of all antipsychotics in Australia, respectively. Concerns over medication adherence and subsequent relapse have not translated into increased long-acting injectable usage despite their significantly longer persistence. Clozapine, the single most 'persistent' antipsychotic, was only used in 9% of people, although up to a third of all cases are likely to be treatment-resistant. Our data suggest clinicians should give consideration to the earlier use of second-generation antipsychotic long-acting injectables and clozapine, to ameliorate prognosis in schizophrenia.
Collapse
Affiliation(s)
- Mark Taylor
- The University of Queensland, Brisbane, QLD, Australia.,Toowong Specialist Clinic, Toowong, QLD, Australia
| | | | - Dennis Liu
- Northern Mental Health Service, Salisbury, SA, Australia.,The University of Adelaide, Adelaide, SA, Australia
| | - Steve Kisely
- The University of Queensland, Brisbane, QLD, Australia
| | | | | | - Sam Colman
- Labcorp Drug Development, Sydney, NSW, Australia
| |
Collapse
|
43
|
Najman JM, Scott JG, Williams GM, Clavarino AM, Kisely S, McGee TR. Predicting Child Maltreatment over the Early Life Course: A Prospective Study. Child Psychiatry Hum Dev 2022; 53:701-714. [PMID: 33788054 DOI: 10.1007/s10578-021-01164-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 11/29/2022]
Abstract
A large number of early life exposures predict child maltreatment. Using data from a 30-year birth cohort study we examine 12 early life course risk factors of four types of self-reported childhood maltreatment recalled at the 30-year follow-up. Of the 7223 children in the sample at birth, 2425 responded to the Child Trauma Questionnaire at the 30-year follow-up. On adjusted analysis being a teenage mother predicts childhood physical and sexual abuse, as well as child neglect. More numerous maternal marital partner changes in the 5 years after the birth predict offspring experiences of emotional abuse, sexual abuse and childhood neglect. Policy responses should focus on the broad social context in which children are reared as the most effective approach to reducing the high level of childhood abuse and neglect.
Collapse
Affiliation(s)
- Jake M Najman
- School of Public Health, University of Queensland, Public Health Building, Herston Campus, 288 Herston Road, Herston, QLD, 4006, Australia.
| | - James G Scott
- Mental Health Research Programme, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia.,Metro North Mental Health Service, Herston, QLD, Australia
| | - Gail M Williams
- School of Public Health, University of Queensland, Public Health Building, Herston Campus, 288 Herston Road, Herston, QLD, 4006, Australia
| | - Alexandra M Clavarino
- School of Public Health, University of Queensland, Public Health Building, Herston Campus, 288 Herston Road, Herston, QLD, 4006, Australia
| | - Steve Kisely
- School of Medicine, Princess Alexandra Hospital, University of Queensland, Woolloongabba, QLD, 4102, Australia
| | - Tara R McGee
- School of Criminology and Criminal Justice, Griffith University, 176 Messines Ridge Road, Mount Gravatt, QLD, 4122, Australia
| |
Collapse
|
44
|
Abstract
OBJECTIVE Psychiatric patients have increased rates of comorbid physical illness. There are less data on dental disease, especially decay, despite risk factors including lifestyle and psychotropic side effects such as xerostomia. We therefore undertook an umbrella review of all meta-analyses on the association between mental illness and oral health. METHODS We searched PubMed, MEDLINE, PsycINFO, the Cochrane Central Register of Controlled Trials, Embase and CINAHL. Articles were independently assessed. Outcomes were caries, periodontal disease, erosion, and partial or total tooth loss (edentulism), measured where possible with standardised measures such as the mean number of decayed, missing and filled teeth or surfaces. Quality was assessed in line with National Institutes of Health guidelines. RESULTS We identified 11 meta-analyses. The most information and strongest association was between dental decay and severe mental illness or substance use, as well as erosion and eating disorders. Depressive, anxiety and eating disorders were also associated with caries, but the datasets were small. People with severe mental illness had nearly three times the odds of having lost all their teeth than the general community (odds ratio = 2.81, 95% confidence interval = [1.73, 4.57]) and those with depression between 1.17 and 1.32. Findings for periodontal disease were more equivocal, possibly because of study heterogeneity. CONCLUSION Mental health clinicians should screen for oral diseases when treating those with mental illness and facilitate referral to affordable dental clinics when indicated. Prevention should be a priority, including the promotion of dental care, as well as the management of xerostomia when psychopharmacologic agents are prescribed.
Collapse
Affiliation(s)
- Jisu Choi
- Jisu Choi - Faculty of Science, Dan Siskind & Steve Kisely - Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Josh Price
- Princess Alexandra Hospital Southside Clinical Unit, Metro South Health Service, Woolloongabba, QLD, Australia
| | - Samuel Ryder
- Princess Alexandra Hospital Southside Clinical Unit, Metro South Health Service, Woolloongabba, QLD, Australia
| | - Dan Siskind
- Jisu Choi - Faculty of Science, Dan Siskind & Steve Kisely - Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Princess Alexandra Hospital Southside Clinical Unit, Metro South Health Service, Woolloongabba, QLD, Australia
| | - Marco Solmi
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
| | - Steve Kisely
- Jisu Choi - Faculty of Science, Dan Siskind & Steve Kisely - Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Princess Alexandra Hospital Southside Clinical Unit, Metro South Health Service, Woolloongabba, QLD, Australia
| |
Collapse
|
45
|
Siskind D, Yen W, Thuzar M, Russell A, Warren N, Kisely S, Kar Ray M, Motamarri B. Outcomes of a co-located approach for metabolic health care for people with schizophrenia. Australas Psychiatry 2022; 30:518-522. [PMID: 35331017 DOI: 10.1177/10398562221080742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Metabolic syndrome is highly prevalent among people with schizophrenia. This study aims to assess the impact on metabolic and attendance outcomes of a co-located, dedicated, endocrinologist-led metabolic clinic in a stand-alone public community mental health service. METHODS Demographic and metabolic data on the first 48 consecutive referrals over a 12-month period were retrospectively collected and analysed. Attendance rates at the co-located clinic were compared to the general hospital obesity and diabetes clinics. RESULTS Clinic attendees had significant reductions in triglycerides and total cholesterol, but not mean weight, BMI, waist circumference, blood pressure or HbA1c. Attendance rates were significantly higher in the co-located clinic compared to the general hospital obesity and diabetes clinics for both initial consult (80.0% vs 51.2%, p < 0.001) and review appointment (64.3% vs 47.6%, p < 0.001). CONCLUSION The co-location of a specialist metabolic clinic within a mental health service resulted in enhanced engagement and improvement of metabolic health in people with schizophrenia.
Collapse
Affiliation(s)
- Dan Siskind
- 157829Metro South Addiction and Mental Health Service, Brisbane, Australia; Faculty of Medicine, 1974University of Queensland, Brisbane, Australia
| | - Wesley Yen
- Faculty of Medicine, 1974University of Queensland, Brisbane, Australia; Department of Endocrinology and Diabetes, Princess Alexandra Hospital, Brisbane, Australia
| | - Moe Thuzar
- Faculty of Medicine, 1974University of Queensland, Brisbane, Australia; Department of Endocrinology and Diabetes, Princess Alexandra Hospital, Brisbane, Australia
| | - Anthony Russell
- Faculty of Medicine, 1974University of Queensland, Brisbane, Australia; Department of Endocrinology and Diabetes, Princess Alexandra Hospital, Brisbane, Australia
| | - Nicola Warren
- 157829Metro South Addiction and Mental Health Service, Brisbane, Australia; Faculty of Medicine, 1974University of Queensland, Brisbane, Australia
| | - Steve Kisely
- 157829Metro South Addiction and Mental Health Service, Brisbane, Australia; Faculty of Medicine, 1974University of Queensland, Brisbane, Australia
| | - Manaan Kar Ray
- 157829Metro South Addiction and Mental Health Service, Brisbane, Australia; School of Medicine, Griffith University, Brisbane, Australia
| | - Balaji Motamarri
- 157829Metro South Addiction and Mental Health Service, Brisbane, Australia; School of Medicine, Griffith University, Brisbane, Australia
| |
Collapse
|
46
|
Ogilvie JM, Kisely S. Examining the health and criminal justice characteristics for young people on compulsory community treatment orders: An Australian birth cohort and data linkage study. Int J Law Psychiatry 2022; 83:101813. [PMID: 35759935 DOI: 10.1016/j.ijlp.2022.101813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/27/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Most studies on the predictors and effectiveness of community treatment orders (CTOs) are restricted to health-related variables and do not consider forensic contacts as established by criminal justice databases or predictors from birth. We used linked administrative health and criminal justice data for a birth cohort in Queensland, Australia to investigate the characteristics and outcomes of people placed on CTOs. METHODS CTOs were identified from administrative data for hospital admissions and community mental health service contacts for a population cohort of 45,141 individuals born in Queensland in 1990. These data were linked with administrative court records, with individuals followed up to age 23/24 years. Logistic regression analyses were used to examine characteristics associated with CTO placement and Tobit regression analyses to examine factors predicting health and criminal justice outcomes in the following year. RESULTS There were 211 CTO cases by age 23/24 years, for whom it was possible to identify 413 controls on voluntary treatment. Non-affective psychoses [F20-F29] were the strongest predictors of CTO placement (ORadj = 4.07, 2.77-5.99) followed by a court appearance (ORadj = 1.99, 1.28-3.09). CTOs were associated with greater, not lower, subsequent psychiatric hospital admissions, inpatient bed-days and community mental health service contacts, although on sensitivity analyses psychiatric hospital admissions were the same as voluntary controls. CTOs were not associated with more subsequent court appearances despite higher rates of offending before CTO placement. CONCLUSIONS Both clinical and forensic variables can determine CTO placement and, on adjustment for these covariates, CTOs were not associated with reductions in psychiatric hospital admission, time spent as an inpatient, or subsequent court appearances. The latter finding might mean that CTOs reduce the risk of offending to that of voluntary controls.
Collapse
Affiliation(s)
- James M Ogilvie
- Griffith Criminology Institute, Griffith University, Australia
| | - Steve Kisely
- Griffith Criminology Institute, Griffith University, Australia; School of Medicine, The University of Queensland and Princess Alexandra Hospital, Woolloongabba, QLD, Australia; Metro South Health Service, Woolloongabba, QLD, Australia.
| |
Collapse
|
47
|
Suetani S, Kisely S, Parker S, Waterreus A, Morgan VA, Siskind D. Characteristics of people on community treatment orders in Australia: Data from the 2010 National Survey of High Impact Psychosis. Aust N Z J Psychiatry 2022; 56:788-799. [PMID: 34340594 DOI: 10.1177/00048674211036032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Existing evidence on factors associated with community treatment order placement is largely restricted to administrative data. We utilised the data from a large nationally representative sample to compare the demographic, clinical, social functioning, substance use and service utilisation profiles of people living with psychosis under community treatment orders with those who were not. METHODS Participants were grouped based on whether they had been subject to a community treatment order in the past 12 months or not. We conducted logistic regressions to examine demographic, clinical, social functioning, substance use and service utilisation profiles associated with the two groups. RESULTS People who had recently been subject to community treatment orders were more likely to be treated with long-acting injectable antipsychotics and lacked insight but were less likely to report suicidal ideation. They also had higher psychiatric inpatient admission rates but a lower frequency of general practitioner visits. CONCLUSION People on community treatment orders in Australia may differ from those who are not under a community treatment order in their treatment needs. Resources and care provision must match the needs of this particularly vulnerable group.
Collapse
Affiliation(s)
- Shuichi Suetani
- The University of Queensland, Brisbane, QLD, Australia.,Physical and Mental Health Stream, Queensland Centre for Mental Health Research, Wacol, QLD, Australia.,Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia.,School of Medicine, Griffith University, Nathan, QLD, Australia
| | - Steve Kisely
- The University of Queensland, Brisbane, QLD, Australia.,Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia
| | - Stephen Parker
- The University of Queensland, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Nathan, QLD, Australia.,The Prince Charles Hospital, Chermside, QLD, Australia
| | - Anna Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, The University of Western Australia, Perth, WA, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, The University of Western Australia, Perth, WA, Australia
| | - Dan Siskind
- The University of Queensland, Brisbane, QLD, Australia.,Physical and Mental Health Stream, Queensland Centre for Mental Health Research, Wacol, QLD, Australia.,Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia
| |
Collapse
|
48
|
Kisely S, Najman JM. A study of the association between psychiatric symptoms and oral health outcomes in a population-based birth cohort at 30-year-old follow-up. J Psychosom Res 2022; 157:110784. [PMID: 35325776 DOI: 10.1016/j.jpsychores.2022.110784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Most studies of the association between psychiatric disorders and poor oral health have been conducted in clinical settings. Where available, data from community surveys have generally been cross-sectional or considered anxiety and depression as a consequence of poor oral health, not the other way round. This study therefore used a birth cohort to assess the association of mental health, measured both cross-sectionally and longitudinally, and oral health at 30-year follow-up. METHODS There were 2456 adults with data on dental outcomes and oral health care at 30-year follow-up. Psychiatric morbidity was measured at both 21- and 30-year follow-up using standardised instruments including the Centre for Epidemiological Studies-Depression (CES-D) scale and Composite International Diagnostic Interview (CIDI). RESULTS At follow-up, 850 participants (34.6%) had undergone a dental extraction for infection or decay, and 810 had experienced significant dental pain over their lifetime. One third had not visited a dental clinic in the previous two years and 40% failed to brush their teeth at least twice daily. On adjusted analyses, dental extraction and pain were significantly associated with psychiatric morbidity cross-sectionally at 30-year follow-up and also longitudinally when psychiatric symptoms were present at both 21 and 30 years old. Several cross-sectional measures of psychiatric morbidity were also associated with frequency of tooth brushing. There were no associations with dental clinic visits. CONCLUSIONS The study demonstrates there are associations between oral and mental health, which are not limited to clinical settings, but were observed at a population level.
Collapse
Affiliation(s)
- Steve Kisely
- School of Medicine, University of Queensland, Princess Alexandra Hospital, Woolloongabba 4102, Queensland, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada.
| | - Jake Moses Najman
- School of Public Health, The University of Queensland, Public Health Building, Herston 4006, Queensland, Australia
| |
Collapse
|
49
|
Ajilchi B, Mohebi M, Zarei S, Kisely S. Effect of a mindfulness programme training on mental toughness and psychological well-being of female athletes. Australas Psychiatry 2022; 30:352-356. [PMID: 34854342 DOI: 10.1177/10398562211057075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Research has shown that mindfulness in athletes is associated with positive outcomes. We therefore assessed the effect of mindfulness training on increasing mental toughness (MT) and psychological well-being (PWB). METHODS This was a parallel-group, pre-and post-test, randomised controlled pilot trial. Forty-five female athletes from Iranian universities in Tehran were randomly assigned into experimental (n = 23) and control groups (n = 22). Forty-two completed the trial. The mindfulness training group received the Mindfulness-Acceptance-Commitment programme for 7 weeks. All subjects completed the Mindfulness Inventory for Sport (MIS), Sports Mental Toughness Questionnaire and PWB Scale. Data were analysed using mixed analysis of variance. RESULTS Mindfulness training increased mindfulness in the experimental group (p < 0.01). In turn, increased mindfulness led to increased MT and PWB at 2-month follow-up (p < 0.05). CONCLUSIONS Given that mindfulness training may increase the MT and PWB of athletes, these techniques should be considered for inclusion in sports coaching.
Collapse
Affiliation(s)
- Bita Ajilchi
- Motor Behavior and Sport Psychology Department, Allameh Tabataba'i University, Tehran, Iran
| | - Mahmoud Mohebi
- Faculty of Physical Education and Sports Sciences, Department of Motor Behavior and Sports Psychology, 48425University of Tehran, Tehran, Iran
| | - Sahar Zarei
- Faculty of Physical Education and Sports Sciences, Department of Motor Behavior and Sports Psychology, 48425University of Tehran, Tehran, Iran
| | - Steve Kisely
- Princess Alexandra Hospital Southside Clinical Unit, Faculty of Medicine, 1974The University of Queensland, Woolloongabba, QLD, Australia
| |
Collapse
|
50
|
Kisely S, Dangelo-Kemp D, Taylor M, Liu D, Graham S, Hartmann J, Colman S. The impact of COVID-19 on antipsychotic prescriptions for patients with schizophrenia in Australia. Aust N Z J Psychiatry 2022; 56:642-647. [PMID: 34240634 DOI: 10.1177/00048674211025716] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the impact, in the Australian setting, of the COVID-19 lockdown on antipsychotic supplies for patients with schizophrenia following a prescription from a new medical consultation when compared to the same periods in the previous 4 years. A secondary objective was to assess the volume of all antipsychotic supplies, from new and repeat prescriptions, over these same periods. METHODS A retrospective pharmaceutical claims database study was undertaken, using the Department of Human Services Pharmaceutical Benefits Scheme 10% sample. The study population included all adult patients with three or more supplies of oral or long-acting injectable antipsychotics for the treatment of schizophrenia at any time between 1 June 2015 and 31 May 2020. The primary outcome compared volumes of dispensed antipsychotics from new prescriptions (which require a medical consultation) between 1 April and 31 May each year from 2016 to 2020. This was to analyse the period during which the Australian Government imposed a lockdown due to COVID-19 (April to May 2020) when compared the same periods in previous years. RESULTS There was a small (5.7%) reduction in the number of antipsychotics dispensed from new prescriptions requiring a consultation, from 15,244 to 14,372, between April and May 2019 and the same period in 2020, respectively. However, this reduction was not statistically significant (p = 0.75) after adjusting for treatment class, age, gender, location and provider type. CONCLUSION The COVID-19 restrictions during April and May 2020 had no significant impact on the volume of antipsychotics dispensed from new prescriptions for patients with schizophrenia when compared to the volume of antipsychotics dispensed from new prescriptions during the same period in previous years.
Collapse
Affiliation(s)
- Steve Kisely
- School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia.,Addiction and Mental Health Service, Metro South Health, Woolloongabba, QLD, Australia
| | | | - Mark Taylor
- School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia.,Toowong Specialist Clinic, Toowong, QLD, Australia
| | - Dennis Liu
- Northern Mental Health Service, Salisbury, SA, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Simon Graham
- Lundbeck Australia Pty Ltd, North Ryde, NSW, Australia
| | | | - Sam Colman
- Covance Market Access Services, Sydney, NSW, Australia
| |
Collapse
|