Search

Purpose: Use of alcohol and other substances is a multifaceted issue impacting young people across multiple life domains. This paper aims to elucidate patterns of substance use and associated demographic and clinical factors among young people seeking treatment for their mental health. Methods: Young people (12–25 years old) were recruited from five youth-specific primary mental health ("headspace") services in Australia. Self-reported substance use and harms in the past 3 months were measured using WHO-ASSIST. Network analyses were conducted to evaluate interrelationships between use and harms associated with different substances. Subgroups were then identified based on whether participants reported using high centrality substances, and associated demographic and clinical factors were assessed with multinomial logistic regression. Results: 1107 youth participated. 70% reported use of at least one substance in the past 3 months, with around 30% of those reporting related health, social, legal or financial problems. Network analysis highlighted substantial interconnections between use and harm indicators for all substances, with amphetamine-type stimulants (ATS) and cannabis being high central substances. Higher levels of substance use and harms were reported in subgroups with ATS or cannabis use and different risk factors were associated with these subgroups. Conclusions: Findings highlight the importance of screening for substance use in youth primary mental healthcare settings, offering a key opportunity for early intervention. Clinicians should be aware of the inner connections of use and harms of different drugs and the role of cannabis and amphetamine use as a marker for more substance use profiles. [ABSTRACT FROM AUTHOR]

Purpose: Males feature prominently in suicide statistics, but relatively little work has been done to date to explore whether endorsement of dominant masculinity norms heightens the risk of or is protective against suicidal thinking. This paper aimed to further knowledge in this area.Methods: We used baseline data from 13,884 men (aged 18-55) in the Australian Longitudinal Study on Male Health (Ten to Men) cohort. These men filled in self-complete questionnaires in 2013/14 which covered a range of topics, including conformity to dominant masculinity norms and suicidal thinking. We conducted logistic regression analyses to estimate the strength of association between these two variables.Results: After controlling for other key predictors of suicidal thinking, one characteristic of dominant masculinity-self-reliance-stood out as a risk factor for suicidal thinking (AOR 1.33; 95% CI 1.25-1.42).Conclusions: It suggests that one particular element of dominant masculinity-being self-reliant-may place men at increased risk of suicidal thinking. This finding resonates with current theories of how suicidal thinking develops and leads to action. It also has implications for the full gamut of suicide prevention approaches that target males in clinical settings and in the general population, and for our broader society. Further work is needed, however, to confirm the direction of the relationship between self-reliance and suicidality, and to unpack the means through which self-reliance may exert an influence. [ABSTRACT FROM AUTHOR]

Purpose: The health inequalities experienced by Aboriginal and Torres Strait Islander Australians are well documented but there are few empirical data outlining the burden, consequences, experience and expression of depressive illness. This paper seeks to address the lack of accessible, culturally specific measures of psychosocial stress, depression or quality of life developed for, and validated within, this population.Methods: Building on an extensive qualitative phase of research, a psychosocial questionnaire comprising novel and adapted scales was developed and piloted with 189 Aboriginal men across urban and remote settings in central Australia. With a view to refining this tool for future use, its underlying structure was assessed using exploratory factor analysis, and the predictive ability of the emergent psychosocial constructs assessed with respect to depressive symptomatology.Results: The latent structure of the psychosocial questionnaire was conceptually aligned with the components of the a priori model on which the questionnaire was based. Regression modelling indicated that depressive symptoms were driven by a sense of injury and chronic stress and had a non-linear association with socioeconomic position.Conclusions: This represents the first community-based survey of psychosocial stress and depression in Aboriginal men. It provides both knowledge of, and an appropriate process for, the further development of psychometric tools, including quality of life, in this population. Further research with larger and more diverse samples of Aboriginal people is required to refine the measurement of key constructs such as chronic stress, socioeconomic position, social support and connectedness. The further refinement, validation against criterion-based methods and incorporation within primary care services is essential. [ABSTRACT FROM AUTHOR]

Purpose: Generally, due to limited availability of official statistics on the topic, little is known about suicide mortality in second-generation migrants. A recent study from Sweden showed that these people could be at a high suicide risk. In a generalised phenomenon, this aspect would represent an important issue in suicide prevention. This paper aims to report the profile of second-generation migrants who died by suicide and the suicide risk differentials of second-generation migrants with other Australians. Methods: Official suicide data from 2001 to 2008 were linked with State/Territory registries to collect information about the birthplace of the deceased's parents to differentiate migration status (first, second or third-plus generation). The profile and suicide risk of second-generation migrants were compared with other generations by logistic and Poisson regression. Results: Suicide in second-generation migrants accounted for 811 cases (14.6 %). These tended to be represented by younger subjects, more often never married, as compared to the other cases. Second-generation males aged 25-39 years tended to have a higher suicide risk than first-generation migrants, but the risk was lower when compared with the third-plus generation. Second-generation migrants aged 60+ tended to have a lower suicide risk than first-generation migrants. Conclusion: In Australia, second-generation migrants are not at a higher suicide risk as compared to first-generation migrants or locals (third-plus-generation). In males aged 25-39, a lower suicide risk was found in second-generations as compared to Australian-born third generation, which may be explained by their more advantageous socioeconomic status and the flexibility and resources rendered by having grown up in a bicultural environment. The higher suicide rates found amongst older first-generation migrants require further examination. [ABSTRACT FROM AUTHOR]

Purpose: Racism is an important determinant of mental and physical health for minority populations. However, to date little is known about the relationship between racism and ill-health outside of the U.S. or the causal pathways between racism and poor health. This paper focuses on the relationship between racism and depression in a non-U.S. indigenous population, including examination of novel mediators and moderators. Methods: One hundred and eighty-five adults in the Darwin Region Urban Indigenous Diabetes study responded to a validated instrument assessing multiple facets of racism. Depressive symptoms were assessed using the Centre for Epidemiologic Studies Depression Scale. Stress, optimism, lack of control, social connections, cultural identity and reactions/responses to interpersonal racism were considered as possible mediators and moderators in linear regression models. Results: Interpersonal racism was significantly associated with depression after adjusting for socio-demographic factors (β = 0.08, p < 0.001). Lack of control, stress, negative social connections and feeling ashamed, amused or powerless as reactions to racism were each identified as significant mediators of the relationship between racism and depressive symptoms. All examined mediators together accounted for 66% of the association between interpersonal racism and depressive symptoms. Conclusions: This study demonstrates that racism is associated with depressive symptoms in an indigenous population. The mediating factors between racism and depressive symptoms identified in this study suggest new approaches to ameliorating the detrimental effects of racism on health. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this paper is to provide an analysis of data from the National Survey of Mental Health and Wellbeing (NSMHWB) on the factors associated with the use of sources of information on mental health. A further aim is to examine the associations between the use of information sources and professional help-seeking. Methods: Data from the 2007 NSMHWB were used. The survey sample comprised 8,841 residents of private dwellings across Australia aged 16-85 years. Results: Television was the most common source of information about mental health issues in the previous 12 months (accessed by 20.5% of respondents) followed by pamphlets and brochures (accessed by 15.6% of respondents). Having an anxiety or affective disorder, female gender, higher levels of education and having a family member with a mental health problem was associated with the seeking of information on mental health issues from the internet, non-fiction books and brochures/pamphlets. Accessing information on the internet was associated with increased use of any mental health services, GPs and mental health professionals (MHPs). Conclusions: The results suggest that promotion of internet resources may offer the opportunity to increase help seeking for mental health problems and may offer the opportunity to engage those least likely to seek professional help, notably young males. [ABSTRACT FROM AUTHOR]

Objective: This paper extends previous epidemiological findings linking panic attacks with future episodes of depression and examines whether this relationship is independent of the effects of gender and neuroticism.Methods: Composite International Diagnostic Interview (CIDI) DSM-IV diagnoses from a stratified multi-stage population survey of 10,641 Australian adults were analysed using logistic regression to examine the relationship between lifetime panic attacks, gender, neuroticism and mental disorders.Results: People who experienced full CIDI DSM-IV panic attacks more than 12 months ago were 4 times more likely to meet criteria for current Depressive Disorder than those who reported no attacks. Those with panic attacks in the past 12 months were 13.3 times more likely to report current Depressive Disorders. A similar pattern was also present for non-panic Anxiety Disorders (odds ratio=7.5 for lifetime, but not 12-month panic attacks, and 21.46 for 12-month panic attacks) and for Substance Use Disorders (2.1 and 4.6, respectively) suggesting a broader relationship with psychopathology than previously reported. For each of these groupings of mental disorders, panic attacks accounted for significant variability over and above the effects of gender, neuroticism, and comorbid Anxiety Disorders.Conclusions: Panic attacks are associated with current and future Anxiety, Depressive, and Substance Use Disorders, and this relationship is not solely accounted for by differences in gender and neuroticism. [ABSTRACT FROM AUTHOR]

Background: The lack of established brief Personality Disorder (PD) screening instruments may account for the absence of PD data from previous national mental health surveys. This paper documents the measurement of PD in a large Australian survey, with a particular focus on the characteristics of the screening instrument and the consequences of its mode of administration and scoring.Methods: PD was assessed in the 1997 Australian National Survey of Mental Health and Wellbeing (N=10,641 adults) using the 59-item version of the International Personality Disorder Examination Questionnaire (IPDEQ), which was administered in a computerised format by trained non-clinical interviewers.Results: Normative profiles are reported for three IPDEQ scoring schemes (simple categorical, IPDEQ(S); ICD-10 criterion based categorical, IPDEQ(C); and dimensional scoring, IPDEQ(D)), together with an examination of the IPDEQ's psychometric properties and associations with Axis I comorbidity, disability, and selected psychosocial characteristics. The overall rate of ICD-10 PD in Australia was estimated to be 6.5%, although the categorical assessment of dissocial PD clearly provided an underestimate. PD was associated with younger age, poorer functioning, and a sevenfold increase in the number of comorbid Axis I disorders during the preceding 12 months.Conclusions: While the methods used to assess PD in the national survey were constrained by project demands, the overall performance of the IPDEQ was considered satisfactory, based on data from a range of sources. In particular, although IPDEQ item and subscale revisions are recommended, evidence is presented suggesting that aggregate IPDEQ dimensional scores should provide useful self-report indices of the overall likelihood of PD. [ABSTRACT FROM AUTHOR]

Background: While much attention has been given to the prediction of violent offending behaviour amongst people with psychotic disorders, less attention has been given to the fact that these same individuals are often the victims of violence. In this paper, we examine victimisation amongst participants in a prevalence study of psychosis, and describe demographic and clinical correlates of victimisation. METHOD The study was based on the Australian National Survey of Mental Health and Wellbeing--Low Prevalence (Psychotic) Disorders. The participants were asked if they had been a victim of violence in the previous year. The association between selected demographic and clinical variables and being a victim of violence was examined using logistic regression.Results: Of the 962 individuals with psychosis, 172 reported being a victim of violence in the past 12 months (17.9 %). The odds of being a victim were increased in those who: (a) were female, (b) were homeless, (c) had a lifetime history of substance abuse, (d) had been arrested in the previous 12 months, (e) had poorer social and occupational function, and (f) had higher scores on the disorganisation summary score.Conclusions: Clinicians should remain mindful that one out of every six individuals with a psychotic disorder reports being a victim of violence in the previous year. Models of care that address issues related to symptom relief, accommodation, and exposure to high-crime areas may reduce the rates of victimisation amongst those with psychotic disorders. [ABSTRACT FROM AUTHOR]

Background: The impact of adversity in childhood is well established in clinical populations, but there is little information about adversity in wider populations. The aim of this paper is to report and to explore the distribution of childhood family adversity in an Australian population.Method: A total of 7485 randomly selected subjects in 20-24, 40-44 and 60-64 year age bands were interviewed at the outset of a longitudinal community study of psychological health in the Canberra region of Australia. In the initial cross-sectional interview, subjects answered 17 questions about experience of adversity in the home to age 16 years.Results: In the population, 59.5% had experienced some form of childhood adversity and 37% had experienced more than one adversity. Domestic conflict and parental psychopathology and substance use are the common adversities. Parental sexual abuse was reported by 1.1%. Adversity was highest in the 40-44 year age group and reported more in women in all age groups. The majority of subjects saw their childhood as happy or normal despite adversity, but happiness is affected most by domestic warmth and harmony, and normalcy by abuse and neglect. Severe adversities, physical and sexual abuse and neglect, were uncommon, but were related to multiple and other severe adversities.Conclusion: Some form of adversity is a common experience, although the severest abuses are less common in this population. Multiple adversities are common and only a minority experience single adversities. Physical abuse, sexual abuse and neglect rarely occur alone, but indicate a context of abuse. [ABSTRACT FROM AUTHOR]

Background: The positive health and wellbeing effects of social support have been consistently demonstrated in the literature since the late 1970s. However, a better understanding of the effects of age and sex is required.Method: We examined the factor structure and reliability of Kessler's Perceived Social Support (KPSS) measure in a community-based sample that comprised younger and older adult cohorts from the Australian Twin Registry (ATR), totalling 11,389 males and females aged 18-95, of whom 887 were retested 25 months later.Results: Factor analysis consistently identified seven factors: support from spouse, twin, children, parents, relatives, friends and helping support. Internal reliability for the seven dimensions ranged from 0.87 to 0.71 and test-retest reliability ranged from 0.75 to 0.48. Perceived support was only marginally higher in females. Age dependencies were explored. Across the age range, there was a slight decline (more marked in females) in the perceived support from spouse, parent and friend, a slight increase in perceived relative and helping support for males but none for females, a substantial increase in the perceived support from children for males and females and a negligible decline in total KPSS for females against a negligible increase for males. The perceived support from twin remained constant. Females were more likely to have a confidant, although this declined with age whilst increasing with age for males.Conclusions: Total scores for perceived social support conflate heterogeneous patterns on sub-scales that differ markedly by age and sex. Our paper describes these relationships in detail in a very large Australian sample. [ABSTRACT FROM AUTHOR]

Background:. Most general practitioners (GPs) are currently treating a small number of patients with schizophrenia; however, little is known about GPs’ experiences in this area. This paper examines the attitudes and roles of Australian GPs in the treatment of schizophrenia and their relationships with specialist services. Methods:. A total of 192 GPs’ ratings of possible sources and forms of help for patients with schizophrenia were compared with the ratings of 50 mental health services (MHS) staff and 129 patients. Comparisons within the health professionals were also made in relation to diagnostic and treatment confidence, perceived roles, and typical problems encountered. Results:. Perceived helpfulness ratings were reasonably consistent across groups. However, patients tended to rank close family members as more helpful. GPs and MHS staff reported complementary roles, with a shared responsibility for early detection and relapse prevention. Treatment compliance, and communication and accessibility to specialist agencies were identified as major problems. Conclusions:. GPs fulfil a valuable role in the treatment of schizophrenia, which could be enhanced through improved training. Mental health services need to work more effectively with GPs in treating schizophrenia and acknowledge their complementary roles. [ABSTRACT FROM AUTHOR]

Background This paper presents findings from the Australian National Survey of Mental Health and Wellbeing (NSMHWB) regarding prevalence and treatment seeking for Australians with DSM-IV alcohol dependence and examines the influence of alcohol use variables on treatment seeking. Method A standardised interview (including CIDI 2.1) was administered to a stratified random sample of 10,641 Australians aged 18 years and over. Demographic variables, common DSMIV mental disorders, physical health status, perceived disability and treatment-seeking behaviour were assessed. Multiple logistic regression was used to ascertain the independent effects of all variables considered. Results The prevalence of DSM-IV alcohol dependence was 4.1% in this population, with 75 % being male and nearly 60% in the 18-34 year age group. Variables that correlated independently with alcohol dependence were sex (male), age (young), not being in a married or de facto relationship and having any affective, anxiety or other substance use disorder. Functional disability did not correlate with a dependence diagnosis. Correlates of treatment seeking for those with dependence were sex (female) and having a comorbid affective disorder. Having a diagnosis of dependence and/or abuse and having more dependence symptoms did not predict treatment seeking. However, meeting either of two criteria assessing psychological, physical or social problems due to alcohol use tended to increase service use. Conclusions People with alcohol dependence do not perceive themselves as disabled and do not seek treatment. However, having a comorbid affective disorder or other problems directly attributable to alcohol use increases the likelihood that such individuals will seek treatment. Efforts should be made at the primary care level to encourage those engaged in harmful drinking practices to recognise the risks of such drinking and reduce it or seek treatment. Similarly, it is recommended that integrated services are... [ABSTRACT FROM AUTHOR]

The research literature on the psychiatric consequences of the Vietnam War focuses primarily on the construct of Posttraumatic Stress Disorder (PTSD), after an initial focus in the 1970s on depression and alcohol and substance abuse. The present paper examines the hypothesis that among men without current PTSD, those with higher combat in Vietnam will be more likely to have current DSM-III-R illnesses. The Australian Vietnam Veterans' Health Study (AVVHS) collected a broad range of interview data on 641 Vietnam veterans throughout 1990-1993. Measures of combat exposure, age at embarkation to Vietnam, enlistment IQ and pre-Army personality problems were drawn from Army records of the era. Retrospective measures of combat were obtained at interview. The interview also involved the administration by trained lay interviewers of the DSM-III-R based Diagnostic Interview Schedule (DIS). This epidemiological instrument provides current psychiatric diagnoses as well as temporal (retrospective) symptom and diagnosis onset data. The results of this study show that current disorders (without PTSD comorbidity) with onsets within 5 years of embarkation to Vietnam are more likely among men who saw higher combat, as indexed by combat-exposure measures drawn from Army records of the era as well as retrospective self-report. This combat relatedness remains when age at embarkation. IQ at enlistment and pre-Army personality measures are used as covariates. No more than 11.4% of sampled Vietnam veterans currently meet DSM-III-R diagnostic criteria for PTSD, while a further 7.8% do not have current PTSD but do have some other current DIS diagnosis with onset in the 5-year period following (first) emabarkation to Vietnam. Our data support the hypothesis that the current illnesses of many of these men without PTSD are combat-related DSM-III-R illnesses. [ABSTRACT FROM AUTHOR]