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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]

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:. 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]

Purpose: This study aims to investigate trends in socioeconomic inequalities of suicide from 1979 to 2013 for Australian males and females aged 15-34 years and 35-64 years.Methods: Data on suicides and population were obtained from national registries. An area-based measure of socioeconomic status (SES) was used, and categorized into low, middle, and high SES areas. Suicide rates for each SES groups were estimated using a negative binomial regression model, adjusted for confounders. Socioeconomic inequalities in suicide were assessed using absolute and relative risk of low-to-high SES areas. Secular changes in socioeconomic inequalities were assessed using trend tests for relative risk.Results: For young males, there was an increase in socioeconomic inequality driven by a significant decrease in suicide rates in high SES areas. For older males, inequality in suicide increased by 29%, which was related to a marked increase in suicide rates in low SES areas. Inequalities in both young and older female suicides also increased. These increases occurred when corresponding suicide rates in high SES areas decreased.Conclusions: Recent widening socioeconomic inequalities in Australian suicide have been primarily associated with declines in suicide rates in high SES areas. However, an increasing inequality in older male suicide is linked with low SES. Efforts targeting people from poor areas, especially older males, should be considered when developing suicide prevention strategy. [ABSTRACT FROM AUTHOR]

Purpose: Many children now live in non-traditional families-including one-parent, blended, and step families. While a substantial body of international evidence indicates that these children display poorer cognitive and socio-emotional outcomes than children living in traditional families, research on childhood mental disorders is scarce. This report provides new evidence of the relationships between family structure and childhood mental disorders in an under-researched context, Australia.Methods: We use recent, nationally representative data on children aged 4-17 from Young Minds Matter, the second Australian Child and Adolescent Survey of Mental Health and Well-being (N = 6310). Mental disorders were assessed using the Diagnostic Interview Schedule for Children-Version IV and included social phobia, separation anxiety disorder, generalised anxiety disorder, obsessive-compulsive disorder, major depressive disorder, attention-deficit/hyperactivity disorder, and conduct disorder.Results: Compared to children living in original families, children in one-parent, blended, and step families experienced a higher prevalence of mental disorders. Amongst children whose parents separated, the time since separation was not statistically significantly related to the prevalence of mental disorders.Conclusions: Although we are unable to assess causality, our findings highlight the strength of the association between family structure and child and adolescent mental health. They also stress the need for programs to support children, parents, and families in non-traditional family types to reduce mental health inequalities in childhood and later life. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about the course of fathers' psychological distress and associated risk factors beyond the postnatal period. Therefore, the current study aimed to: (a) assess the course of distress over 7 years postnatally; (b) identify classes of fathers defined by their symptom trajectories; and (c) identify early postnatal factors associated with persistent symptoms. Method: Data from 2,470 fathers in the Longitudinal Study of Australian Children were analysed using latent growth modelling. Fathers' psychological distress was assessed using the Kessler-6 (Kessler et al. in Arch Psychiatry 60:184-189, ) when their children were aged 0-1, 2-3, 4-5 and 6-7 years. Results: Overall, distress was highest in the first postnatal year and then decreased over time. Two distinct trajectories were identified. The majority of fathers (92 %) were identified as having minimal distress in the first postnatal year which decreased over time, whilst 8 % had moderate distress which increased over time. Low parental self-efficacy, poor relationship and job quality were associated with 'persistent and increasing distress'. Conclusions: Early postnatal factors associated with fathers' persistent distress were identified, providing opportunities for early identification and targeted early intervention. [ABSTRACT FROM AUTHOR]

Background: Migration has been found to be a risk factor for schizophrenia in several high-income countries. Aim: To examine whether overseas migrants to New South Wales (NSW) have higher rates of admission to psychiatric hospitals for psychotic disorders, including schizophrenia and mania, compared to people born in Australia. Methods: The country of birth of people admitted to public mental health units for the treatment of psychotic illness and for non-psychotic disorders between 2001 and 2010 was compared to the country of birth for the NSW population in the 2006 census. Meta-analysis was used to estimate the odds of being admitted for any psychotic disorder, for a schizophrenia-related psychosis and for mania compared to non-psychotic disorder, for those born in Australia, New Zealand and for nine global regions. Results: Those born in Oceania (including Melanesia, Fiji, Samoa, Tonga and other Polynesian islands, but excluding Hawaii and New Zealand) had the highest odds of admission for the treatment of psychosis compared to a non-psychotic disorder and had the highest odds of being admitted with a diagnosis of schizophrenia or mania. Conclusions: In the years 2001-2010, those born in Oceania were at an increased risk of admission to NSW psychiatric hospitals for the treatment of psychotic illness. [ABSTRACT FROM AUTHOR]

The utilization of mental health services is low among Chinese immigrants in Australia, yet their help-seeking pattern has not been investigated. The aims of this study were to describe the delay among Chinese immigrants in seeking treatment for an anxiety disorder and to compare the results with previous research from the general population in Australia. Forty-nine participants were recruited from the community. Their demographic data, DSM-IV diagnosis and help-seeking patterns were assessed by a self-report questionnaire and the CB-SCID (Chinese-bilingual Structured Clinical Interview Schedule for the DSM-IV). The average length of the delay for treatment was 7.04 years and the average time to problem recognition was 8.07 years. The most common barriers to help-seeking reported by Chinese immigrants include a lack of knowledge about available treatment, being unable to afford the cost of the treatment, and having no transportation to access the service. The most frequently endorsed reason for help-seeking was “I recognized the problem was anxiety”. General medical practitioners were most commonly their first professional contact. The time taken for Chinese immigrants in Australia to seek help was typically long, suggesting a similar help-seeking delay to the Australian general population. However, different barriers to help-seeking emerged, suggesting that Chinese immigrants would benefit from education about the symptoms of psychiatric disorders and available treatments. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated secular trends in socio-economic status (SES) differentials in Australian suicide (1979-2003), which includes overall declines in male suicide from 1998.Method: Suicide rates were stratified by approximate equal-population quintiles of area-based SES for the period 1979-2003 and examined across five quinquennia, centred on each Australian Census from 1981 to 2001, to determine if (1) SES differentials in suicide have persisted over time, and (2) if SES differentials have widened or narrowed. Suicide rates (per 100,000) were adjusted for confounding by sex, age, country-of-birth, and urban-rural residence using Poisson regression models, and secular changes in SES differentials were assessed using trend tests on suicide rate ratios (low to high SES quintiles).Results: Socio-economic status (SES) differentials persisted across the study period for both males and females after adjusting for the effects of age, migrant status, and urban-rural residence, with the largest differences between low and high SES groups evident in males, and especially young males (20-34 years). For males, suicide rates increased significantly in all SES groups until 1998, before diverging significantly in the most recent 5-year period, particularly in younger males (P<0.0001). In young males, suicide rates in the most recent period increased in the low SES group from 44.8 in 1994-1998 to 48.6 in 1999-2003 (an 8% increase). In contrast, suicide rates in the middle SES group decreased from a peak of 37.3 to 33.5 (a 10% decrease), and in the high SES group from a peak of 33.0 to 27.9 (a 15% decrease). A similar statistically significant divergence of a lesser magnitude was also evident in all age males and younger females (20-34 years).Conclusion: This study shows that SES differentials in suicide persisted in Australia for most of the period 1979-2004. The decline in suicide in young males in the most recent quinquennium was limited to middle and high SES groups, while the low SES group displayed a continued increase. The continued increase in suicide in low SES males has implications for social and economic intervention and suicide control programs. [ABSTRACT FROM AUTHOR]

Background: Double depression, or dysthymia with superimposed major depression, is a major public health issue that imposes considerable burden on the community. Double depression and its associated morbidity have not previously been delineated in an Australian population.Methods: A random and representative sample of the South Australian population was assessed by trained interviewers. The mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD), the Short-Form Health Status Questionnaire (SF-36), and Assessment of Quality of Life (AQoL) instruments were administered, and data related to treatment use and role functioning were collated.Results: Double depression was present in 2.2% of the population. This group reported high levels of treatment-seeking behaviour with 90% seeking treatment in the last month and 42.4 % taking antidepressants. They also had a highly significantly poorer quality of life than did others in the community.Conclusions: The 2.2% of the population with double depression reported high use of services with poor functioning and health-related quality of life. More effective intervention strategies are required. [ABSTRACT FROM AUTHOR]

Background: The initial delay to seek treatment accounts for a significant proportion of the unmet need for treatment of common psychiatric conditions. This study aimed to examine the barriers to initial help-seeking and factors that facilitate help-seeking for anxiety and depression.Methods: Help-seeking history was retrospectively self-reported by 233 patients at a specialist anxiety clinic, all of whom had delayed seeking professional treatment for at least one month. Data gathered included age at onset, age at help-seeking, primary reason for the delay, prompt to seek help and first professional contacted.Results: The most frequently endorsed reasons for the delay related to lack of knowledge about mental illness or available treatment. Increasing illness severity or disability was the primary prompt to seek help for the majority of respondents. Reason for the delay showed some relationship with length of the delay, but prompt to seek help did not. A general medical practitioner (GP) was the first professional contacted in 71 % of cases.Conclusions: Lack of public 'mental health literacy' contributes to slow problem recognition. Increasing illness severity eventually facilitates problem recognition and prompts help-seeking. Structural barriers to initial help-seeking are relatively unimportant within the Australian health care system. General practitioners play an important role as gate-keepers to appropriate mental health care. [ABSTRACT FROM AUTHOR]