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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]

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]

Purpose: People with mental illness are a vulnerable and stigmatised group with poor health outcomes including greater premature mortality. This study aimed to investigate trends and rates of change in unintentional drug-related deaths for people with mental illness, describe types of medicines involved, and identify populations at risk in a cohort from New South Wales, Australia. Methods: Features of unintentional drug-related deaths for people with mental illness between 2012 and 2016 were identified in a retrospective review of data from the National Coronial Information System. Results: A total of 495 unintentional drug-related deaths were identified (1.6 deaths/100,000 population), showing an upward trend (p < 0.01). The most common substance involved was diazepam in both genders (males 135/319, 42%, female 76/176, 43%) and more than one contributory drug was included in 80% of cases. Between 2012 and 2016, amphetamine-related deaths showed the highest increase (3.2-fold), followed by codeine (2.5-fold) and quetiapine (2.5-fold). Males (RR 1.8, 95% CI 1.5–2.2) and people aged 35–44 (RR 1.7, CI 1.3–2.2) were more likely to die from unintentional drug-related deaths compared with the reference (females and people aged 25–34). Conclusion: This study found that the drugs commonly involved in deaths are also the drugs commonly used by and prescribed to people with mental illness. There were also significant differences between gender, age group, and marital status in the trend and rate of unintentional drug-related deaths for people with mental illness. A multifaceted approach encompassing both pharmaceutical prescribing and targeted public health messaging is required to inform intervention and prevention strategies. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to examine in a national survey sample the risks of having a specific personality disorder (PD) and associations with gender, of having one or more physical conditions, of having one or more Axis 1 conditions, and of the severity (or degree) of disability. We also examined the association of specific PDs with having sought a consultation for health or mental health problems with a general practitioner (GP), a psychologist, or psychiatrist over the past 12 months.Method: Data were derived from the Australian National Mental Health and Well-Being Survey, conducted between May and August 1997. A stratified random sample of households was generated, from which all persons aged 18 or over were considered potential interviewees. There were 10,641 survey respondents, this representing a response rate of 78%. Each interviewee was asked 59 questions indexing specific ICD-10 PD criteria.Results: Logistic regressions identified that some specific PDs, especially borderline PD, were more strongly associated with having one or more Axis I conditions, greater mental disability and lost days of total and partial role functioning than having No PD, and that others, notably anankastic PD, were less likely to be associated with the same variables. Some specific PDs, again most notably borderline PD, were more associated than others, again most notably anankastic PD, with having sought mental health consultations from GPs, psychiatrists, and psychologists. By contrast, PD associations with gender, physical conditions, physical disability and health consultations with the three professional groups were weaker as reflected in the comparatively smaller odds ratios and were also less consistent than the pattern with the previously mentioned variables.Conclusion: The study reports findings from a nationwide survey and, as such, the data are less influenced by the selection and setting bias found in most other studies investigating these variables. The findings of the study do point to some specific PDs, such as borderline PD, being associated with greater Axis 1 psychopathology, disability and mental health consultations than others, such as anankastic PD. It appears that although anankastic PD in itself is associated with more disability than having No PD, it becomes significantly more disabling when it is associated with other comorbid PDs. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the scope and nature of discrimination and positive treatment experienced by adults with mental health problems from their friends and family in a population-based survey.Methods: An Australian telephone-survey of 5220 adults included 1381 individuals who reported a mental health problem or scored high on a screening questionnaire. Respondents were interviewed about their experience of discrimination and positive treatment from their friends, spouse and other family members. Descriptions of experiences were content-analysed to identify key characteristics.Results: Mental health diagnoses were primarily depression or anxiety disorders, and just over half had received treatment in the last 12 months. Positive treatment from family and friends was far more common than discrimination, reported by 74.1% of respondents. This was primarily characterised by providing emotional support and maintaining contact, as well as checking on their mental health and being a good listener. Nevertheless, discriminatory behaviours from friends and family were reported by 25.8% of respondents, with reducing or cutting contact being by far the most common. Friends and family also commonly dismissed that mental illness was real or caused suffering and showed a lack of understanding about mental health problems or treatments and how they can impact behaviour and functioning.Conclusions: This nationally representative study of real life experiences highlights the potential for harm or benefit from a person's social support network. Despite positive experiences being common, there is an ongoing need to reduce mental illness stigma and improve understanding of how to support a loved one with a mental health problem. [ABSTRACT FROM AUTHOR]

Studies have consistently demonstrated a reciprocal relationship between internalizing disorders and several chronic physical health conditions. Yet, much of the extant literature fails to take into account the role of comorbidity among internalizing disorders when examining the relationship with poor physical health. The current study applied latent variable modelling to investigate the shared and specific relationships between internalizing (fear and distress factors) and a range of physical health conditions. Data comprised 8841 respondents aged 16-85 years who took part in the 2007 Australian National Survey of Mental Health and Wellbeing. Multiple indicator, multiple causes models were used to parse the shared and specific relationships between internalizing disorders and variables associated with poor physical health. The study found that several physical conditions were significantly related to mean levels of fear and distress. The results were broadly similar but minor differences emerged depending on whether lifetime or past 12 months indicators of mental disorders and physical conditions were utilized in the model. Finally, the results demonstrated that the association between individual mental disorders and physical health conditions are better accounted for by indirect relationships with broad transdiagnostic dimensions rather than including additional disorder-specific relationships. The results indicate that researchers should focus on common mechanisms across multiple internalizing disorders and poor physical health when developing prevention and treatment initiatives. [ABSTRACT FROM AUTHOR]

Purpose: To assess the associations between beliefs about the dangerousness of people with mental health problems and exposure to media reports of violence or personal experiences of fear, threat or harm.Methods: Telephone interviews were carried out with 5220 Australians aged 18+. Respondents heard a vignette of a person with depression or early schizophrenia and were asked whether they believed him to be dangerous. Other questions covered past 12-month recall of media reports of violence and mental health problems, contact with and experiences of fear, threat or harm by people with mental health problems. Multinomial logistic regression was used to assess the associations between beliefs about dangerousness and media and these types of contact with people with mental health problems.Results: For the early schizophrenia vignette, recall of media reports and having felt afraid of someone were associated with beliefs about dangerousness. For the depression vignette, media reports about violence and mental health problems or the experiences of feeling afraid or having been threatened or harmed were not strongly associated with beliefs about dangerousness. For both vignettes, knowing someone with a mental health problem and having a higher level of education were associated with less belief in dangerousness.Conclusions: Media reports may play a greater role in forming attitudes in low prevalence disorders and further efforts to reduce any adverse impact of media reporting should focus on these disorders. The study also supports the effectiveness of contact with people with mental health problems in reducing beliefs about dangerousness. [ABSTRACT FROM AUTHOR]

Purpose: Communication of a mental health diagnosis can be a difficult process and is a poorly understood area of service provision. The aim of this qualitative study was to examine clinicians' perceptions of barriers and helpful strategies to discussing information about a mental health condition.Method: Qualitative interviews with 19 Australian clinicians (general practitioners, mental health nurses, psychiatrists, and psychologists) working in several settings (community, hospital inpatient, outpatient, accident and emergency) and locations (urban, suburban and rural) were conducted and analysed thematically.Results: After theme saturation was reached, four primary themes relating to barriers and facilitators to communication at the time of diagnosis were identified in the data. Outside a recognised lack of focus on this area in training, themes included (1) engagement and timing of conversations; (2) stigma and its reduction; (3) perceived and desired knowledge for diagnostic information; and (4) working with distress. The synthesis of themes is demonstrated in a flowchart of suggestions for communicating news of mental health diagnosis that tracks the patient journey in receiving information from initial engagement to follow-up.Conclusions: Talking with an individual about a mental health diagnosis is a non-linear, complex and changeable situation. However, health professionals report using specific strategies to aid this communication process, to meet the specific individual's needs. Strategies such as tailoring to the person's situation, utilising collaborative practice, effective coordination, and addressing stigma may be useful to inform clinician training and support whilst diagnosis remains a key feature of the mental health system in Australia. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this review is to report on recent developments in youth mental health incorporating all levels of severity of mental disorders encouraged by progress in the field of early intervention in psychotic disorders, research in deficiencies in the current system and social advocacy.Methods: The authors have briefly reviewed the relevant current state of knowledge, challenges and the service and research response across four countries (Australia, Ireland, the UK and Canada) currently active in the youth mental health field.Results: Here we present information on response to principal challenges associated with improving youth mental services in each country. Australia has developed a model comprised of a distinct front-line youth mental health service (Headspace) to be implemented across the country and initially stimulated by success in early intervention in psychosis; in Ireland, Headstrong has been driven primarily through advocacy and philanthropy resulting in front-line services (Jigsaw) which are being implemented across different jurisdictions; in the UK, a limited regional response has addressed mostly problems with transition from child-adolescent to adult mental health services; and in Canada, a national multi-site research initiative involving transformation of youth mental health services has been launched with public and philanthropic funding, with the expectation that results of this study will inform implementation of a transformed model of service across the country including indigenous peoples.Conclusions: There is evidence that several countries are now engaged in transformation of youth mental health services and in evaluation of these initiatives. [ABSTRACT FROM AUTHOR]

Purpose: To identify variables associated with common mental disorders in an Australian university population. Methods: We invited all Australia-based students from a large public university ( N = 24,209) to participate in a web-based student mental health survey. Outcome measures included the patient health questionnaire depression, anxiety, and eating disorders modules, and the alcohol use disorders identification test. Explanatory variables of interest included gender, age, year of study, degree type, financial means, parental education, domestic/international status, and sexual orientation. Multiple logistic regression analysis was used to estimate independent associations with the four outcomes. Results: Complete responses were received from 6,044 students (25 %). Proportions reporting depression, anxiety, eating disorders, and harmful drinking were 8, 13, 14, and 8 %, respectively, while 30 % had at least one of these disorders. The groups with the highest rates of disorder were women, 25-34-year-olds, students on low income, and homosexual or bisexual students. Parental education was not associated with disorder, nor was international/domestic status. Conclusion: This is the first study examining mental disorders in a population-based sample of university students in Australia. Given increasing student numbers and participation of students from lower socio-economic backgrounds, policy is urgently needed to promote better mental health in this population, to routinely identify vulnerable students, and to intervene early. Groups in particular need are women, students on low incomes, and homosexual or bisexual students. [ABSTRACT FROM AUTHOR]

Purpose: Mental disorders are common in young people, yet many do not seek help. Being able to label the problem may facilitate effective help-seeking, but it is not clear which labels are best. This study aims to examine which labels commonly used by young people are associated with a preference for recommended sources of help and treatment. Method: A national telephone survey was conducted with a randomly selected sample of 2,802 Australian young people aged 12-25 years. Respondents were read out one of three vignettes describing symptoms of a mental disorder, and asked a series of questions regarding labelling of the problem described and related help-seeking preferences and beliefs. Binary logistic regression analyses were used to measure the association between type of label used and help-seeking preferences and beliefs. Results: Use of the accurate label to describe the problem in the vignette predicted a preference for recommended sources of help with greater consistency than any other labels commonly used by young people. Inaccurate mental health labels did predict some preferences for recommended sources of help and treatment, but not to the extent of the accurate label. Lay labels such as 'stress', 'paranoid' and 'shy' predicted less intention to seek any help for the problem described in the vignette. Conclusions: Labelling a disorder accurately does predict a preference for recommended sources of help and a belief in the helpfulness of recommended treatments. Importantly, it is also apparent that some commonly used lay labels cannot do this and indeed may limit appropriate help-seeking and treatment acceptance. [ABSTRACT FROM AUTHOR]

Canada and Australia although geographically distant have similarities in human geography and history. Each has had a national mental health policy for some years, but Australia has driven policy implementation in this area harder than has Canada. Comparable epidemiological surveys from Australia in 1997 and Canada in 2002 allow us to explore relative rates of mental disorders and compare estimates of access to care from mental health services. We compare findings from the Australian National Survey of Mental Health and Wellbeing (1997) with those from the Canadian Community Health Survey on Mental Health and Well Being, cycle 1.2 (2002). Differences in prevalence rates and in service utilisation emerge between the two countries: Anxiety Disorders are estimated as almost 2% higher in Canada than in Australia while there is suggestion that Major Depressive Disorder, Alcohol Dependence and Drug Dependence may be more prevalent in Australia. More of the people with co-morbid disorders in Australia than in Canada make use of mental health services and a finding of marginal significance suggests that this may be true across all disorders. Causation cannot be determined from this study but possible explanations for differences in prevalence include changes in global economic, political and security contexts and concerns between 1997 and 2002 and the possible role of greater availability of alcohol in Australia. The findings also provide encouragement that strenuously implementing a national mental health policy may have been of benefit to people with mental health problems in Australia. [ABSTRACT FROM AUTHOR]

Background: Only a limited number of population-based studies have been able to prospectively follow the mental health of their participants. We aimed to describe diagnostic changes in a population based cohort over a two year period, and to explore associations between a range of individual factors and recovery from, or onset of, disorders.Methods: Two year, face-to-face follow-up of a community-based cohort drawn from random telephone screening using the CIDI as diagnostic instrument. Unlike most similar research we did not exclude individuals with prior history from analysis.Results: 1407 participants were administered face-to-face interviews and 968 were re-interviewed. In multivariate analysis, recent adverse life events, poor physical health, and high neuroticism score were significant predictors of developing a mental disorder in participants who were disorder free at baseline. Higher baseline levels of physical activity were protective of new disorders in univariate analysis. Most participants with a baseline disorder and not lost to follow-up were disorder-free two years later. For participants with a disorder at both interviews, there was marked lability in diagnoses, with only a small minority having an unchanged diagnosis at both baseline and follow-up. Factors predicting a poor outcome in participants with a disorder included the number of baseline diagnoses, high neuroticism score and adverse life events.Conclusions: These findings suggest that the diagnosis of common mental disorders is complex and that diagnoses are relatively unstable. The factors that influence the emergence of mental disorders in individuals who may, or may not, have had a disorder in the past, are similar to those associated with the development of new disorders in subjects without a lifetime history. [ABSTRACT FROM AUTHOR]

Background: Surveys of the public in several countries have found a predominant belief in social environmental causes of mental disorders. The present study was conducted to determine whether this has changed over time in Australia.Method: Beliefs about causes and risk factors were assessed using questions based around case vignettes of a person with depression or schizophrenia. These questions were asked in a national survey of 2,031 Australians aged 18-74 carried out in 1995, and a second survey of 1,823 persons carried out in 2003-2004.Results: The major changes were an increase in belief in genetic causes of both depression and schizophrenia, increases in beliefs about problems from childhood and the death of someone close as causes of depression, and a decrease in the belief that "weakness of character" is a cause of schizophrenia.Conclusion: There has been an increase in belief about genetic causes, which may be due to publicity about the human genome project and related scientific advances. This change has not been at the expense of belief in social causes, and it has been accompanied by a decrease in the belief that personal weakness is a cause. [ABSTRACT FROM AUTHOR]

A study was conducted to assess the belief systems of the general public concerning the appropriate treatments for mental disorders and correlates of these belief systems. The study was based on the results of a household survey of the general public in Australia, using a national random sample of 2,031 adults aged 18–74 years. Respondents were given a vignette describing either a person with depression or one with schizophrenia, and were asked for their opinions about the helpfulness of various professional and non-professional treatments for the person described. A principal components analysis of the helpfulness ratings gave three factors: a Medical factor with high loadings on all drug treatments (except Vitamins) and on Psychiatric ward and ECT; a Psychological factor with high loadings on Counsellor, Social worker, Phone counselling, Psychiatrist, Psychologist, Psychotherapy and Hypnosis; and a Lifestyle factor with high loadings on Close family, Close friends, Naturopath, Vitamins, Physical activity and Get out more. The same factors emerged from ratings of the two vignettes. Mean scores on scales constructed from the items with high loadings showed that the public tend to have a negative view of medical treatments and a positive view of psychological and lifestyle ones. However, medical treatments were rated more negatively for depression than for schizophrenia, psychological treatments were rated more positively for schizophrenia, and lifestyle treatments more positively for depression. Age, sex and education of respondents showed few associations with scores on the scales, although the better educated were more in favour of psychological treatments for both depression and schizophrenia and were less opposed to medical treatments for schizophrenia. Respondents who had suffered from the symptoms described in the schizophrenia vignette were more negative towards medical treatments. These findings about public belief systems could have implications for the provision of treatment: where there is a discrepancy in belief system between the patient and the clinician there may be poor adherence to treatment. [ABSTRACT FROM AUTHOR]