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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.

Objectives: There is limited evidence on the impact of parental mental health problems on offspring's educational outcomes. We investigated the impact of maternal anxiety and depressive symptoms, as well as paternal emotional problems on the educational outcomes of their adolescent and young adult offspring., Methods: We used data from a longitudinal birth cohort recruited between 1989 and 1991 in Australia (the Raine Study). The Depression, Anxiety and Stress Scale was used to assess maternal depressive and anxiety symptoms, and a self-reported question was used to measure paternal mental health problems. Both were assessed when the offspring was aged 10 years. Outcomes included offspring's self-reported education attainment-not completing year 10 at age 17, not attending tertiary education at ages 17 and 22 and primary caregiver's reports of offspring's academic performance at age 17., Results: A total of 1033, 1307 and 1364 parent-offspring pairs were included in the final analysis exploring the association between parental mental health problems and offspring's academic performance at school, completing year 10 and attending tertiary education, respectively. After adjusting for potential confounders, the offspring of mothers with anxiety symptoms were 3.42 times more likely than the offspring of mothers without anxiety symptoms to have poor or below-average academic performance (odds ratio = 3.42; 95% confidence interval = [1.31, 8.92]) and more than 2 times more likely to not attend tertiary education (odds ratio = 2.55; 95% confidence interval = [1.10, 5.5.88]) and not to have completed year 10 (odds ratio = 2.13; 95% confidence interval = [1.04, 4.33]). We found no significant associations between maternal depressive symptoms or paternal emotional problems and offspring educational attainment., Conclusion: Maternal anxiety symptoms, but not depression and paternal emotional problems, are associated with poor educational attainment and achievement in adolescent offspring. The findings highlight that efforts to improve the outcomes of offspring of mothers with anxiety could focus on educational attainment.

Background: Evidence suggests that externalizing and internalizing symptoms are expressed early in life and are associated with problematic drinking in young adulthood. However, few studies have examined their role during childhood and adolescence in predicting alcohol problems later in life., Objectives: To examine the role of childhood and adolescent externalizing and internalizing symptoms in predicting alcohol use disorders in young adulthood., Methods: We searched five electronic databases (PubMed, Scopus, PsycINFO, Web of Sciences and Embase) for studies which diagnosed alcohol use disorders through either the International Classification of Diseases or American Psychiatric Association - Diagnostic and Statistical Manual of Mental Disorders criteria and followed up children or adolescents into the transition to young adulthood. We performed a meta-analysis and obtained pooled odds ratio estimates with 95% confidence intervals using random-effects models., Results: A total of 12 longitudinal studies met eligibility criteria and were included in the meta-analysis. All measured the outcome using Diagnostic and Statistical Manual of Mental Disorders criteria. The majority were of good quality and were conducted in the United States. A total of 19,407 participants (50% female) were included in this meta-analysis. Of these, n  = 2337 (12%) had diagnoses of alcohol use disorders/alcohol dependence. Participant ages ranged from birth to 36 years. Internalizing symptoms increased the risk of young adult alcohol use disorders by 21% (odds ratio = 1.21; 95% confidence interval = [1.05, 1.39]), with no strong evidence of publication bias. Subgroup analysis suggested significantly lower heterogeneity than for externalizing studies. Externalizing symptoms increased the risk of alcohol use disorders by 62% (odds ratio = 1.62, 95% confidence interval = [1.39, 1.90]). We found some evidence of publication bias and significant heterogeneity in the studies., Conclusion: Our findings highlight the contribution of early behavioural problems to the development of alcohol use disorders in young adulthood and the need for timely scrutiny of and intervention on early behavioural problems.

Objectives: Previous research suggests that child maltreatment is associated with adverse outcomes, but the potential impact on cognitive and educational outcomes into adulthood has rarely been studied using a birth cohort design. The aim of this study is to investigate whether child maltreatment is associated with adverse outcomes in cognitive function, high school completion and employment by the age of 21., Methods: Longitudinal birth cohort study commencing in the prenatal period, with mothers and infants followed up to age 21. Of the original birth cohort of 7223, 3778 (52.3%) young people participated at age 21. Child maltreatment was identified by linkage with prospectively collected data from the relevant government agency. Associations between child maltreatment (abuse and neglect) and the outcomes were adjusted for relevant sociodemographic and perinatal variables., Results: After full adjustment, young people who had been notified as cases of child maltreatment had reduced performance on the Peabody Picture Vocabulary Test by over a quarter of a standard deviation (coefficient = -2.85, p = 0.004). Maltreated young people also had three times the odds of failing to complete high school (odds ratio = 3.12, p < 0.001) and more than twice the odds of not being engaged in either study or employment at age 21 (odds ratio = 2.38, p < 0.001). Both abuse and neglect were similarly associated with adverse outcomes., Conclusion: Child maltreatment, including both abuse and neglect, is associated with adverse cognitive, educational and employment outcomes in young adulthood. This adds further impetus to efforts to prevent child maltreatment and assist young people who have experienced it.

Objective: Prisoners are at increased risk of both self-harm and suicide compared with the general population, and the risk of suicide after release from prison is three times greater than for those still incarcerated. However, surprisingly little is known about the incidence of self-harm following release from prison. We aimed to determine the incidence of, identify risk factors for and characterise emergency department presentations resulting from self-harm in adults after release from prison., Method: Cohort study of 1325 adults interviewed prior to release from prison, linked prospectively with State correctional and emergency department records. Data from all emergency department presentations resulting from self-harm were secondarily coded to characterise these presentations. We used negative binomial regression to identify independent predictors of such presentations., Results: During 3192 person-years of follow-up (median 2.6 years per participant), there were 3755 emergency department presentations. In all, 83 (6.4%) participants presented due to self-harm, accounting for 165 (4.4%) presentations. The crude incidence rates of self-harm for males and females were 49.2 (95% confidence interval: [41.2, 58.7]) and 60.5 (95% confidence interval: [44.9, 81.6]) per 1000 person-years, respectively. Presenting due to self-harm was associated with being Indigenous (incidence rate ratio: 2.01; 95% confidence interval: [1.11, 3.62]), having a lifetime history of a mental disorder (incidence rate ratio: 2.13; 95% confidence interval: [1.19, 3.82]), having previously been hospitalised for psychiatric treatment (incidence rate ratio: 2.68; 95% confidence interval: [1.40, 5.14]) and having previously presented due to self-harm (incidence rate ratio: 3.91; 95% confidence interval: [1.85, 8.30])., Conclusion: Following release from prison, one in 15 ex-prisoners presented to an emergency department due to self-harm, within an average of 2.6 years of release. Demographic and mental health variables help to identify at-risk groups, and such presentations could provide opportunities for suicide prevention in this population. Transition from prison to the community is challenging, particularly for those with a history of mental disorder; mental health support during and after release may reduce the risk of adverse outcomes, including self-harm.

Objective: Compared to the substantial body of research examining links between cannabis use and psychosis, there has been relatively little attention to the role of tobacco as a potential risk factor for psychosis. This study explored the association between age at first tobacco use and psychosis-related outcomes in a birth cohort., Method: This study is based on a large birth cohort (the Mater-University Study of Pregnancy). At approximately 21 years of age, cohort members (N = 3752) were assessed for three psychosis-related outcomes (International Classification of Diseases non-affective psychosis, the presence of any hallucination and total count of delusional-like experiences) with the Composite International Diagnostic Interview and the Peters Delusional Inventory. Associations between age at first tobacco use and psychosis-related outcomes were examined using logistic regression in a model (a) adjusted for sex and age and (b) in a second model excluding all respondents who had a history of past problematic and current cannabis use., Results: When adjusted for age and sex, those who commenced tobacco at 15 years of age or younger were significantly more likely to (a) have non-affective psychosis, (b) be in the highest quartile of total score of the Peters Delusional Inventory and (c) report hallucinations. After excluding all those with a history of a cannabis use disorder, or who were current (last month) cannabis users, a significant association between age at first tobacco use and the presence of hallucinations persisted., Conclusion: There is an association between age at first tobacco use and subsequent psychosis-related outcomes in young adults. While the findings cannot be used to deduce causality, it adds weight to the hypothesis that early tobacco use may contribute to the risk of developing psychosis-related outcomes., (© The Royal Australian and New Zealand College of Psychiatrists 2015.)

Objective: The objective of this study was to examine whether maternal factors such as socioeconomic status (SES), attitudes towards the baby, and mental health at 6 months or earlier, are associated with non-penetrative and penetrative childhood sexual abuse (CSA) in her offspring., Methods: This was a prospective birth cohort study followed up to 21 years. Set in one of two obstetric hospitals in Brisbane, Australia, the Mater-University of Queensland Study of Pregnancy (MUSP) involves a prospective birth cohort from a population based sample of 7223 singletons whose mothers were enrolled between 1981 and 1984 at the first antenatal visit. The present cohort consisted of 2664 participants who provided CSA data, and whose mothers had responded to all relevant questions., Results: About 16% of young adults reported non-penetrative sexual abuse before the age of sixteen and 9% reported penetrative abuse. After adjusting for all variables in the model, an increased risk for non-penetrative CSA was associated with the child being female, unwanted pregnancy, mother being a heavy smoker, and maternal anxiety. Increased risk for penetrative CSA was associated with the child being female, the mother having failed to complete a high school level education, living in an alternative arrangement other than marriage, and being either a moderate or heavy smoker. We found no associations between maternal age and CSA after correcting for other predictors., Conclusion: CSA was not uncommon in this cohort with one in four reporting some form of sexual abuse before 16. The results suggest that several early factors may predict later CSA and that the associations are different according to type of CSA.

Objectives: The purpose of the present study was to examine the longitudinal association between early childhood factors and early initiation of use of substances and substance use disorders in a large prospective study., Method: Data were from the Mater Hospital University of Queensland Study of Pregnancy, a prospective birth cohort study in Brisbane, Australia. Use of nicotine, alcohol and cannabis and age of initiation of such use were reported at the 21 year follow up. DSM-IV diagnosis of nicotine, alcohol and cannabis use disorders was assessed at 21 years using a computerized version of the Composite International Diagnostic Interview (CIDI-Auto). Early childhood factors were measured between mother's pregnancy and child age 5 years., Results: Of the 3647 respondents with complete data, 15.4% had started to smoke cigarettes before 15 years. Another 17.4% and 12.2% reported having started to consume alcohol or use cannabis in early adolescence, respectively. Some 16.2%, 27.8% and 21.9% had ever had nicotine, alcohol or cannabis abuse or dependence (disorder) by 21 years, respectively. In multivariate models early initiation of use of substances, and substance use disorders were associated with disrupted families or drug-using parents, childhood problem behaviours, and poor parental monitoring and supervision in childhood., Conclusions: There are four independent factors in early or middle childhood that predict early initiation of use of substances and subsequent substance use disorders by early adulthood. There is a need to consider whether what is known about the risk factors that predict young age of substance use, and substance use disorders, may be incorporated into treatment and/or prevention initiatives.

Objective: The aim of the present study was to examine whether maternal attitudes to pregnancy and infant caregiving predict drinking initiation in adolescence., Method: Data were used from the Mater University Study of Pregnancy, an Australian longitudinal study of mothers and their children from pregnancy to when the children were 14 years. Logistic regression analyses examined whether maternal attitudes to pregnancy and infant caregiving at birth and 6 months contributed to the prediction of drinking initiation at age 14, after controlling for a range of confounding covariates., Results: Mother's negative feelings about being pregnant and not planning/wanting the pregnancy predicted adolescent alcohol initiation at the 14 year follow up. Negative maternal attitudes to infant caregiving at birth and 6 months did not predict adolescent alcohol initiation., Conclusions: Maternal attitudes in pregnancy are important and there is a need for effective perinatal interventions.