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Introduction Founded at the beginning of the COVID-19 pandemic, Hand-n-Hand Peer Support (HnH) offers free, confidential peer support to healthcare workers (HCWs) across Australia and New Zealand. This survey aimed to evaluate HCWs experiences of peer support and collect demographic data about what groups of HCWs were seeking support. Methods An online survey was conducted in November 2021 of HCWs who were either active or past HnH participants ( n = 158). Questions included 5-point Likert scales, multiple choice and free text responses. Results We received 66 responses (42% response rate). The median age range of respondents was 41–45 years and most were female (87.9%). Most respondents (57.4%) reported experiencing no barriers to accessing peer support. The vast majority (81.4%) of HCWs reported a ‘good’ or ‘very good’ peer support experience. Respondents felt peer support helped in multiple ways, particularly in feeling less alone and having a safe space to discuss issues. Conclusion Australian HCWs accessing peer support tended to be female and more senior clinicians. Most HCWs engaged in HnH reported overall very positive experiences. Our survey helped to identify several areas for improvement in HnH, including clearer marketing about peer support and more targeted triage assessments.

Objective We evaluated the impact of medical emergency simulation training on self-reported attitudes, confidence level and knowledge amongst psychiatric doctors and mental health nurses. Methods Before and following Essential Life Support (ELS) simulation training for medical emergencies, pre and post-questionnaires were employed. Paired t-tests were used to analyse change in self-reported attitudes, confidence in self and the team, and theoretical knowledge. Results In 37 participants we found significant improvement in doctors and nurses attitudes (t = 2.168 p < .05 and 2.651 p < .05) and doctor’s confidence t = 3.711 p < .001) following training. Knowledge increased for all participants and was significant for doctors (t = 2.112, p < .041). Comments supported training. Conclusion Many doctors and nurses in mental health feel inadequately prepared and lack confidence in themselves and their colleagues to respond to medical emergencies. A structured simulation course was useful to change attitudes and increase confidence and knowledge which could benefit the team and patients.

Objective: Classification systems and their practical implications have become increasingly important in child and adolescent psychiatry. This paper presents the evolution and practical applications of a multiaxial classification system for children and adolescents presenting to mental health services. Included are some worked examples demonstrating both the complexity of many presentations and how broadening the use of the multiaxial system can help in identifying appropriate interventions. Conclusions: Classification systems in child and adolescent psychiatry have largely remained uniaxial in nature. A multiaxial system encapsulates the broader biopsychosocial aspects of the presenting child or adolescent, and orders complex data in a concise manner. This approach can be used to concisely communicate with other treating clinicians, and assist with case reviews, formulation and teaching.

Objective: To investigate the rate of attendance at Alcohol Tobacco and Other Drug Services (ATODS) for patients discharged from an acute mental health unit with a primary/secondary diagnosis of substance use disorder (SUD); and describe factors, demographics, diagnoses and service provision that relate to their attendance. Method: All inpatients between 1 November 2016 and 31 October 2017 with a diagnosis of SUD were compared for their attendance at ATODS within 30 days of discharge. Other measures included their admission data (e.g. demographics, diagnosis), and indices of their illness severity. Results: Of 1295 admissions for a total of 900 patients, 32.4% of patients had an SUD diagnosis. Only 10.3% of these patients attended ATODS. There were no significant differences by gender, age, indigenous status, illness severity or dual diagnosis intervention during their inpatient stay on attendance. Relative to the SUD-only group, individuals with any psychiatric comorbidity were three–four times less likely to attend ATODS. Conclusion: Despite the ongoing emphasis on dual diagnosis treatment, the rate of engagement with ATODS remains low. Further review is needed to determine whether enhanced information sharing or case management models may improve attendance rates.

This article aims to identify the risk factors associated with paternal perinatal depression and anxiety. Studies published between January 1950 and December 2017 that report paternal depression and anxiety in the perinatal period were obtained from 5 different databases. In total, 84 studies were included in the systematic review, and 31,310 participants from 45 studies were included in the final meta-analysis. Risk factors obtained were classified based on the frequency of distribution of factors. Maternal depression is an important risk factor for fathers in the postnatal period (odds ratio [OR] = 3.34, 95% confidence interval [CI; 2.51, 4.46]). Marital distress was also linked to a twofold increase in the likelihood of paternal depression in the postnatal period (OR = 2.16, 95% CI [1.47, 3.19]). Parenting stress as a risk factor was strongly and significantly associated with paternal anxiety in perinatal period (OR = 14.38, 95% CI [7.39, 27.97]). The findings suggest that maternal depression, marital distress, and parental stress are important risk factors for fathers’ mental health in the perinatal period. The current meta-analysis also identifies gender role stress, domestic violence, and mismatched expectancies from pregnancy and childbirth as the risk factors that are unique to fathers only in the perinatal period. Future intervention programs should screen and target fathers with no previous children, or a depressed partner, and aim to enhance relationship satisfaction.

Difficulties in regulating feelings of shame is a risk factor for the onset and recurrence of mental health disorders. The present research investigated the impact of the individual differences in propensity to experience shame (or shame-proneness) on two emotion regulation strategies-perspective taking and positive reappraisal. A total of 228 participants, undergraduate students, were allocated randomly to one of the eight experimental conditions. The results revealed that for high shame-prone participants, the use of perspective taking, without positive reappraisal, led to a heightened experience of shame. In contrast, the combination of perspective taking and positive reappraisal led to reductions in shame among high shame-prone participants. The findings highlight the relationship between individual differences, and the separate and combined effects of affect regulation strategies on the experience of shame.

Objective Building upon the tripartite model of anxiety and depression, the current study aims to examine mechanisms of comorbidity between anxiety and depression using the ProQOL (Professional Quality of Life; including the constructs of burnout, secondary traumatic stress, and compassion satisfaction) in a sample of Chinese health-care clinicians. Method A randomized cross-sectional survey was distributed to 1620 participants who were recruited from eight state-owned hospitals in a city in southern China between January and May 2017. A total of 1562 questionnaires were returned (a response rate of 96.4%). After the cases with more than 10% missing variables and multivariate outliers being removed, 1423 valid cases remained. Multiple mediator models were used for mediation analysis that was conducted using the PROCESS v3.1 macro for SPSS. Results The indirect effects of anxiety upon depression through burnout (a1 = . 601 (95% confidence interval (CI): .552, .650), p Conclusions In the current sample, burnout and compassion satisfaction mediated the effect of anxiety upon depression and secondary traumatic stress mediated the effect of depression upon anxiety. The findings of the current study offer support to the tripartite model.

Health risk behaviours (HRB) across the lifespan have been associated with higher cumulative physiological burden as measured by allostatic load (AL). This study examines the contribution of HRB and their effects on multisystem biological risk associated with morbidity and early mortality. We systematically reviewed the literature to assess the links between HRB and AL. Twenty-six eligible human studies were included in our assessment of the current literature investigating the association of different HRB that included overeating/obesity, alcohol, smoking, drug use, physical inactivity and sleep impairments in relation to AL. We found that 50 % of obesity and substance abuse, 75 % of sleep and 62.5 % of combined HRB studies showed a significant association with AL. Lifestyle coping behaviours therefore have a significant contribution to AL. This study is among the first to explore multiple domains of HRB in relation to AL. Further research should focus on evaluating lifestyle factors that adapt HRB as a strategy to cope with chronic stress to help decrease AL and resulting long-term negative health consequences.

The coronavirus (COVID-19) disease pandemic has been associated with adverse psychological outcomes. This cross-cultural study (N = 1326, 71% female) aimed to investigate Canadian and Australian adolescents’ subjective experiences of COVID-19, gender differences, and psychological implications. Mixed-methods analyses were used to examine differences in COVID-19 experiences and mental health outcomes between country and gender in a Canadian (N = 913, 78% female) and an Australian sample (N = 413, 57% female) of adolescents. Canadian adolescents reported increased COVID-19 discussions and more concerns related to their COVID-19 experiences compared to Australian adolescents. Girls consistently reported more concerns related to COVID-19 and poorer psychological outcomes compared to boys. School lockdown for the Canadian sample may have played a role in these country differences. Further, girls might be at significantly more risk for mental health concerns during COVID-19, which should be considered in adolescent mental health initiatives during the pandemic. Although school disruption and separation of peers due to the pandemic likely have a role in adolescent perceived stressors and mental health, the differences between Canadian and Australian adolescents were less clear and future investigations comparing more objective pre-COVID-19 data to current data are needed.

Objective To examine the efficacy of weight-adjusted D-cycloserine (DCS) (35 or 70 mg) relative to placebo augmentation of intensive exposure therapy for youth with obsessive-compulsive disorder (OCD) in a double-blind, randomised controlled trial, and examine whether antidepressant medication or patient age moderated outcomes. Methods Youth (n = 100, 7-17 years) with OCD were randomised in a 1:1 ratio to either DCS + exposure (n = 49) or placebo + exposure (n = 51). Assessments occurred posttreatment, 1 month later, and at 3 and 6 months. Pills were ingested immediately before sessions. Results Significant improvements on all outcomes were observed at posttreatment, and to 6-month follow-up. Treatment arms did not differ across time, with no significant time-by-medication interactions on symptom severity (T1 to T2 estimate: 9.3, 95% confidence interval [CI]: -11.2 to -7.4, and estimate -10.7, 95% CI: -12.6 to -8.7), diagnostic severity (T1 to T2 estimate: -2.0, 95% CI: -2.4 to -1.5 and estimate -2.5, 95% CI: -3.0 to -2.0) or global functioning (T1 to T2 estimate: 13.8, 95% CI: 10.6 to 17.0, and estimate 16.6, 95% CI: 13.2 to 19.9). Neither antidepressants at baseline nor age moderated primary outcomes. There were significantly fewer responders/remitters at 1- and 6-month follow-up among youth in the DCS condition stabilised on SSRIs, relative to youth not taking SSRIs. Conclusions DCS augmented intensive exposure therapy did not result in overall additional benefits relative to placebo. Intensive exposure proved effective in reducing symptoms for the overall sample. National Health and Medical Research Council [APP1058025] Published version National Health and Medical Research Council, Grant/Award Number: APP1058025

In child and adolescent psychiatry, the multiaxial classification approach has been developed over some decades and remains very relevant as it encapsulates the biopsychosocial approach, an approach which is also central to paediatric practice. There is considerable overlap between developmental-behavioural paediatrics and child and adolescent mental health, including presenting clinical problems, diagnoses, multidisciplinary and holistic approach to assessment and management, and similar use of pharmacological agents and psychosocial interventions. Multiaxial classification can be of use to paediatricians in a variety of ways, both in clinical practice and for teaching purposes. It can improve communication between the two disciplines and promotes a more holistic diagnostic representation in a structured and consistent format. Presented here are a number of practical ways in which the multiaxial biopsychosocial framework can be used, including case description, formulation, timeline and interventions, training and teaching.

Psychiatric disorders are complex, disabling, and chronic conditions that are often accompanied by one or more systemic medical comorbidities. In this narrative review, we provide an overview of the allostatic load concept, which represents a multi-system dysregulation in response to chronic stress and link it to systemic comorbidities associated with psychiatric disorders. We synthesized published literature gathered using Medline (Ovid), Scopus, and PsychInfo and identified a high frequency of systemic comorbidities for both mood and psychotic disorders. The identified cardiovascular, metabolic, and immune comorbidities may represent the result of chronic wear and tear caused by a complex interaction between chronic psychosocial stress, health risk behaviors, pharmacological stressors, and the biological systems involved in the development of allostatic load. These findings support the notion that psychiatric disorders should be re-conceptualized as systemic disorders, affecting the brain and systemic biological pathways in an interconnected fashion to result in systemic comorbidities. We suggest that the multi-systemic and multi-dimensional approach that drives the allostatic load concept should be considered for understanding comorbidities in vulnerable psychiatric patients.

Objective: The study evaluated the workload and workflow of registrars engaged in a psychiatry after-hours roster, quantified their perceptions of this experience and provided recommendations for system redesign. Method: Multiple sources of information, including medical student observers and telephone logs, quantified the tasks performed during shifts. Registrars completed a satisfaction questionnaire. Results: After-hours shifts often started with a lack of attendance of key clinicians at handover. Tasks handed over and completed during shifts varied; there was very little difference between evening, weekends and night shifts except for the higher likelihood of seclusion reviews on weekends. Registrars experienced a significant and complex workload including emergency department and ward reviews, and admissions. Workflow interruptions were frequent; the high number of phone calls and critical incidence warrant further investigation. Registrars were confident in their own ability, but had less confidence in other key clinicians. Many registrars did not discuss after-hours work during supervision. Conclusions: The after-hours experience of psychiatry registrars at a university hospital is arduous and includes a wide range of clinical tasks. This activity is an essential service provision undertaking as well as a training activity. This must be weighed against the impact of after-hours work on registrar well-being.

Objective: This paper describes the development of the third edition of the National Health and Medical Research Australian Guidelines for the Prevention and Treatment of Acute Stress Disorder, posttraumatic stress disorder and Complex posttraumatic stress disorder, highlighting key changes in scope, methodology, format and treatment recommendations from the previous 2013 edition of the Guidelines. Method: Systematic review of the international research was undertaken, with GRADE methodology used to assess the certainty of the evidence, and evidence to decision frameworks used to generate recommendations. The Guidelines are presented in an online format using MAGICApp. Results: Key changes since the publication of the 2013 Guidelines include a new conditional recommendation for Child and Family Traumatic Stress Intervention for children and adolescents with symptoms within the first 3 months of trauma, and a strong recommendation for trauma-focused cognitive behaviour therapy for the child alone or with a caregiver, for those with diagnosed posttraumatic stress disorder. For adults with posttraumatic stress disorder, strong recommendations are made for specific types of trauma-focused cognitive behaviour therapy and conditional recommendations are made for five additional psychological interventions. Where medication is indicated for adults with posttraumatic stress disorder, venlafaxine is now conditionally recommended alongside sertraline, paroxetine or fluoxetine. Conclusion: These Guidelines, based on systematic review of the international literature, are intended to guide decision making for practitioners, service planners, funders and those seeking treatment for trauma related mental health concerns. For an Australian Guideline, a critical limitation is the absence of research on the treatment of Australian Aboriginal and Torres Strait Islander peoples. The new online format of the Australian posttraumatic stress disorder Guidelines means that they can be updated as sufficient new evidence becomes available.

While there is a general lack of evidence of the safety of antipsychotic medications in pregnancy, there is a specific reluctance to continue clozapine in treatment resistant patients who become pregnant. Our aim is to systematically review adverse maternal and infant outcomes following clozapine use during pregnancy.A systematic review of all observational and intervention studies which highlighted adverse maternal and infant outcomes following clozapine continuation in pregnancy was undertaken. Article selection and quality were independently assessed and PRISMA guidelines adhered to.Of 481 studies identified only two studies met the inclusion criteria. Both were rated as poor quality. The first found no significant increase in any adverse maternal or infant outcomes associated with antipsychotic exposure, except an increased rate of low birth weight in antipsychotic exposed babies. The number of patients exposed to clozapine was too small for separate statistical analysis. The second study found higher APGAR scoring at one minute for the clozapine group, but the scores were not statistically different at five-minutes.Limited evidence was found to show significant adverse maternal and infant outcomes in pregnancy following clozapine continuation.Key messagesLimited evidence to show that clozapine has adverse effects on mother and infant when used during pregnancy.Risk/benefit analysis should be done thoroughly for each individual patient regarding clozapine continuation when pregnancy is confirmed.Close monitoring of mother and infant during perinatal period when clozapine is continued.Further research is needed to more clearly define the effects of clozapine on mother and infant during pregnancy and into the postnatal period.

Depression can be quite common in the palliative care population. The estimated prevalence ranges from 24% to 70%. Depression in this population leads to a decreased quality of life and may lead to a desire for an earlier death. We conducted a systematic review to establish a better understanding of the available treatment interventions, both pharmacological and nonpharmacological specific to the palliative population. PubMed, PsycINFO, and CINAHL databases were searched using the MeSH terms: Palliative Care, Palliative Medicine, Terminal Illness, End of Life Care, and Depression or Depressive Disorder, as well as the keywords palliative care, care palliative, and depression. We considered all published peer-reviewed articles written in English and pertaining to humans. Articles were hand searched from citations. The Mixed Methods Appraisal Tool was used for study quality appraisal. Thirty-nine eligible articles were found; 29 articles examined nonpharmacological options, while 10 focused on pharmacological options. The 29 articles discussing nonpharmacological methods discussed 22 interventions. Of the 22 interventions, 10 showed therapeutic benefit. Of the 10 studies focusing on pharmacological interventions, seven showed therapeutic benefit. This is the first systematic review that examined both nonpharmacological and pharmacological methods to treat depression in the palliative setting. There is evidence to indicate that methylphenidate and antidepressants can provide a therapeutic benefit for palliative care patients with depressive symptoms. This benefit may be enhanced when these medications are used in combination. The use of music therapy or future-focused psychotherapy may also be beneficial in the treatment of depression.

Objective: The primary aim was to examine differences in functional health outcomes in consumers entering a regional mental health service compared with a city service. Method: A retrospective analysis of consumer outcomes and characteristics was undertaken. Consumer demographics and diagnoses were compared between the two services. Functional outcomes were measured using the 16-item Life Skills Profile (LSP-16). The data analysis plan utilised descriptive statistics. For between-clinic comparisons, relevant inferential statistics was used. Results: Patients attending the regional health service were five times more likely to be in the high impairment category on the LSP-16, independent of demographic factors and diagnosis. Other independent contributions to high impairment were being male, Indigenous and a diagnosis of schizophrenia. Of the four LSP-16 subscales, regional consumers scored relatively higher on withdrawal, compliance and anti-social but not self-care subscales. Conclusions: There was a greater level of functional impairment in consumers attending the regional service. The independent contributions did not explain the higher impairment; therefore, other factors such as socioeconomic disadvantage may explain the difference. Regional clinicians may need to consider recovery-orientated interventions that address a greater burden of functional impairments in regional services.

Adverse Childhood Experiences (ACEs) are stressful and/or traumatic experiences associated with an increased lifetime risk of negative health outcomes. The Allostatic Load (AL) is a measure of multisystem dysregulation, resulted by chronic stress. We systematically reviewed the English language literature on the association between ACEs and AL to identify the clinical risk profile, with the exclusion of reviews and preclinical studies. Searches covered the publication period up to the 1

[Extract] The coronavirus disease 2019 (COVID-19) pandemic has placed the health care workforce under an unprecedented level of stress. No area of the health workforce is immune to COVID-19-related changes to usual work practices. The impact of this acute stress has occurred in the context of a health care profession that was already struggling with major work-related challenges including anxiety, depression, secondary trauma, compassion fatigue and burnout. Importantly, these issues may have been exacerbated by the COVID-19 pandemic due to the direct consequences of health care workers being infected, and the indirect consequences of the economic impact on their families and friends, the rigours of lockdown and the adverse effects on health and wellbeing felt across all aspects of society.

This study examined the psychosocial burden of inflammatory bowel disease (IBD) in young people aged 15-25 years attending a tertiary specialist health centre for adolescents and young adults in Brisbane.To describe the impact of IBD on psychosocial well-being in young people and to compare well-being in the IBD cohort to well-being among young people with other chronic conditions, with a view to identifying characteristics and challenges unique to those with IBD.Young people with IBD provided demographic information and psychosocial data through a cross-sectional self-report survey. Psychosocial data included the Kessler Psychological Distress Scale, Perceived Stress Scale, Brief Illness Perception Questionnaire, World Health Organisation Well-being Index, Paediatric Quality of Life Inventory, Short Quality of Life Questionnaire for IBD, Multidimensional Scale of Perceived Social Support, Connor Davidson Resilience Scale 2 and the Multidimensional Health Locus of Control Scale.Surveys were collected from 51 young people with IBD and compared with surveys from 210 young people with juvenile rheumatic disease (n = 31), phenylketonuria (n = 21), cystic fibrosis (n = 33), renal transplants (n = 14) and craniomaxillofacial conditions (n = 111). On the psychosocial domains, 41% of young people with IBD had poor well-being and 37% were at risk of depression. When assessed against the comparison group, young people with IBD reported higher depressive symptoms (P = 0.04), worse illness perceptions (P 0.01) and lower internal locus of control (P 0.01).Early recognition and treatment of depression and other psychosocial comorbidities within integrated pathways of care is crucial in adolescents and young adults with IBD and likely to improve the course of IBD and their overall health and well-being. Interventions aimed at enhancing self-efficacy and increasing public awareness are also likely to be helpful.

Objective: The primary aims were to compare the characteristics and health outcomes of consumers entering a regional mental health service compared with a city service. Method: A retrospective audit was undertaken of consumers aged 18 and over from a regional town and city mental health service. Consumer demographics, diagnoses and outcomes were compared between the two services. The data analysis plan utilised descriptive statistics. For between-clinic comparisons, relevant inferential statistics was used. Results: Regional service patients had a significantly greater proportion of substance use disorder diagnoses. Outcome rating scales were higher (worse) for regional consumers. There was significantly less overall service utilisation for regional service consumers including shorter duration of episodes of care, less hospitalisations and less people treated under the Mental Health Act. Conclusions: There were a broader range of patient presentations in the regional town. Regional practitioners may specifically need more training and skills in treating substance use disorders.

Objectives: We aimed to report substance use across a five-year period in individuals admitted to an acute mental health unit, utilizing data from a routine clinical measure, diagnoses, and findings related to gender, ethnicity and the implementation of a new dual-diagnosis policy. Methods: Data was extracted from the electronic records of 2118 individuals who had consecutive admissions to the acute inpatient unit. Analysis focused on demographic and diagnosis variables and the drug and alcohol question in the Health of the Nations Outcome Scale. Results: Some 57.6% of the sample was in the at-risk drug and alcohol category. Male and indigenous inpatients were most at risk. More than 50% of patients with schizophrenia, anxiety and personality disorders were deemed at-risk. Following implementation of the dual-diagnosis policy, recorded primary and secondary substance use disorder (SUD) diagnoses significantly increased. Conclusions: The study replicated previous findings of a high proportion of patients with co-morbid drug and alcohol use. In this sample it seems likely that the dual-diagnosis policy and related activities increased the rate of SUD diagnoses recorded, although it is likely to still be under-reported.

Aim The 22q11.2 deletion syndrome (22qDS) is a genetic syndrome that results in a complex physical, behavioural and psychological phenotype. Health-related quality of life (HRQOL) is an established clinical outcome that has been minimally studied in children with 22qDS. The purpose of this study was to explore HRQOL among children and adolescents with 22qDS from the perspective of the child and to determine how their HRQOL measures compare to those of a healthy peer group and a chronic disease peer group. Methods We recruited individuals between the ages of 8 and 18 with a positive genetic diagnosis of 22qDS (n = 28) and a parent of the child. Participants completed the paired Paediatric Quality of Life Inventory 4.0 questionnaires. Comparisons were made with a previous study of healthy and diseased children. Results Children with 22qDS had a significantly poorer HRQOL when compared to age-matched cohorts of healthy children and children with chronic disease. Within the study, there was variable proxy-self agreement, and children with 22qDS reported lower HRQOL than adolescents with 22qDS. Conclusion This study is the first to explore HRQOL from the perspective of the child with 22qDS, and our findings support the existing literature that this condition is associated with a poor HRQOL.

There is a need to identify the most appropriate standardized instruments for research evaluating pharmacotherapy for youth with violent and aggressive behaviors. Youth violence and aggression are heterogeneous behaviors which differ depending on age and gender. Instruments used in randomised controlled trials evaluating efficacy of pharmacotherapy in conduct disorder and its comorbidities were reviewed for psychometric, administrative and practicality evidence. Evidence was rated on a 3-point scale, adapted from the Scientific Advisory Committee's Instrument Review Criteria. Of the nine included instruments, the Nisonger Child Behavior Rating Form (NCBRF), Conners' 3rd Edition, and Behavior Problems Inventory (BPI-01) were rated the highest for their psychometric properties. The Children's Aggression Scale (CAS), Aberrant Behavior Checklist (ABC) and Disruptive Behavior Disorder Rating Scale (DBDRS) were rated moderate, and the Child Behavior Checklist (CBCL), Modified Overt Aggression Scale (MOAS) and Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) were rated lowest. The NCBRF, BPI-01 and CAS were the only instruments that could be used to measure both frequency and severity of aggressive behaviors. The CAS and MOAS featured the most items pertaining to violence and aggression. The broad-band scales, the NCBRF and Conners' 3rd Edition, rated highest for their psychometric properties, however their usefulness in youth violence and aggression research is limited. The heterogeneity of aggressive and violent behaviors, age, gender, functional level, situational context and the type of informant should be taken into account when considering an appropriate instrument. All items in the CAS and the MOAS can be used to measure violent and/or aggressive behaviors. Further research into the psychometric properties of the MOAS in violent and aggressive youth is required before its use can be recommended. The CAS was found to be the most psychometrically sound and useful instrument that exclusively measures aggressive behaviors in youth.

Background: Routine psychosocial screening and management of people with diabetes is recommended. Aims: To profile demographic, medical and psychosocial characteristics of young people with diabetes, and to develop a screening tool and care pathway for routine use. Methods: Indices of diabetes control and recorded diabetes complications were complimented by psychosocial screening tools assessing psychological, diabetes specific and perceived stress (Kessler 10, Problem Area in Diabetes, Perceived Stress Scale), well-being (World Health Organization Well Being Index-5), disordered eating (Eating Disorder Risk Inventory-3 Risk Composite), compensatory behaviour questionnaire, social support (Multidimensional Scale of Perceived Social Support), resilience (Connor Davidson Resilience Scale – 2 item) and financial concerns. Service provision and demographic data were also collected. Diabetes and mental health clinicians then identified a subset of measures to use for routine screening along with care pathways. Results: Psychosocial screening was well accepted. Participants (151) had suboptimal glycaemic control (glycated haemoglobin 8.0 interquartile range 1.8%/64 interquartile range 22 mmol/mol). Severe diabetes-related distress (Problem Area in Diabetes ≥40) was found in 19.4% and 26.0% reported difficulties managing healthcare costs. A mental health disorder was likely in 9.7%, whilst 23.4% had high Kessler 10 scores. Low World Health Organization Well Being Index-5 scores (≤13) were seen in 29.0%. Risk for an eating disorder (Eating Disorder Risk Inventory-3 Risk Composite) was 12.7%, whereas approximately 36.0% had disturbed eating behaviours. Conclusion: Psychosocial screening of young adults with diabetes identified complex needs. A brief psychosocial screening tool and associated care pathways were developed for routine use in a young adult tertiary referral diabetes clinic. The tool assesses constructs, such as diabetes distress, depression, anxiety, well-being, hypoglycaemia-unawareness, fear of hypoglycaemia, social support, weight, shape and eating concerns and financial concerns. This will provide a longitudinal data source for further research to inform clinical practice.

Cortisol is the primary glucocorticoid produced by the activation of the hypothalamic pituitary adrenal (HPA) axis after a psychological or physiological stressor. The dysregulation of the HPA axis by chronic stress has been associated with psychiatric disorders. Although hair is currently the main validated source of chronic cortisol concentrations, cortisol is also bound to human nails, another keratinised matrix. Therefore, nail cortisol has the potential to be an alternative retrospective chronic measure of HPA activation. The aim of this systematic review was to assess the temporal resolution, methodological issues, HPA correlates, and target populations in nail cortisol investigations. A qualitative synthesis was performed to assess current literature exploring cortisol concentrations from human nails. A total of 18 eligible human studies extracted from Medline (PubMed and Ovid), ProQuest (PsycINFO), and Scopus found that immunoassays and mass spectrometry were the two primarily methods of analysis. However, methodological variability remained evident between studies. Nail cortisol correlated with saliva and hair in some studies and was investigated across multiple developmental periods. Finally, when applied as an outcome measure in health disorders, higher nail cortisol concentrations have been shown to be associated with acute coronary syndrome and depression. In conclusion, nail cortisol may serve as a retrospective biomarker of chronic stress; however, the ability to track how much cortisol is accumulating within nail clippings is complex and may represent a large timespan. Further, very few studies have reported effect sizes and investigated the effects of covariates, such as age, sex, ethnicity, and nail characteristics, which limits the validation of this measure. Further studies are required to validate the utility of nail cortisol as a biomarker of chronic stress across the human lifespan.

Conduct disorder (CD) is a common mental health disorder of childhood and adolescence. CD's complexity, with its heterogenous clinical manifestations and overlapping comorbidities makes the application of evidence-based management approaches challenging. This article aims to combine a systematic review of the available literature, with a consensus opinion from both child and adolescent psychiatrists and developmental pediatricians on the clinical and pharmacological management of children and adolescents with conduct disorder (CD).The authors review the CD population and provide a systematic review and meta-analysis of the effectiveness and safety of pharmacotherapies using preferred reporting items for systematic review and meta-analysis (PRISMA) and strength of evidence recommendation taxonomy (SORT) guidelines. The authors then provide an expert clinical opinion for the use of different pharmacotherapies to address aggressive and disruptive behavior in children.Atypical antipsychotics (e.g. risperidone) demonstrate evidence for efficacy in CD. Other pharmacotherapies (e.g. mood stabilizers, anticonvulsants, psychostimulants and selective norepinephrine reuptake inhibitors) have a low level of evidence for CD alone, however, can sometimes be effective in managing the symptoms of CD when other psychiatric disorders are also present.

There is a critical need for evaluation of the pharmacotherapies used in conduct disorder (CD), due to the high incidence of off-label prescribing. The aim of this review was to identify concerns associated with the safety, efficacy and impact on quality of life (QOL) that pharmacotherapy has in children and adolescents with CD. A systematic review was undertaken using pre-defined search criteria and four databases, including reference searches. We assessed these studies using the Strength of Recommendation Taxonomy, Grading of Recommendations Assessment, Development and Evaluation, and Review Manager Risk of Bias (RevMan®) tools. There were 12 randomised controlled trials that met our inclusion criteria. Studies included: antipsychotics, atomoxetine, lithium, clonidine, divalproex sodium and psychostimulants. The antipsychotics demonstrated efficacy, but were associated with adverse effects. Other agents demonstrated mixed responses, highlighting the lack of clinical significance and increased incidence of adverse effects. The management of related adverse effects was addressed to assist with clinical gaps. Overall, there is limited evidence regarding the role of pharmacotherapy in CD. More research is needed that takes into account the heterogeneity of CD and analysis of pharmacotherapy in pure CD.

Background Since the development of digital records, claims have been made that they improve audits. Clinical audits play important role in evaluation of evidence-practice gaps. Antipsychotic medications are one of the commonly prescribed group of drugs in severe adverse mental conditions. Youth and young people are highly prone to develop drug induced metabolic syndrome. Present study evaluated the extent of data documentation on evidence for metabolic monitoring of antipsychotics and compared paper based to electronic records with good documentation standards. Methods First phase of this study involved a retrospective clinical audit of paper-based documentation on the extent of documentation of weight (primary outcome); lipid and blood glucose (secondary outcomes) of youth prescribed atypical antipsychotics. This was undertaken in three public mental health clinics and a public/private developmental service in Australia based on paper-based documentation. The second phase included auditing electronic data capture from one community clinic. Evidence of documentation was compared with practice standards and published clinical audits (adherence rate benchmark: 40–60%). Results A total of 310 cases were assessed of which 51 and 37 cases met the eligibility criteria for paper-based and electronic based audit respectively as a component of clinical audit. Evidence of paper documentation of weight was 43% among participants and was comparable with other published clinical audits (p = 0.07) with poor monitoring rates for other blood tests. Findings revealed poor rate of documentation at 35.1% (13 cases), 5.4% (2 cases) and 8.1% (3 cases) for weight, lipid assessments and glucose monitoring, respectively based on electronic records. Conclusion Present study demonstrate lack of good documentation practices on metabolic monitoring of youth prescribed antipsychotics. It appears transitioning from paper to electronic records did not impact the rate of increase in documentation of metabolic monitoring. This study recommends inclusion of e-monitoring icon with built in metabolic monitoring chart as a component of youth prescribed antipsychotic case records. Good documentation practice is a first step in determination of causality of antipsychotics induced metabolic syndrome. Appropriate strategies to a user-friendly electronic reminder system will be crucial to address on the mechanistic of documentation.

One in five adolescents and young adults (AYA) has a chronic health condition necessitating on-going engagement with healthcare systems. Despite increasing prevalence there remains limited understanding of the burden of illness they experience. Living with a chronic illness can challenge healthy adolescent development, with the unique health and developmental issues affecting AYA requiring different responses from the healthcare system.To examine and compare the burden of illness in this group across a large range of chronic health conditions.In a dedicated health service for AYA aged 15-25 years with chronic health conditions, (13-25 years for those with substance use issues) we detail a protocol where demographics, general health, disease-specific indicators and comprehensive psychosocial variables will be collected. The health conditions include chronic gastrointestinal disease, cystic fibrosis, chronic rheumatic disease, phenylketonuria, craniomaxillofacial deformities, renal transplant patients and problematic substance use. Results will be compared to AYA without chronic illness and AYA with diabetes.This protocol outlines a comprehensive screening study for AYA with a large range of chronic health conditions, inclusive of medical, mental health, impairment and quality of life variables. It will inform service planning and provide a foundation upon which allied health service requirements (e.g. psychology) can be based. Whilst currently cross-sectional we anticipate further utility in broadening outcomes to include non-physical illness-related constructs.The commonalities and differences between conditions will be examined to facilitate efficiencies of scale for systems and supports. Further iterations including quantifying access to allied health services will facilitate studying the impact of such interventions on treatment adherence and improving psychosocial functioning, quality of life and disease outcomes.

Objectives Prescription of second-generation antipsychotics (also called atypical antipsychotics) in youth and young people is rapidly increasing globally, despite the potential for significant adverse effects (metabolic syndrome, MS) and long-term health consequences. The adverse effects of atypical antipsychotics are more severe in youth and young people than in adults (in particular, obesity and diabetes). They can gain a significant amount of weight after taking antipsychotics even for a short period (weight gain observed within 8–12 weeks). Evidence suggests that screening strategies for MS are not effective and that implementation of guidelines and health policies is falling short of acceptable standards of care as a component of pharmacovigilance. There is significant evidence gap on monitoring strategies among youth and young people. Present research examined these factors through assessment of intervention studies that aimed at improving the rate of metabolic monitoring in this target population. Method A systematic review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) protocol. Studies were identified through Medline/PubMed, EMBASE and CINAHL abstract databases from 2000 to December 2017. Search terms included metabolic monitoring, children, atypical antipsychotics, mental health, diabetes, adherence, barriers and facilitators. Experimental (randomised, quasi-randomised trials); and observational (cross-sectional clinical audits, drug utilisation evaluation studies) studies conducted among youth/young people (10–24 years of age) were included. Key outcome measures were the most and least likely strategies to improve the rate of metabolic monitoring and the barriers to monitoring. The strategies were then ranked based on the Strength of evidence recommendation taxonomy (SORT) ratings. Results A total of 7 studies met the inclusion criteria and were analysed. The studies primarily targeted adherence to metabolic monitoring by practitioners. Four studies included patients and/or carers. Barrier analysis identified prescriber related factors affecting poor rate. The common prescriber targeted intervention included behavioural change strategies such as PDSA (plan, do study, act) quality improvement framework, education (e.g. periodic seminars, workshop, drop-in sessions) and reminders (e.g. physical health check reminder card, one page monitoring chart embedded in the patient file). Patient focused strategies were limited to diabetes education and management assessing the feasibility of point-of-care testing for metabolic monitoring of antipsychotics. Consumer related barriers to metabolic monitoring include stigma to undergo monitoring, challenging and vulnerable age group with severe mental illness, troubled family/carers and lack of knowledge to undergo monitoring. A modest improvement in glucose testing monitoring was observed but couldn’t meet the guidelines recommendation. Conclusions This is one of the first studies that evaluated intervention studies to improve metabolic monitoring of youth/young people prescribed antipsychotics. The clinical audits targeted prescriber related factors. Patient and health service factors remains understudied. Significant evidence gaps exist on what youth and carers feel about medication reviews including potential regular blood tests, physical examination and remedial action to counter the effects of obesity. Reform of practice and health service monitoring behaviour needs to work in parallel with changes in consumer behaviour. Significant service gap exists in the physical care of mentally ill youth/young people on antipsychotic medication.

Objective: This study investigates if the routine use of the urine drug screen offers any diagnostic or management benefit in the assessment and treatment of psychiatry patients in a suburban psychiatry emergency service. Methods: Data was collected retrospectively from consecutive patients 18 years and above, who presented to a large suburban hospital emergency department and had a urine drug screen ordered in the emergency department. A total of 111 patients, (with mean age of participants being 34.9 years, SD 10.2 years, minimum 18 – maximum 62 years, 62.2% (69/111) were male) met the inclusion criteria. Results: The most common drug group identified was benzodiazepines (59.5%; 66/111), followed by cannabis (40.5%; 45/111). Other drugs were identified at much lower levels, including amphetamines (9.0%; 10/111), opiates (4.5%; 5/111) and methadone (0%; 0/111). For most individuals only one drug was detected (55.9%; 62/111), with equal numbers (18.9%) with either zero or two drugs identified by a urine drug screen. Fewer patients had three drugs on a urine drug screen (5.4%; 6/111) or four (0.9%; 1/111). Conclusions: Qualitative urine drug screens provide limited additional information compared to history taking and has minimal impact on clinical management decisions in a psychiatry emergency service.

Screening is recommended as a simple method for identifying those who should be monitored for risk following trauma. Effective methods for implementing large-scale screening programs are yet to be established. This study tested the feasibility and utility of a screening program with hospitalized youth exposed to injury in 3 Australian hospitals. Eligible families (N = 1,134) were contacted and 546 children (48.0%) screened for risk of posttraumatic stress disorder (PTSD) at 1-2 weeks postinjury. There were 95 (17.4%) children whose screen result was at risk. A rescreening phase was introduced during the study, with 68 children completing the rescreen at 4-6 weeks postinjury, and 26 (38.2% of those rescreened) still at risk. Of those initially screened, 29 (5.3%) completed diagnostic assessments, 21 (3.8%) were diagnosed with partial or full PTSD, and 17 (3.1%) commenced treatment. Screening was successful at identifying and reaching children with PTSD, but the response rate was lower than expected, which limited the utility of the program. The addition of a rescreening phase demonstrated that not all at-risk children required intervention. These findings replicate previous studies that have shown natural remission in PTSD symptoms and highlight the potential for rescreening as part of a watchful waiting approach.

This study investigated parents' satisfaction with postdisaster school-based screening and whether satisfaction was related to follow-through with screening recommendations. From among 1,268 there were 224 children, ages 7-18 years (M = 10.97, SD = 2.44 years) screened for emotional distress 4 months after a flood and 130 parents who completed the screening evaluation. Of the 44 children who showed severe emotional distress, less than 50% of their parents reported concerns and only 29.5% had sought assistance. Following screening, 86.7% of these children completed treatment. Overall satisfaction ratings by parents were high, with 99.2% very or mostly satisfied. Language: en

Natural disasters have become more frequent with climate change. Postdisaster, children and adolescents represent a particularly vulnerable group. Parents have a vital role in influencing how their children make sense of and respond to any potentially traumatic event. Supporting parents is particularly critical postdisaster, as parents will typically have been affected also, with implications for their parenting and the parent–child relationship. To date, only one postdisaster parenting intervention has been described and evaluated. A new, universal parenting intervention—Disaster Recovery Triple P (DRTP)—is introduced and efficacy data presented. Implementation issues to be considered in making a parenting intervention such as DRTP work in a postdisaster context are discussed.

The 22q11.2 deletion syndrome (22qDS) is a genetic syndrome that results in a complex physical, behavioural and psychological phenotype. Health-related quality of life (HRQOL) is an established clinical outcome that has been minimally studied in children with 22qDS. The purpose of this study was to explore HRQOL among children and adolescents with 22qDS from the perspective of the child and to determine how their HRQOL measures compare to those of a healthy peer group and a chronic disease peer group.We recruited individuals between the ages of 8 and 18 with a positive genetic diagnosis of 22qDS (n = 28) and a parent of the child. Participants completed the paired Paediatric Quality of Life Inventory 4.0 questionnaires. Comparisons were made with a previous study of healthy and diseased children.Children with 22qDS had a significantly poorer HRQOL when compared to age-matched cohorts of healthy children and children with chronic disease. Within the study, there was variable proxy-self agreement, and children with 22qDS reported lower HRQOL than adolescents with 22qDS.This study is the first to explore HRQOL from the perspective of the child with 22qDS, and our findings support the existing literature that this condition is associated with a poor HRQOL.

Aims: This study estimates the prevalence of chlamydia infection amongst teenage substance users aged 14–18years and investigates risk factors associated with a positive diagnosis of chlamydia infection. Methods: Data was collected from the medical files of adolescents who attended a statewide drug and alcohol treatment facility during a three-year period commencing June 2011. Results: The highest rate of chlamydia detection (18.0%) was found in the group with a reported history of abuse, a non-substance use psychiatric diagnosis, and individuals who did not complete year 10 education. Conclusion: Adolescents attending a detoxification facility are a suitable group for targeted chlamydia infection screening and early treatment.

Routine psychosocial screening and management of people with diabetes is recommended.To profile demographic, medical and psychosocial characteristics of young people with diabetes, and to develop a screening tool and care pathway for routine use.Indices of diabetes control and recorded diabetes complications were complimented by psychosocial screening tools assessing psychological, diabetes specific and perceived stress (Kessler 10, Problem Area in Diabetes, Perceived Stress Scale), well-being (World Health Organization Well Being Index-5), disordered eating (Eating Disorder Risk Inventory-3 Risk Composite), compensatory behaviour questionnaire, social support (Multidimensional Scale of Perceived Social Support), resilience (Connor Davidson Resilience Scale - 2 item) and financial concerns. Service provision and demographic data were also collected. Diabetes and mental health clinicians then identified a subset of measures to use for routine screening along with care pathways.Psychosocial screening was well accepted. Participants (151) had suboptimal glycaemic control (glycated haemoglobin 8.0 interquartile range 1.8%/64 interquartile range 22 mmol/mol). Severe diabetes-related distress (Problem Area in Diabetes ≥40) was found in 19.4% and 26.0% reported difficulties managing healthcare costs. A mental health disorder was likely in 9.7%, whilst 23.4% had high Kessler 10 scores. Low World Health Organization Well Being Index-5 scores (≤13) were seen in 29.0%. Risk for an eating disorder (Eating Disorder Risk Inventory-3 Risk Composite) was 12.7%, whereas approximately 36.0% had disturbed eating behaviours.Psychosocial screening of young adults with diabetes identified complex needs. A brief psychosocial screening tool and associated care pathways were developed for routine use in a young adult tertiary referral diabetes clinic. The tool assesses constructs, such as diabetes distress, depression, anxiety, well-being, hypoglycaemia-unawareness, fear of hypoglycaemia, social support, weight, shape and eating concerns and financial concerns. This will provide a longitudinal data source for further research to inform clinical practice.

There is widespread support for the hypothesis that, post-disaster, children's mental health is impacted--at least in part--via the impact on parents, parenting, parent-child interactions, and the family environment. To some degree, the enthusiasm with which this hypothesis is held outstrips the evidence examining it. The current paper critically evaluates the empirical evidence for this hypothesis and concludes that although limited (both in terms of number of existing studies and methodological flaws), the extant literature indicates some parent-related variables, as well as some aspects of the family environment are likely to constitute risk or protective factors for children. Given that parenting is modifiable, it is proposed that the identified parent- and family-related factors represent important therapeutic targets, and a universal post-disaster parenting intervention (Disaster Recovery Triple P) is described.

Repeated retelling of trauma narratives within Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) assists participants to habituate to experiences that have precipitated symptoms of post-traumatic stress. In this study, the narratives produced by children and adolescents, who developed post-traumatic stress disorder following a natural disaster, and who were treated with a manualized TF-CBT intervention, were examined. The first author developed a coding system utilizing three major concepts (coherence, elaboration, and evaluation) to identify changes in the narratives as they were retold at each therapeutic session. Analysis using this coding system identified that the internal logic of the stories was maintained as the detail diminished, and that the level of evaluation increased. Compression emerged as a major pattern, alongside the reduction in participant distress over the course of the treatment. Although requiring replication, these trial concepts, developed by the coding system, have potential analyzing trauma narratives and enhancing clinician observations.

Aim To describe the presence and type of disturbed eating behaviours and thoughts in a combined male/female Australian sample of adolescents with type 1 diabetes, and examine the association of eating behaviours and thoughts with glycaemic control as evidenced by high glycosylated haemoglobin levels (HbA1c). Methods In this cross-sectional descriptive study, 124 adolescents aged 13-18 years were invited to complete three self-administered questionnaires. The Youth Eating Disorder Examination Questionnaire (YEDE-Q) and the Eating Disorder Inventory -3 Risk Composite (EDI-3RC) assessed risk for an eating disorder. The third questionnaire, the Strengths and Difficulties Questionnaire (SDQ) assessed emotional and behavioural concerns. Clinical data were collected from the medical records, routine clinic appointments and the adolescent. Results Any disturbed eating behaviour was reported by approximately one-third of participants (32.3%) and was common in females and males (37.9% vs. 25.9%). Binge eating (17.7%), driven exercise (13.0%) and dietary restraint (8.9%) were the most common disturbed eating behaviours, although restraint was not evident in males. Insulin manipulation/omission (5.6%), vomiting (3.3%), laxative (0.8%) or diuretic use (0.8%) were less common. Regression analysis showed a significant association between HbA1c and more disturbed eating behaviours and thoughts which remained significant when adjusted for confounders. Conclusions High rates of disturbed eating behaviours and thoughts were seen in this Australian sample of adolescents with type 1 diabetes. High scores on both eating disorder measures were associated with poorer glycaemic control. These results highlight the need to screen for disordered eating in adolescents with type 1 diabetes. © 2012 The Authors. Journal of Paediatrics and Child Health

Parents and family members whose adult child or relative has a mental illness endure significant losses, to which they respond with grief. Such grief may negatively affect family members’ physical and psychological health and also the relationship with their relative. Yet, research in this field is sparse. Very few studies have examined parents’ loss and grief in the context of the patient being a child or teen. It is not clear the extent to which parents’ loss and grief in response to their child or adolescent’s mental illness is similar or different to the accounts of older parents and family members caring for an adult relative with major psychopathology (e.g., Schizophrenia, Bipolar disorder). Parental loss and grief is not often addressed in child and adolescent mental health services’ provision of care; alarmingly, little is known about how best to support parents who access these services. The present study aimed to bridge this knowledge gap and identify the therapeutic needs of this younger parent population. Comprehensive interviews were conducted with 14 parents and one custodial grandparent of a youth aged 18 years or younger who was currently attending a child and adolescent mental health service. An inductive thematic analysis identified six themes; parents’ narrative of finding out, profound and pervasive loss, complex grief, waning support, the challenges of caregiving and a call for assistance. It can be inferred from these results that youth mental illness can constitute a source of loss and grief for parents. Participants’ loss and grief was largely consistent with the experience of families caring for an adult relative with major psychopathology. Opportunities for mental health practitioners to support families’ loss and grief were identified. Further studies are needed to enhance understanding of this complex and, to a large extent, ignored familial experience. Results do underscore the importance of clinicians acknowledging parents’ loss and grief and working directly with this experience over the course of youths’ treatment, perhaps in conjunction with family psychoeducation approaches.

Aim: Eating disorder screening tools have not been adequately validated for use with adolescents with type 1 diabetes. This study compared the Youth Eating Disorder Examination-Questionnaire (YEDE-Q) and the Eating Disorder Inventory-3 Risk Composite (EDI-3RC) against the child Eating Disorder Examination (chEDE). These screening tools were chosen because they broadly assess eating disorder psychopathology and have subscales helpful for clinical management. Methods: In this cross-sectional study, 124 adolescents with type 1 diabetes aged 13-18 years completed two self-administered questionnaires, the YEDE-Q and the EDI-3RC. Cronbach's alpha was used to assess internal consistency of the tools. Fifty-one adolescents, randomly selected, participated in the chEDE. Intraclass correlations and Spearman's correlations were used to measure concordance of the chEDE with the YEDE-Q and EDI-3RC. Results: The YEDE-Q and EDI-3RC demonstrated good subscale internal consistency; Cronbach's alpha for YEDE-Q (0.78-0.95) and EDI-3RC (0.79-0.94). High levels of concurrent validity with the chEDE were seen with both tools. Conclusion: Preliminary evidence is provided for the validation of the YEDE-Q and EDI-3RC for use in adolescents with type 1 diabetes. The YEDE-Q also defines individual disturbed eating behaviours with frequency ratings which can be helpful for tailoring early intervention. © 2012 The Author(s)/Acta Paediatrica