Mental Health Australia

Post-mortem detection of a medicine following suicide can be due to two main reasons: the decedent was taking that medicine therapeutically before death, and/or the medicine was involved in the suicidal act (poisoning-related suicide). We aimed to investigate how antidepressant concentrations differed between poisoning and non-poisoning suicides. We hypothesized that the predictive value of these concentrations and the separation between poisoning and non-poisoning concentrations would improve by adjusting for dose dispensed to the decedent. We analysed post-mortem toxicology results from suicides in Australia, July 2013 to October 2019, linked to the individual's dispensing history. Suicides were classified as poisoning- or non-poisoning-related by coroners. We analysed the distribution of concentrations through descriptive statistics, precision-recall curves and quantile regression to compare poisoning and non-poisoning concentrations. We adjusted concentrations by estimated daily dose and total drug quantity dispensed in 90 days and re-assessed model performance. We had sufficient sample size to analyse nine antidepressants: amitriptyline (n = 149), mirtazapine (n = 399), citalopram (n = 116), escitalopram (n = 297), fluoxetine (n = 183), sertraline (n = 253), duloxetine (n = 122), venlafaxine (n = 261), desvenlafaxine (n = 194). Selective Serotonin Reuptake Inhibitor non-poisoning and poisoning concentrations were similar, with no high certainty threshold for poisoning for citalopram and sertraline. Amitriptyline had the best separation between poisoning and non-poisoning concentrations. Adjustment by estimated daily dose improved the separation of lower quantiles through quantile regression but did not help identify thresholds that separated poisonings and non-poisonings. Dose adjustment generally did not improve the separation of poisoning vs non-poisoning suicides, indicating that post-mortem concentrations may not have clear dose-concentration relationships.

Debilitating Symptom Complexes Attributed to Ticks (DSCATT) is a chronic, debilitating illness associated with tick bites in Australia. DSCATT is of unknown aetiology, can impact emotional well-being and has no recognised treatments. The development and piloting of a novel psychotherapeutic adjunctive intervention for DSCATT that aimed to increase daily functioning, improve quality of life and reduce the impact of symptoms in people with DSCATT. This is a single-site, intervention development and acceptability study. The intervention was developed iteratively according to a Human-Centred Design (HCD) approach and manualised across four phases, with input from end users at each phase: qualitative interviews, development of the intervention, piloting, and revising and refining the intervention. Acceptability of the prototype intervention was evaluated through thematic template analysis of exit interviews. Self-report measures were completed before and after intervention delivery. Following qualitative interviews with 13 participants (11 females and 2 males; aged 35-70 years), the intervention was informed by an Acceptance and Commitment Therapy (ACT) model interwoven with cognitive and behavioural strategies that targeted DSCATT-specific difficulties. The manualised intervention consisted of 12 1-h weekly individual sessions, delivered by psychologists via Telehealth (video call or telephone). Modules addressed the six core psychological processes of ACT, alongside DSCATT-specific modules addressing cognitive function, sleep and social relationships. Pilot testing and follow-up interviews were conducted in a separate sample of six individuals with DSCATT (all females; aged 46-71 years). All participants reported that the approach benefited their emotional well-being and overall health and would recommend it to others with DSCATT. This is a novel and theoretically driven psychotherapeutic intervention for DSCATT, co-produced with patient involvement across four phases. Pilot testing suggested the manualised intervention was feasible and acceptable, supporting future evaluation of feasibility and treatment outcomes with randomised controlled trials. This study involved the engagement and participation of individuals with DSCATT across four stages of the project, according to an HCD approach-the choice of the intervention; the development of the intervention; the piloting of the intervention, and the assessment of the intervention. The pilot study component of this project was prospectively registered on the Australian and New Zealand Clinical Trial Registry (ANZCTR); trial ID: ACTRN12621001032842.

In most countries, a criminal conviction requires evidence that the individual committed the act and that they had the mental capacity to understand what they were doing and that it was wrong. Youth, as an indicator of brain development, is one factor affecting criminal capacity. Worldwide, this has commonly been managed in part by setting in law an age below which criminal incapacity is presumed, so no prosecution is possible. Considerable variation in the MACR was confirmed across 195 countries. Some countries have no MACR. Otherwise, the MACR ranges from 7years (some African and South Asian countries) to 18 (some South American countries); many North Asian, European and a few African countries set theirs at 14 which is the most frequently found level, and also the minimum age recommended by the United Nations Convention on the Rights of the Child. Therefore, how do countries set or change their MACR? To explore change, efforts to change and impact of change in MACR internationally. Between February 1st 2022 and December 31st 2023, members of an international research group (GIRAF-Group of International Researchers in Adolescent Forensics) were asked to complete an emailed questionnaire about changes in the MACR, or efforts to change it, in their country since 2000. Reports were then collated, circulated and discussed within the group. Among the 14 countries responding in detail about the MACR, efforts to raise the MACR had been successful in three, but in nine such efforts had been unsuccessful; in at least two countries pressures were to lower their MACR, but in only one, Denmark, did that happen (from 15 to 14) in the data collection period (though this change was subsequently reversed). Factors most influencing retention of a lower age were exceptional individual cases, which triggered press and political interest in retaining a higher age, and well-evidenced and developed arguments from legal, social and medical or other clinical bodies. The wide differences in the MACR between countries suggest under-use of evidence in deciding it. We need more governmental willingness to bring the MACR at least to the UN-recommended level-but accompanied by research into the impact of this. Efforts targeted exclusively on child and adolescent welfare may have less effect if they also force children through the criminal justice system, with consequent impact on self-identity and sense of citizenship. A low MACR is also likely to be more directly and indirectly costly than a higher one.

Cognitive impairment in individuals attending treatment for substance use disorders is common. However, multiple aetiologies contribute to the presentation of cognitive issues in this population, and key risk factors for significant impairment are unclear. This limits effective screening, including identifying which clients are most appropriate for comprehensive neuropsychological assessment. The aims of the current study were to: (i) examine clinical characteristics and risk factors for cognitive impairment in individuals engaged with community-based substance use treatment services; and (ii) explore which risk factors predicted objective cognitive impairment based on a cognitive screening measure. The current study retrospectively analysed clinical data collected from individuals who participated in cognitive screening programs (n = 559) in two community drug and alcohol services in New South Wales, Australia between 2015 and 2020. This included collation and analysis of: (i) risk factors for cognitive impairment; (ii) objective cognitive screening and questionnaire data. On cognitive screening, 72% of clients met criteria for suspected cognitive impairment, with high rates of non-modifiable and modifiable risk factors reported by clients. A history of neurodevelopmental conditions, education level, and self-rated cognitive and functional ability significantly predicted score on the Montreal Cognitive Assessment. This study highlights the high rates of risk factors for cognitive impairment in individuals attending community substance use treatment, and the complexity of determining who requires more comprehensive cognitive assessment. A history of neurodevelopmental conditions or self-reported functional or cognitive difficulties may indicate the need for objective cognitive screening.

Youth depression disrupts the social and vocational transition into adulthood. Most depression burden is caused by recurring or chronic episodes. Identifying young people at risk for relapsing, recurring, or chronic depression is critical. We systematically reviewed and meta-analyzed the literature on prognostic factors for relapsing, recurrent, and chronic depression in young people. We searched the literature up (MEDLINE, PsycINFO, CINAHL, Embase, CENTRAL, WHO ICTRP, ClinicalTrials.gov, bioRxiv, MedRxiv) to March 6, 2024, and included cohort studies and randomized trials that assessed any prognostic factor for relapse, recurrence, or chronicity of depression in young people (aged 10-25 years at baseline) with a minimum of a 3-month follow-up. We assessed individual study risk of bias using the QUIPS tool and the certainty of evidence via the GRADE approach. We conducted random-effects meta-analyses with Hartung-Knapp-Sidik-Jonkman adjustment when 3 or more estimates on the same prognostic factor were available. Qualitative synthesis was conducted to identify promising prognostic factors that could not be meta-analyzed. A total of 76 reports of 46 studies (unique cohorts or trials) were included that tested 388 unique prognostic factors in 7,488 young people experiencing depression. The majority of the reports were at high risk of bias (87%). We conducted 22 meta-analyses on unadjusted, and 7 on adjusted, prognostic factors of a poor course trajectory (ie, combined relapse, recurrence, and chronicity). Female sex (adjusted; odds ratio [95% CI] = 1.49 [1.15, 1.93], p = .003), higher severity of depressive symptoms (unadjusted; standardized mean difference [95% CI] = 0.53 [0.33, 0.73], p < .001), lower global functioning (unadjusted; standardized mean difference [95% CI] = -0.35 [-0.60, -0.10], p = .005), more suicidal thoughts and behaviors (unadjusted; standardized mean difference [95% CI] = 0.52 [0.03, 1.01], p = .045), and longer sleep-onset latency (unadjusted; mean difference [95% CI] = 6.96 [1.48, 12.44] minutes, p = .013) at baseline predicted a poor course trajectory of depression. The certainty of the evidence was overall very low to moderate. Promising prognostic factors that could not be meta-analyzed included relational/interpersonal factors (friend relationships and family relationships/structure). Our findings demonstrate the prognostic value of demographic and clinical factors for poor course trajectories of depression in young people. More research is needed to confirm the potential value of relational/interpersonal factors in predicting poor depression course. Limitations of the literature include the high risk of bias of included studies, which indicates that future studies should include large sample sizes and wider diversity of prognostic markers (eg, genetic and neurobiological) in multivariable models. The critical next step is to combine the identified prognostic factors and to evaluate their clinical value in identifying individuals at risk for a poor course trajectory of depression during youth, a life stage in which most of the disability and burden attributable to depression can be averted. This systematic review and meta-analysis summarized the evidence for factors that can be used to identify relapsing, recurrent, and chronic depression in young people. Data from 76 reports of 46 unique cohorts, including a total of 7,488 young people experiencing depression, found that female sex, more severe depressive symptoms, suicidal thoughts and behaviors, lower global functioning, and longer sleep-onset latency were predictive of a poor course trajectory of depression. This information has the potential to identify youth at risk for a poor course of depression, a life stage in which most of the disability and burden attributable to depression can be averted. Prognostic factors for relapsing, recurrent or chronic depression in youth: a systematic review with meta-analysis; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023458646.

Social support is a key coping resource; its specific role for refugees from sub-Saharan Africa in high-income settings remains poorly understood. This systematic review synthesises existing evidence on the sources of social support and how these networks aid coping during resettlement. We applied an optimised search strategy to identify studies examining social support among sub-Saharan African refugees across six academic indexing databases. We then undertook a meta-synthesis of the identified studies. This involved the use of meta-thematic analysis of the interpretations and quotes presented in each study, combining thematic analysis through the reviewer’s reflexivity. The PRISMA framework guided the review process to ensure methodological rigour. A total of 22 articles were included in the qualitative meta-synthesis. The synthesis revealed four key sources of social support: 1) family, 2) friends, 3) ethnic and community groups, and 4) cultural and religious supports. These support sources played multiple roles, including enhancing community engagement and reciprocity, providing practical and emotional assistance, offering relief from distress and cultivating cultural continuity and adaptation. However, some individuals distanced themselves from their ethnic community and preferred self-driven coping. Access to social support systems remains a crucial coping resource for many sub-Saharan African refugees in high-income settings, alleviating distress and enhancing resilience. Programs that strengthen informal social support networks through community-driven initiatives can enhance the relevance of social support. Future research should investigate the role of social support across various phases of resettlement in relation to psychosocial well-being.

• The risk factors for suicidal behaviours in military aligned with the social-ecological model. • Adverse military experiences were the most important factors associated with suicidality. • The most feasible factors for Defence to address were clustered as workplace culture. • Concept mapping is a novel approach in suicidology overcoming limitations of a Delphi study. There are increasing efforts to better understand suicidal behaviour among current and former military personnel in Australia. More research using innovative methodologies is needed to identify risk and protective factors that could be addressed within the military. To better understand perceived risk and protective factors associated with suicidal behaviour within the military context. Three groups of stakeholders were recruited: people with lived experience of suicide in a military context, military mental health clinicians, and researchers with expertise in suicide in a military context. Using concept mapping, participants individually generated risk and/or protective factors for suicidal behaviour in a military context, before organising and rating all statements. Data were collected, analysed, and visually represented using the GroupWisdom platform. In total, 57 stakeholders participated in at least one stage of the study (i.e., brainstorming, sorting and/or rating). Brainstorming generated 97 perceived risk-factors and 63 perceived protective factors, which were thematically grouped by participants. A multidimensional scaling and hierarchical cluster analysis generated a 7-cluster solution for risk factors and a 5-cluster solution for protective factors. Most of the risk and protective factors rated highly both in terms of importance and feasibility for the military to address were from workplace-related clusters. The risk and protective factors for suicidal behaviours within a military context were identified on three social-ecological levels: workplace (community), relational, and individual. The results of this study may inform future suicide research and prevention activities targeted to military personnel.

ABSTRACTCoproduction has emerged as an important means of effective mental health service delivery. Unfortunately, this term is commonly misunderstood, with tokenistic participation too often presented as coproduction. Funding and resourcing have been identified as significant, and often insurmountable, barriers to achieving coproduction. This paper presents findings from a cooperative inquiry project, addressing ideas and strategies for working towards coproduction within an academic unit. Three consumer/lived Experience academics and three nonconsumer academics (from Nursing, Occupational Therapy and Social Work) participated in a series of in‐depth conversations to consider and identify potential strategies to advance the faculty's progress towards coproduction. Conversations were transcribed and analysed using a thematic approach. Five main themes were identified: importance of coproduction; preparing for coproduction; barriers to coproduction; the need for university transformation; and power. A belief in the inherent value of coproduction was shared among the group, and strategies were identified to clarify the level of participation. Radical transformation of universities, aligned with contemporary industry practice, is essential to achieving coproduction. Strategies such as allocating vacant academic positions for health professionals to consumer academics are indicative of measures required for genuine aspirations for coproduction to be realised and to address the seemingly insurmountable funding issues. Universities must recognise power differences and remain honest about their position according to participation ladders. These findings provide guidance for academics who acknowledge the value of coproduction to address the commonly identified barriers to its implementation.

Hesitancy about the COVID-19 vaccine in high-income countries can be caused by diverse psychological and social factors. Few studies on vaccine concerns have examined the interplay of the effects of mental disorders, social and economic factors, gender and refugee status. To investigate these issues, this article reports findings from the 2023 wave of a longitudinal study involving 709 women who are mothers of young children in Australia, both refugees and Australian-born. Respondents were asked if they had any worries or fears about receiving the COVID-19 vaccine. In previous waves they completed standardized assessments of mental health and sociodemographic factors. An open-ended question provided insights into the reasons for self-reported vaccine concerns. Descriptive statistics and binary logistic regression analyses were conducted, and demographic adjusted logistic regression undertaken separately for Australian-born and refugee women. Formal comparisons of effect sizes between Australian-born and refugee women were performed, with Cohen's d quantifying the magnitude of these differences. Qualitative responses were coded by topic and ranked by frequency. More than half of the respondents reported worries about receiving a COVID-19 vaccine. Concerns were significantly higher for younger age women, those with a lower educational level and those with a history of mood disorder, panic disorder or separation anxiety disorder. Vaccine hesitancy was associated with poorer quality of life, living difficulties and disability among refugee women only. Separation anxiety disorder and a younger age were associated with an increased odds among Australian-born women only. The newness of the vaccine and concern about side effects were the greatest concerns among respondents who reported hesitancy. Young mothers with mental health problems and lower education need to be sensitively targeted to improve COVID-19 vaccine uptake. Mental health and public health professionals need to be aware of differences reported for women from refugee background. Improved quality of life and economic status will increase vaccine uptake among socioeconomically challenged communities.