Orygen Youth Health

Self-report surveys were conducted in Australia between May 2020 and April 2024, allowing for an analysis of perceived psychological resilience in those with and without suicidal ideation (SI) during and after the COVID-19 pandemic. Linear mixed models were used to describe the factors associated with psychological resilience in these populations and in people experiencing transitions between SI states. Of the 1145 people who responded more than once to the survey, 879 (77%) always reported "never SI", 84 (7%) always reported SI, while 182 (16%) reported SI for only some of their surveys. People who moved between SI states reported significantly lower psychological resilience than those who reported "never SI", but significantly higher psychological resilience than those reporting SI in all their surveys. For participants always reporting SI, greater psychological resilience was significantly associated with greater hopefulness and quality of life, and less sleep than usual. In people who moved between SI states, greater psychological resilience was significantly associated with greater hopefulness, less psychological distress and lower likelihood of mental illness. Only participants with "never SI" reported better psychological resilience alongside consistent sleep and exercise quantities. These results have important implications for suicide prevention in Australia. However, bidirectional associations require further investigation.

Puberty is a critical developmental process that is associated with changes in pubertal (or steroid) hormone levels, which are believed to influence adolescent behaviour via their effects on the developing brain. So far, there are limited and inconsistent findings regarding the relationship between steroid hormones and brain structure and function in adolescent females, with many existing studies employing small sample sizes. Thus, in this study, we explored the association between oestradiol (E2), testosterone (Tes), and dehydroepiandrosterone (DHEA) and brain structure (gray matter volume, sulcal depth, cortical thickness, and white matter microstructure) and function (resting-state connectivity, emotional n-back task-related function) in 3024 adolescent females (age 8.92-13.33 years, mean age (SD) = 10.37 (0.94) years) from the Adolescent Brain Cognitive DevelopmentSM (ABCD) Study. We used elastic-net regression with cross-validation to investigate associations between hormones and brain phenotypes derived from multiple imaging modalities. We found that structural brain features, including cortical thickness, sulcal depth, and white matter microstructure, and resting state connectivity between cortical networks and subcortical regions, were important features associated with hormones. E2 was most strongly associated with prefrontal and premotor regions involved in working memory and emotion processing, while Tes and DHEA were most strongly associated with parietal and occipital regions involved in visuospatial functioning. All three hormones were also associated with prefrontal, temporoparietal junction, and insula cortices. Thus, using an advanced methodological approach, this study suggests both unique and overlapping neural correlates of pubertal hormones in adolescent females and sheds light on the mechanisms by which puberty influences adolescent development and behaviour.

The current Guidelines aim to provide evidence-based management recommendations for treatment of people living with schizophrenia in Australia and Aotearoa New Zealand. The Australian and New Zealand Journal of Psychiatry (ANZJP) commissioned a panel of experts to establish these Guidelines. The existing literature was reviewed to address key health questions. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, and the strength of the recommendation was determined by the panel. The ANZJP GRADE Guidelines examined the current evidence base for a range of areas relevant to treatment for people with schizophrenia including: initial physical health assessment; pharmacological treatment; psychological and psychosocial interventions; family, whānau and carers; psychiatric comorbidities; physical health and lifestyle interventions; and special populations. It is hoped that the current Guidelines provide useful recommendations in important aspects of care for people living with schizophrenia and their family, whānau and carers in Australia and Aotearoa New Zealand, both at the individual and systemic levels.

Background:In 2014, a coal mine fire in regional Australia exposed the local community to 6 weeks of hazardous fine particulate matter less than 2.5 µm in diameter (PM2.5). We investigated longitudinal associations between PM2.5 exposure and respiratory symptoms over 9 years postfire.Methods:In 2016–2017 (wave 1, W1), 4,056 exposed and unexposed adult residents completed surveys, including validated questionnaires for respiratory symptoms. Individual PM2.5 exposures were estimated using modeled smoke data and time-location diaries. Respiratory symptoms were followed up 4-, 7-, and 9 years postmine fire (W2, W3, and W4) in a weighted random subsample of 519 participants (346 exposed) oversampled for people with asthma. Longitudinal associations between mine fire PM2.5 and respiratory symptoms were assessed using mixed-effects logistic regression, adjusting for age, sex, socioeconomic factors, smoking, occupational exposures, and self-reported chronic respiratory diseases diagnosed premine fire.Results:Several patterns were observed. PM2.5 exposure was associated with elevated wheeze across the survey waves, and the associations tended to be higher among participants with premine fire asthma. Dyspnea (nocturnal and resting) increased at the first survey wave but was not detectable afterwards. Chest tightness and chronic cough had detectable increases at follow-up (W2 for both, W3 for chest tightness), but attenuated in the following surveys. No effects were detectable for chronic phlegm or nasal symptoms.Conclusion:While there was some variation over time, exposure to mine fire-related PM2.5 was no longer associated with chest tightness, dyspnea, and chronic cough 9 years postmine fire. The exception was wheeze, where effects of PM2.5 exposure persisted 9 years later, particularly in people with asthma.

The link between chronic exposure to ambient PM2.5 and lung cancer is well established. However, there is limited evidence on the effects of acute, high-level exposure such as that resulting from the 2014 Hazelwood coal mine fire in regional Australia. We investigated the effects of PM2.5 from this fire on cancer incidence 8.5 years later. We obtained Victorian Cancer Registry data linked to 2,872 Hazelwood Health Study Adult Cohort members, from August 2014 to December 2022 and analysed all cancers combined and cancer subtypes. Individual fire-related PM2.5 exposure was estimated by blending time-location diaries with spatial and temporal air pollution modelling data. To evaluate cancer risk from fire-related PM2.5 exposure, we used a competing risks survival model, specifically the Fine-Gray subdistribution hazard model for deaths from causes other than the cancer outcome being analysed, and to adjust for confounders including demographics, occupational exposures, and socioeconomic factors. In the post-mine fire period, 295 people (14.3/1000 person-years) were diagnosed with 332 new cancers (12.7/1000 person-years). No significant association was found between fire-related PM2.5 exposure and the overall incidence of cancer (hazard ratio = 1.00, 95 % confidence interval: 0.90-1.11). Additionally, no associations were identified with any specific cancer subtypes, including lung cancer. We found no evidence that this coal mine fire increased cancer incidence. However, it would be premature to rule out potential carcinogenic effects. Cancer has a long latency period, which means it will be necessary to analyse new data as they become available to more conclusively determine the effects of medium-duration, high-level smoke exposure.

Introduction: The current definition of hallucinations as perception-like experiences has been criticized for neglecting their experiential character and context. This study examined the phenomenology of auditory verbal hallucinations (AVHs) and visual hallucinations (VHs) in schizophrenia and their relation to other psychopathology, particularly basic self-disorders. Methods: Twenty patients with schizophrenia-spectrum psychosis and hallucinations participated in phenomenologically oriented, semi-structured interviews exploring the experiential characteristics and context of AVH and VH as well as a comprehensive psychopathological examination, including the Examination of Anomalous Self-Experience (EASE). Results: The far majority of participants considered their hallucinations distinct from perceptual experience and described alterations of the ordinary experiential structure of sensory experience. Generally, both AVH and persistent VH were experientially intertwined with self-disorders and other subjective pathological phenomena. Moreover, AVHs were characterized by alterations of spatiality and experienced as private, i.e., not being accessible to others. Compared to a control group, the participants with hallucinations had significantly higher levels of self-disorders, earlier onset of psychopathology, and lower IQ. Conclusion: The findings align with prior research proposing that most AVHs in schizophrenia reflect an underlying alteration of the structure of subjectivity (i.e., disorder of basic self). We report novel findings suggesting that a similar link between self-disorders and VH should be further investigated. Our study highlights the importance of assessing hallucinations within the broader context of the patient’s psychopathology for adequate differential diagnostic evaluation and understanding of lived experience.

ABSTRACTIntroductionBody image dissatisfaction is a risk and maintenance factor for disordered eating. Parents may contribute to offspring body image dissatisfaction through weight‐related criticism (direct influence), as well as expressed parental body image dissatisfaction and dieting (indirect influence). This study retrospectively investigated the contribution of parental influence towards adult offspring's body image dissatisfaction.MethodsOne hundred and fifty six participants from a general community sample completed a survey recording their experience of direct and indirect parental influence throughout adolescence, in addition to their current body image satisfaction.ResultsWhile controlling for peer and media influences, hierarchical linear regression determined that parental influence was a significant contributor to offspring body image dissatisfaction (p < 0.001), and this effect was driven by direct influence (p < 0.001). Indirect parental influence was non‐significant (p = 0.899).ConclusionsThe observed strength of direct influence supports the need for parents to reinforce positive weight‐related behaviours at home as a method of reducing and managing body image dissatisfaction levels in their offspring.

There are few effective treatments for methamphetamine use disorder, despite increasing global demand. Here, we assessed the safety and feasibility of outpatient psilocybin-assisted psychotherapy for methamphetamine use disorder. Single arm, open label pilot study. Outpatient public stimulant treatment program at St. Vincent's Hospital, Sydney, Australia. We recruited 15 participants that were ≥25 years old, seeking treatment for methamphetamine use, using methamphetamine ≥4 days/month at screening, and without serious mental illness or contraindicated medical conditions or medications. Participants received three preparatory psychotherapy sessions over two weeks before a single psilocybin dosing session (25 mg oral), followed by two integration psychotherapy sessions over one week. Psychotherapy included elements of motivational enhancement and acceptance and commitment therapy. Participants were followed for 90 days post psilocybin-assisted psychotherapy session. Primary endpoints were safety (as measured by adverse events over the trial and vital signs during psilocybin dosing) and feasibility (as measured by enrolment and dropout rates), and secondary endpoints included measuring self-reported methamphetamine and other illicit drug use, drug craving, depression, anxiety, stress and quality of life measures. Of 56 participants pre-screened, 15 were eligible and enrolled, 14 completed the intervention and 13 completed 90-day post-dose follow-up.". No serious adverse events (AEs) occurred, and the seven treatment related AEs were self-limiting and mild to moderate in severity. AEs included hypertension during the dosing session and headache (n = 4), nausea (n = 1) and noise sensitivity (n = 1) within the week following the dose. Methamphetamine use (over the prior 28 days) was observed to be lower at screening (median 12 days, IQR 7-16, n = 15) relative to day 28 (median 0 days, IQR 0-2, n = 13) and 90 (median 2 days, IQR 1-4, n = 14) post psilocybin. Methamphetamine craving was also observed to be lower while quality of life, depression, anxiety, and stress were observed to be higher at days 28 and 90 follow-up relative to baseline. Psilocybin assisted psychotherapy for methamphetamine use disorder was feasible to implement in an outpatient setting and did not appear to generate safety concerns. A larger randomised controlled trial is required to confirm efficacy and safety.

Rates of self-harm and suicide-related thoughts and behaviors are high among young people and there are growing concerns about the potential role of social media on this, and on youth mental health more broadly.These concerns have led several countries to strengthen their legislative approaches to online safety, in particular as they relate to young people.In Australia, a mandatory minimum age of 16 for young people accessing some social media platforms will come into effect in December 2025 (Online Safety Amendment [Social Media Minimum Age] Bill; Parliament of Australia, 2024).However, what is being referred to as the "social media ban" will almost certainly also have unintended harmful consequences for some young people.In this editorial we will (1) consider both the potential harms and benefits that exist regarding online safety and suicide prevention; (2) critique the approach being taken by Australia; and (3) present a possible framework for future approaches to improve online safety, as it relates to self-harm and suicide.Although the legislation for this minimum age requirement has passed in Australia, we argue that that restricting access to social media risks doing more harm than good and that complementary measures are also required.

BackgroundBipolar depression remains difficult to treat, and people often experience ongoing residual symptoms, decreased functioning and impaired quality of life. Adjunctive therapies targeting novel pathways can provide wider treatment options and improve clinical outcomes. Garcinia mangostana Linn. (mangosteen) pericarp has serotonogenic, antioxidant anti-inflammatory and neurogenic properties of relevance to the mechanisms of bipolar depression.AimsThe current 28-week randomised, multisite, double-blind, placebo-controlled trial investigated mangosteen pericarp extract as an adjunct to treatment-as-usual for treatment of bipolar depression.MethodThis trial was prospectively registered on the Australia New Zealand Clinical Trials Registry (no. ACTRN12616000028404). Participants aged 18 years and older with a diagnosis of bipolar I or II and with at least moderate depressive symptoms were eligible for the study. A total of 1016 participants were initially approached or volunteered for the study, of whom 712 did not progress to screening, with an additional 152 screened out. Seventy participants were randomly allocated to mangosteen and 82 to a placebo control. Fifty participants in the mangosteen and 64 participants in the placebo condition completed the treatment period and were analysed.ResultsResults indicated limited support for the primary hypothesis of superior depression symptom reduction following 24 weeks of treatment. Although overall changes in depressive symptoms did not substantially differ between conditions over the course of the trial, we observed significantly greater improvements for the mangosteen condition at 24 weeks, compared with baseline, for mood symptoms, clinical impressions of bipolar severity and social functioning compared with controls. These differences were attenuated at week 28 post-discontinuation assessment.ConclusionsAdjunctive mangosteen pericarp treatment appeared to have limited efficacy in mood and functional symptoms associated with bipolar disorder, but not with manic symptoms or quality of life, suggesting a novel therapeutic approach that should be verified by replication.