Australian & New Zealand Journal of Psychiatry

Characteristics and outcomes of all patients treated involuntarily under Victoria’s Severe Substance Dependence Treatment Act 2010 between 2011 and 2023 were described. Predictors of outcomes 6 months after the end of the Severe Substance Dependence Treatment Act 2010 treatment period were examined.

All admissions under the Severe Substance Dependence Treatment Act 2010 from when the programme began in January 2011 to December 2023 were audited. Data were analysed using descriptive statistics and univariate logistic regression.

There were 70 admissions for 60 patients. 58% were male, and 5% were Aboriginal and Torres Strait Islander people. Alcohol was a substance of concern for 91%, 43% had liver disease and 78% had additional psychiatric diagnoses. Six months after the end of treatment, 15% were deceased and 48% of patients had returned to their previous level of substance use. 27.6% were either using less or abstinent at 6 months which was predicted by reduced use or abstinence at 1 month (OR = 70, 95% CI = [11.5, 424.8], p < 0.001).

This study suggests that brief involuntary treatment is associated with meaningful improvements in substance use outcomes for a minority of patients. If reduced substance use is achieved early following involuntary admission, it is likely to be sustained. No other clear predictor of outcome emerged in this cohort. In the absence of a control group, it is not possible to attribute these results to treatment under the Severe Substance Dependence Treatment Act 2010. Larger cohorts are required to determine variables that can be used to predict outcomes and enable judicious use of involuntary treatment for substance use disorders.

Post-traumatic stress disorder is a leading driver of distress and premature mortality.

To provide contemporary, nationally representative estimates of post-traumatic stress disorder in Australia using data from the Australian population-based 2020–2022 National Study of Mental Health and Wellbeing, including sex-specific prevalence, remission and comparisons with the 2007 National Study of Mental Health and Wellbeing.

Post-traumatic stress disorder and 14 other Diagnostic and Statistical Manual of Mental Disorders (4th ed.) disorders were assessed with the World Mental Health Composite International Diagnostic Interview 3.0. Kaplan–Meier survival analysis estimated projected lifetime risk and time to remission. Cox regression tested for projected lifetime remission. Logistic regression tested associations between post-traumatic stress disorder and demographic, mental health, and physical health variables, and prevalence changes between the 2007 and 2020–2022 surveys.

Lifetime post-traumatic stress disorder prevalence (n = 15,893) was 7.1%. Females had higher odds than males (odds ratio = 2.3, confidence interval = [2.0, 2.7]) of post-traumatic stress disorder diagnosis. Projected lifetime risk was 9.6% and higher for females (12.3%) than males (6.4%; hazard ratio = 2.2, standard error = 0.10). Projected lifetime remission was 63.3%, with higher remission for males than females (68.7% vs 61.2%; hazard ratio = 0.81; standard error = 0.10). Three quarters entered remission after 10 years for males and 20 years for females. Individuals with post-traumatic stress disorder had higher odds of experiencing any anxiety disorder (adjusted odds ratio = 6.0, confidence interval = [5.0, 7.3]), any mood disorder (adjusted odds ratio = 4.8, confidence interval = [3.9, 5.9]), sedative use disorder (adjusted odds ratio = 7.9, confidence interval = [3.9, 15.9]), suicidality (adjusted odds ratio = 5.0, confidence interval = [4.2, 5.9]), asthma (adjusted odds ratio = 2.0, confidence interval = [1.7, 2.4]) and diabetes (adjusted odds ratio = 1.8, confidence interval = [1.2, 2.6]). No differences in post-traumatic stress disorder diagnosis were observed between the 2007 and 2020–2022 surveys.

Post-traumatic stress disorder remains a prevalent and chronic condition in Australia, frequently co-occurring with other mental and physical health conditions and characterised by significant sex differences in risk and remission.

The objective is to investigate associations between anxiety accessing mental health services and structural stigma as self-reported by people with borderline personality disorder.

A retrospective cohort design was used to investigate data from the 2017 National Consumer Survey undertaken in Australia between June and July 2017. Analyses were performed using multivariate binary logistic regression models.

Data comprised 423 people with borderline personality disorder aged 18 years and above, where 384 (93.7%) were females. Associations were found between anxiety and stigma in relation to mental health service access for borderline personality disorder. Strikingly, most people with borderline personality disorder reported experiencing anxiety accessing mental health services irrespective of having anxiety disorder/s, indicative of stigma leading to anxiety rather than a by-product of anxiety disorder/s. People with borderline personality disorder and anxiety disorder/s were 9.8 times more likely to feel very anxious about not being taken seriously in mental health services, than respondents with no anxiety disorder/s. Contrastingly, people with borderline personality disorder and anxiety disorder/s were 79% less likely to feel anxious about cost of services, than respondents with no anxiety disorder/s. People with borderline personality disorder previously refused public hospital admission were 8.7 times more likely to feel very anxious about cost of services and 5.3 times more likely to feel very anxious about long wait lists for services than people with borderline personality disorder not refused hospital admission.

Associations were observed for people with borderline personality disorder experiencing anxiety accessing mental health services, attributed to stigma in health systems. Findings provide nuanced understanding of structural mechanisms and system-level problems affecting services and advances knowledge on the impact of borderline personality disorder–related stigma in healthcare.

Universal screening for perinatal mental illness is recommended in Australia; however, these tools do not screen for perinatal post-traumatic stress disorder (PTSD). While existing perinatal PTSD tools show validity, they vary in diagnostic agreement, and most are focused on PTSD following childbirth. Early detection of PTSD symptoms at any phase of perinatal care is critical to improve maternal/infant outcomes and engagement with effective treatment. Unfortunately, gaps remain in practice for identifying perinatal PTSD.

The aim of the study was to develop a screening tool to detect current symptoms of perinatal PTSD or higher risk of developing the disorder, resulting from index perinatal event(s) or experience(s) during conception, pregnancy and the postpartum.

If any perinatal trauma was endorsed, participants completed an online questionnaire and if consenting, a semi-structured clinical telephone interview during their current pregnancy.

Twenty-five items were submitted for exploratory factor analysis, n = 114, and the results supported a two-factor solution. After removing items with poor loadings, a 17-item, two-factor solution explained 68.36% of the total variance. Each of the components had excellent internal consistency; component one α = .954 and component two α = .897. Following a receiver operating characteristic analysis n = 52, the optimal cutoff score of ⩾11 was identified with 90.9% sensitivity and 61% specificity.

Moderate predictive validity of the tool shows promise for detecting those currently experiencing symptoms of perinatal PTSD and at higher risk of developing the disorder, supporting utility in clinical settings, pending future validation.

Diversionary approaches seek to address criminal legal system involvement among people with psychosis and other mental illness. There is limited evidence examining health characteristics of people with psychosis in Australian criminal legal systems and how these vary with court outcomes, including diversion.

We conducted a data-linkage study of 21,229 adults hospitalised with psychosis in New South Wales (June 2001 to December 2019) with a subsequent offence finalised in the New South Wales Local Court. We described psychosis types, co-occurring conditions and prior health service use and examined their associations with court outcome (diversion vs conviction) using logistic regression, adjusting for sociodemographic and legal factors.

A total of 70.8% of participants had a schizophrenia spectrum disorder (substance-induced psychosis 22.6%; affective psychosis 6.6%). Co-occurring conditions were common (lifetime substance-related harm 84.8%; personality disorder 41.3%; neurodevelopmental disorder 17.5%; physical condition 25.6%), and 76.3% used mental health services in the year before the index offence. Affective and substance-induced psychoses were negatively associated with diversion vs schizophrenia spectrum disorders (adjusted odds ratios = 0.64 [95% confidence interval = 0.54–0.74] and 0.29 [95% confidence interval = 0.26–0.33], respectively). Duration of psychosis admissions and past-year mental health service use were positively associated with diversion, while in those with schizophrenia spectrum disorders, lifetime substance-related harm was negatively associated.

Court defendants with psychosis have a complex health profile. Although people with schizophrenia spectrum disorders are more likely to be diverted than those with other psychosis types, substance use may inhibit diversion. Health and criminal legal system collaboration is needed to facilitate diversion and treatment for this group.

Estimate and compare rates of cardiometabolic blood screening, elevated results and clinical follow-up actions for Māori and non-Māori mental health service users with psychosis in Canterbury, Aotearoa New Zealand.

A retrospective cohort study (N = 3840) with dynamic entry was conducted with people aged 18–64 years with a psychosis diagnosis in Canterbury Specialist Mental Health Service (1 August 2012 to 31 December 2019). Linked administrative data captured lipid and HbA1c screening within 1 year of study entry, elevated results (triglycerides > 2.2 mmol/L; total cholesterol:high-density lipoprotein cholesterol > 5; HbA1c > 40 mmol/mol) from individual study entry to 31 December 2023, and clinical actions (repeat test; statin/metformin dispensing) within 1 year following an elevated result.

887/3840 (23%) of Canterbury Specialist Mental Health Service users with psychosis were Māori. First-year screening rates were modest (31–44%), similar by ethnicity and broadly higher among clozapine/olanzapine users. Māori had higher odds of both elevated lipids and HbA1c. About one-third of elevated results were followed up with re-testing within 1 year. Rates of follow-up testing and medication dispensing were broadly similar for Māori and non-Māori, except Māori were more likely to receive repeat HbA1c testing after an elevated result (odds ratio = 1.71 [1.16, 2.50]).

Findings highlight large gaps in cardiometabolic screening and follow-up actions among Māori and non-Māori Specialist Mental Health Service users with psychosis. Māori presented with psychosis 4 years younger, had significantly higher rates of elevated cardiometabolic risk markers and were more likely to receive HbA1c re-testing following an elevated result.

Hallucination studies in psychiatry have typically focused on the auditory domain, despite mounting evidence that non-auditory hallucinations are prevalent, and elicit distress and functional interference. Proponents have called for more in-depth phenomenological enquiries into hallucinations across multiple sensory modalities, but there are no comprehensive, validated assessment tools to date. This study aimed to document the design and pilot validation of such a transdiagnostic instrument – the Multisensory Hallucinations Schedule.

Leveraging off a precursor measure, the Multisensory Hallucinations Schedule comprised eight modules: Auditory, Visual, Olfactory, Somatic-tactile, Gustatory, Other modalities, Multimodal and Delusions, across lifetime and current time frames. Pilot validation analyses sought to confirm its factor structure via principal components analyses, verify acceptability, convergent and divergent validities, and compute reliability (equivalence and stability) statistics as well as internal consistencies.

Based on 76 participants diagnosed with a primary psychotic illness, the Multisensory Hallucinations Schedule demonstrated acceptable factor structure, with two- to four-factor solutions generated across its subscales, explaining 39.2–76.9% of variance. It displayed excellent acceptability (98.7% completion) as well as robust convergent (r < 0.807) and divergent (r > 0.005) validities. Moderate to high equivalence (intraclass correlation coefficient = 0.574–0.993) and stability (intraclass correlation coefficient = 0.535–0.991), and good internal consistency (Cronbach’s α = 0.462–0.851) were shown.

The Multisensory Hallucinations Schedule represents an initial foray into inclusively documenting multisensory hallucinations in psychosis. Future validation endeavours should look towards replication using more robust participant numbers as well as expanding to other psychiatric and neurological cohorts experiencing prominent hallucinations.

Maternal perinatal depression is a well-established risk factor for adverse child developmental outcomes; however, its long-term association with academic achievement remains unclear. This study examined its association with children’s academic performance across multiple stages of schooling.

Data were drawn from the New South Wales Perinatal Data Collection, linked with the New South Wales Admitted Patient Data Collection and the New South Wales National Assessment Program – Literacy and Numeracy. Maternal perinatal depressive disorders were identified from hospital admission records using the International Classification of Diseases, 10th Revision, Australian Modification codes. Academic performance was assessed using the National Assessment Program – Literacy and Numeracy results in Grades 3, 5 and 7. Outcomes were classified as meeting or not meeting the national minimum standards in reading, spelling, writing, grammar and numeracy. Generalised estimating equations and propensity score matching were applied to examine associations.

After adjustment and matching, maternal perinatal depressive disorders were associated with increased odds of children not meeting the national minimum standards in reading (odds ratio = 1.24, 95% confidence interval = [1.10, 1.41]), spelling (odds ratio = 1.28, 95% confidence interval = [1.13, 1.46]), writing (odds ratio = 1.32, 95% confidence interval = [1.19, 1.47]) and grammar (odds ratio = 1.18, 95% confidence interval = [1.06, 1.33]), but not numeracy (odds ratio = 1.10, 95% confidence interval = [0.96, 1.27]). Associations were more consistent for antenatal depression, while postnatal depression was associated with reading and writing only.

Children of mothers with perinatal depressive disorders showed an association with suboptimal academic performance, particularly in literacy-related domains. The stronger associations observed for antenatal depression suggest that early gestational exposure may affect foundational cognitive and socio-emotional development, highlighting the importance of timely identification and treatment of maternal depression during pregnancy to support long-term educational outcomes.

We aimed to assess the alignment in defining and measuring psychosocial disability and/or mental health challenges across major Australian national mental health data sources.

We reviewed the definition and measurement of psychosocial disability and mental health challenges in two stages. First, we examined the data items across five national data sources: the Survey of Disability, Ageing and Carers (SDAC), the National Health Survey (NHS), the National Study of Mental Health and Wellbeing (NSMHW), the Census and the National Disability Insurance Scheme (NDIS) administrative data. In the second stage, we analysed the prevalence of psychosocial disability and mental health challenges across the datasets.

The definition and measurement approaches for psychosocial disability and mental health challenges vary across data sources, reflecting differences in the conditions included and the purpose for which data were collected. Psychosocial disability is inconsistently defined: broad population surveys (SDAC, NHS) include neurodevelopmental and neurodegenerative conditions, whereas the NDIS captures only severe mental illnesses with substantial functional impairment. Prevalence across Australia varied widely from 42.9% for lifetime mental disorders (NSMHW) and 26.1% for long-term conditions (NHS), down to 6% when strictly defining psychosocial disability (SDAC).

There are variations in definitions and measurement across major Australian mental health data sources with respect to conditions captured in the datasets and the definitions used. Researchers and policymakers should therefore critically appraise – and where possible adjust for – these variations when using these data to inform strategic decisions and resource allocation.