The role of human involvement and support in digital mental health interventions for people with schizophrenia spectrum disorders: a critical review.

PURPOSE OF REVIEW: Schizophrenia spectrum disorders (SDD) are characterized by a complex array of psychosis symptoms, and typically require ongoing and long-term support, including pharmacological and nonpharmacological management. Digital mental health interventions (DMHIs) have been suggested as a novel therapeutic approach to enable low-cost, scalable improvements in quality of care for adults living with SSD. However, the types and role of human involvement and support within DMHIs is currently unknown. RECENT FINDINGS: Several recent systematic reviews and meta-analyses have investigated the potential efficacy of DMHIs for people with SSD, with scant yet emerging systematic evidence on the effects of human support within DMHIs on mental health outcomes. Further, several recent individual studies examined the efficacy of DMHIs with human support among people with SSD and provided valuable insights into the potential key elements of such support on outcomes relevant to this population. SUMMARY: The current critical review provides the first narrative synthesis of available evidence to guide clinicians and intervention develops in designing DMHIs with adequate human support that may enhance long-term outcomes of people living with SSD.

Breast cancer treatment disparities in patients with severe mental illness: A systematic review and meta-analysis.

OBJECTIVE: The incidence and mortality rates of breast cancer in individuals with pre-existing severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major depression, are higher than in the general population. Reduced screening is one factor but there is less information on possible barriers to subsequent treatment following diagnosis. METHODS: We undertook a systematic review and meta-analysis on access to guideline-appropriate care following a diagnosis of breast cancer in people with SMI including the receipt of surgery, endocrine, chemo- or radiotherapy. We searched for full-text articles indexed by PubMed, EMBASE, PsycInfo and CINAHL that compared breast cancer treatment in those with and without pre-existing SMI. Study designs included population-based cohort or case-control studies. RESULTS: There were 13 studies included in the review, of which 4 contributed adjusted outcomes to the meta-analyses. People with SMI had a reduced likelihood of guideline-appropriate care (RR = 0.83, 95% CI = 0.77-0.90). Meta-analyses were not possible for the other outcomes but in adjusted results from a single study, people with SMI had longer wait-times to receiving guideline-appropriate care. The results for specific outcomes such as surgery, hormone, radio- or chemotherapy were mixed, possibly because results were largely unadjusted for age, comorbidities, or cancer stage. CONCLUSIONS: People with SMI receive less and/or delayed guideline-appropriate care for breast cancer than the general population. The reasons for this disparity warrant further investigation, as does the extent to which differences in treatment access or quality contribute to excess breast cancer mortality in people with SMI.

Do you see what I see: A mother's plea.

There is sometimes dissonance between the medical services that the general public expects an ED to provide and the acute critical care that emergency clinicians hope to provide. One explanation for this is that the ED is both a territory and a meeting place for a cornucopia of clinicians, some of whom are not ED clinicians themselves. Roles are sometimes ambiguous and location-specific. Recently, one Queensland mother believed that her son's suicide could have been prevented had emergency staff been better educated. This perspective aims to reflect on several pertinent questions: Should suicide risk be treated as a medical emergency? Is suicide prevention everyone's business? Is suicide risk assessment and management a core component of ED? How common, precise and non-stigmatising is the language around suicide? To what extent is that language underpinned by mythology rather than fact? For some, these will be inconvenient questions. How they are answered is undoubtedly framed within the language used when discussing suicide.

Suicide in Children: A Systematic Review.

The objective of this study was to provide a review of studies on suicide in children aged 14 years and younger. Articles were identified through a systematic search of Scopus, MEDLINE, and PsychINFO. Key words were "children, suicide, psychological autopsy, and case-study." Additional articles were identified through manual search of reference lists and discussion with colleagues. Fifteen published articles were identified, 8 psychological autopsy studies (PA), and 7 retrospective case-study series. Suicide incidence and gender asymmetry increases with age. Hanging is the most frequent method. Lower rates of psychopathology are evident among child suicides compared to adolescents. Previous suicide attempts were an important risk factor. Children were less likely to consume alcohol prior to suicide. Parent-child conflicts were the most common precipitant.

Suicides in Aboriginal and Torres Strait Islander children: analysis of Queensland Suicide Register.

OBJECTIVE: Suicide rates among Indigenous Australian children are higher than for other Australian children. The current study aimed to identify factors associated with Indigenous child suicide when compared to other Australian children. METHODS: Using the Queensland Suicide Register, suicides in Indigenous children (10-14 years) and other Australian children in the same age band were compared. RESULTS: Between 2000 and 2010, 45 child suicides were recorded: 21 of Indigenous children and 24 of other Australian children. This corresponded to a suicide rate of 10.15 suicides per 100,000 for Indigenous children - 12.63 times higher than the suicide rate for other Australian children (0.80 per 100,000). Hanging was the predominant method used by all children. Indigenous children were significantly more likely to suicide outside the home, to be living outside the parental home at time of death, and be living in remote or very remote areas. Indigenous children were found to consume alcohol more frequently before suicide, compared to other Australian children. Current and past treatments of psychiatric disorders were significantly less common among Indigenous children compared to other Australian children. CONCLUSIONS: Western conceptualisation of mental illness may not adequately embody Indigenous people's holistic perspective regarding mental health. Further development of culturally appropriate suicide prevention activities for Aboriginal and Torres Strait Islander children is required.

Factors related to childhood suicides: analysis of the Queensland Child Death Register.

BACKGROUND: Suicide among children under the age of 15 years is a leading cause of death. AIMS: The aim of the current study is to identify demographic, psychosocial, and psychiatric factors associated with child suicides. METHOD: Using external causes of deaths recorded in the Queensland Child Death Register, a case-control study design was applied. Cases were suicides of children (10-14 years) and adolescents (15-17 years); controls were other external causes of death in the same age band. RESULTS: Between 2004 and 2012, 149 suicides were recorded: 34 of children aged 10-14 years and 115 of adolescents aged 15-17 years. The gender asymmetry was less evident in child suicides and suicides were significantly more prevalent in indigenous children. Children residing in remote areas were significantly more likely to die by suicide than other external causes compared with children in metropolitan areas. Types of precipitating events differed between children and adolescents, with children more likely to experience family problems. Disorders usually diagnosed during infancy, childhood, and adolescence (e.g., ADHD) were significantly more common among children compared with adolescents who died by suicide. CONCLUSION: Psychosocial and environmental aspects of children, in addition to mental health and behavioral difficulties, are important in the understanding of suicide in this age group and in the development of targeted suicide prevention.