Association between psychotic experiences and non-accidental self-injury: results from a nationally representative survey of adolescents.

PURPOSE: The association between psychotic experiences (PEs) and non-accidental self-injury (NASI; including self-harm and suicide attempts) is well established, although variables influencing this relationship have not been comprehensively examined. This study aimed to investigate (1) the cross-sectional PE-NASI association before and after adjustment for confounders, and (2) the individual contribution of each confounding and potentially mediating variable to the association. METHODS: A random sample of Australian adolescents aged 14-17 years (n = 1998) completed self-report questions regarding any self-harm, suicidality or PEs experienced in the past 12 months in 2013-2014 as part of the Young Minds Matter Survey, a national household survey. We conducted logistic regression analyses to investigate the association between NASI and PEs, after controlling for confounders (sociodemographics, substance use, and parental mental illness) as well as the influence of potential mediators (major depression, bullying, psychological distress, sleep, self-esteem, disordered eating behaviour, social isolation, and intervention factors). RESULTS: Except for special messages, all PE subtypes (auditory and visual hallucinatory experiences [HEs], and two of the three delusional experiences [DEs]) were associated with NASI after adjustment for confounders (OR range: 2.60-5.21). Depression and psychological distress significantly influenced all PE-NASI associations, where depression appeared to fully explain the DE-NASI association, and partially attenuate the HE-NASI association. Variables such as parental mental illness, disordered eating behaviour, and social isolation had negligible effects in nearly all self-harm and attempted suicide models. CONCLUSIONS: Adolescents reporting any PE in the past 12 months reported increased likelihood of NASI in the same time period and, auditory HEs in particular, were strongly and independently associated with self-harm and suicide attempts. These results highlight the importance of PEs as indicators of risk of self-injurious behaviour among Australian youth.

Prevalence and correlates of psychotic experiences in a nationally representative sample of Australian adolescents.

OBJECTIVE: Despite growing literature on psychotic experiences, no nationally representative study has reported on the prevalence of both hallucinatory experiences and delusional experiences in Australian adolescents. Also, while many studies have examined the association between psychotic experiences and certain demographic and clinical correlates, there are more variables of interest to be investigated, including disordered eating behaviour and hours of sleep. The aims of this study were to examine (1) the prevalence of hallucinatory experiences and delusional experiences in Australian adolescents, and (2) the associations between different types of psychotic experiences with a broad range of demographic, clinical, and psychosocial variables. METHODS: A random sample of Australian adolescents aged 14- to 17-year-olds were recruited in 2013-2014 as part of the Young Minds Matter Survey. Participants completed self-report questions regarding five different psychotic experience types (auditory and visual hallucinatory experiences, and thoughts read, special messages, spied upon) experienced in the past 12 months. Using logistic regression analyses, we investigated associations between psychotic experiences and demographic, clinical, and psychosocial factors. RESULTS: The 12-month prevalence ranged from 3.3% (95% confidence interval = [2.6, 4.3]) for special messages to 14.0% (95% confidence interval = [12.3, 15.8]) for auditory hallucinatory experiences. At the bivariate level, each psychotic experience subtype was associated with increased likelihood of major depression, being bullied, psychological distress, low self-esteem, mental health service use and insufficient sleep (<8 hours per night). Multivariate analyses revealed both auditory and visual hallucinatory experiences were associated with an increased likelihood of four of these variables (depression, being bullied, service use, insufficient sleep), whereas associations with delusional experiences were inconsistent. CONCLUSION: Hallucinatory and delusional experiences are common in Australian adolescents. Hallucinatory experiences, rather than delusional experiences, may be more clinically relevant in this demographic. When psychotic experiences are endorsed by adolescents, further assessment is indicated so as to ascertain more detail on the phenomenology of the experiences to better understand their clinical relevance.

Prevalence and correlates of bullying victimisation and perpetration in a nationally representative sample of Australian youth.

OBJECTIVE: Bullying prevalence studies are limited by varied measurement methods and a lack of representative samples. This study estimated the national prevalence of bullying victimisation, perpetration and combined victim-perpetration experiences in a representative population-based sample of Australian youth. The relationships between the three types of bullying involvement with a range of mental health symptoms and diagnoses were also examined. METHODS: A randomly selected nationally representative sample aged 11-17 years ( N = 2967, Mage = 14.6 years; 51.6% male) completed the youth component of the Second Australian Child and Adolescent Survey of Mental Health and Wellbeing (Young Minds Matter). Parents or carers also completed a structured face-to-face interview that asked questions about a single randomly selected child in the household. The youth survey comprised self-reported bullying victimisation and perpetration (Olweus Bully-Victim Questionnaire-adapted), psychological distress (K10), emotional and behavioural problems (Strengths and Difficulties Questionnaire), as well as self-harm, suicide attempts and substance use. Modules from the Diagnostic Interview Schedule for Children Version IV were administered to all youth and parents to assess for mental disorder diagnoses (major depressive disorder, any anxiety disorder and any externalising disorder [attention-deficit hyperactivity disorder, oppositional defiant disorder and conduct disorder]). RESULTS: The 12-month prevalence of bullying victimisation was 13.3%, perpetration 1.6% and victim-perpetration 1.9%. Logistic regression models showed all forms of involvement in bullying were associated with increased risk of psychological distress, emotional and behavioural problems, substance use, self-harm and attempted suicide. Victimisation and victim-perpetration were associated with youth-reported major depressive disorder. There were also significant associations between bullying involvement and parent-reported diagnoses of major depressive disorder, any anxiety disorder and any externalising disorder. CONCLUSION: Bullying continues to be frequently experienced by Australian adolescents. The current findings showed that involvement in any bullying behaviour was associated with increased risk of concurrent mental health problems. This evidence can be used to inform decisions concerning the allocation of resources to address this important health issue.

Internet use and electronic gaming by children and adolescents with emotional and behavioural problems in Australia - results from the second Child and Adolescent Survey of Mental Health and Wellbeing.

BACKGROUND: Concerns have been raised of a potential connection between excessive online activity outside the academic realm and increased levels of psychological distress in young people. Young Minds Matter: the second Australian Child and Adolescent Survey of Mental Health and Wellbeing provides estimates of the prevalence of online activity and allows an exploration of associations between this activity, a range of mental disorders, socio-demographic characteristics and risk taking behaviour. METHODS: Based on a randomized nationally representative sample, a household survey of mental health and wellbeing (Young Minds Matter) was conducted in 2013-14. Interviews were conducted with 6,310 parents and carers of 4-17 year-olds (55 % response rate), together with self-report questionnaires completed by 2,967 11-17 year-olds in these households (89 % response rate). The survey identified a range of mental disorders and emotional problems using a variety of diagnostic tools, with the self-report including questions about use of the Internet and electronic games. Five behaviours were measured related to this activity, with 'problem behaviour' being defined as exhibiting at least four out of five behaviours. RESULTS: Levels of Internet use (98.9 %, CI 98.5-99.3 %) and electronic gaming (85.3 %, CI 83.9-86.6 %) were high, and 3.9 % (CI 3.2-4.6 %) of young people reported problem behaviour. The proportion of girls with very high levels of psychological distress and problem behaviour (41.8 %,CI 28.8-54.9 %) was twice that for boys (19.4 %, CI 7.7-31.1 %). Those engaging with a range of risk factors reported higher prevalence of problem behaviour than others. Youth who suffered from emotional problems or high levels of psychological distress spent the most time online or playing games. Multivariate analysis showed associations with problem behaviour and having attempted suicide, experiencing high to very high levels of psychological distress, using alcohol, and living in a poorly functioning family. It was not possible to determine the direction of the associations. CONCLUSION: There are links between problem behaviours associated with Internet use and electronic gaming, and mental disorders and risk-taking behaviour in young people. Further studies are required to determine whether these are precursors or sequelae.

Self-harm: Prevalence estimates from the second Australian Child and Adolescent Survey of Mental Health and Wellbeing.

OBJECTIVE: To (1) estimate the lifetime and 12-month prevalence of self-harm without suicide intent in young people aged 12-17 years, (2) describe the co-morbidity of these behaviours with mental illness and (3) describe their co-variation with key social and demographic variables. METHOD: A nationally representative random sample of households with children aged 4-17 years recruited in 2013-2014. The survey response rate was 55% with 6310 parents and carers of eligible households participating. In addition, 2967 (89%) of young people aged 11-17 completed a self-report questionnaire with 2653 of the 12- to 17-year-olds completing questions about self-harm behaviour. RESULTS: In any 12-month period, about 8% of all 12- to 17-year-olds (an estimated 137,000 12- to 17-year-olds) report engaging in self-harming behaviour without suicide intent. This prevalence increases with age to 11.6% in 16- to 17-year-olds. Eighteen percent (18.8%; 95% confidence interval [CI] = [14.5, 23.0]) of all 12- to 17-year-old young people with any mental health disorder measured by parent or carer report said that they had engaged in self-harm in the past 12 months. Among young people who were measured by self-report and met criteria for the Diagnostic and Statistical Manual of Mental Disorders' major depressive disorder almost half (46.6%; 95% CI = [40.0, 53.1]) also reported that they had engaged in self-harm in the past 12 months. Suicide risk among those who self-harm is significantly elevated relative to the general population. CONCLUSION: The demonstrated higher risks in these young people for continued harm or possible death support the need for ongoing initiatives to reduce self-harm through mental health promotion, improved mental health literacy and continuing mental health reform to ensure services are accessible to, and meet the needs of families and young persons.

Service use by Australian children for emotional and behavioural problems: Findings from the second Australian Child and Adolescent Survey of Mental Health and Wellbeing.

OBJECTIVE: To identify the proportion of children and adolescents in Australia and the proportion of those with mental disorders who used services for emotional and behavioural problems, the type of services used and what characteristics were associated with service use. METHOD: During 2013-2014, a national face-to-face household survey of mental health and wellbeing (Young Minds Matter) was conducted, involving 6310 parents and carers of 4- to 17-year-olds (55% of eligible households) and self-report surveys from 2967 11- to 17-year-olds in these households (89% of eligible youth). The survey identified 12-month mental disorders based on the Diagnostic Interview Schedule for Children-Version IV and asked about service use for emotional or behavioural problems in the previous 12 months. RESULTS: Overall, 17.0% of all 4- to 17-year-olds used services for emotional or behavioural problems in the previous 12 months. Of those with mental disorders, 56.0% used services (48.9% of 4- to 11-year-olds; 65.1% of 12- to 17-year-olds). Service use was highest among 4- to 17-year-olds with major depressive disorder (79.6%) and lowest for those with attention-deficit/hyperactivity disorder (52.7%). Two-fifths (41.2%), 72.5% and 87.6% of those with mild, moderate and severe disorders used services. General practitioners, psychologists, paediatricians and counsellors/family therapists were the most commonly accessed health service providers. Two-fifths with mental disorders had attended school services. About 5% of adolescents reported use of online personal support or counselling for help with their problems. From multivariate models, service use was higher in sole carer families, but also among those living in the least socially and economically disadvantaged compared to the most disadvantaged areas. CONCLUSION: Rates of service use for mental disorders in Australia's children and adolescents appear to have increased substantially. Health services and schools are the major providers of services for emotional and behavioural problems, but telephone counselling and online services have become well-established parts of the service environment.

Suicidal behaviours: Prevalence estimates from the second Australian Child and Adolescent Survey of Mental Health and Wellbeing.

OBJECTIVE: To (1) estimate the lifetime and 12-month prevalence of suicidal behaviours in Australian young people aged 12-17 years, (2) describe their co-morbidity with mental illness and (3) describe the co-variation of these estimates with social and demographic variables. METHOD: A national random sample of children aged 4-17 years was recruited in 2013-2014. The response rate to the survey was 55% with 6310 parents and carers of eligible households participating. In addition, of the 2967 young people aged 11-17 years in these households, 89% (2653) of the 12- to 17-year-olds completed a self-report questionnaire that included questions about suicidal behaviour. RESULTS: In any 12-month period, about 2.4% or 41,400 young people would have made a suicide attempt. About 7.5% of 12- to 17-year-olds report having suicidal ideation, 5.2% making a plan and less than 1% (0.6%) receiving medical treatment for an attempt. The presence of a mental disorder shows the largest significant association with lifetime and 12-month suicidal behaviour, along with age, gender, sole parent family status and poor family functioning. Of young people with a major depressive disorder, 19.7% reported making a suicide attempt within the previous 12 months. There are also significant elevations in the proportions of young people reporting suicidal behaviour who have anxiety and conduct disorders. CONCLUSION: Mental disorders should be a leading intervention point for suicide prevention both in the primary health sector and in the mental health sector specifically. The associations examined here also suggest that efforts to assist sole parent and/or dysfunctional families would be worthy areas in which to target these efforts.

Methodology of Young Minds Matter: The second Australian Child and Adolescent Survey of Mental Health and Wellbeing.

OBJECTIVE: To describe the study design of Young Minds Matter: The second Australian Child and Adolescent Survey of Mental Health and Wellbeing. The aims of the study, sample design, development of survey content, field procedures and final questionnaires are detailed. METHOD: During 2013-2014, a national household survey of the mental health and wellbeing of young people was conducted involving a sample of 6310 families selected at random from across Australia. The survey included a face-to-face diagnostic interview with parents/carers of 4- to 17-year-olds and a self-report questionnaire completed by young people aged 11-17 years. RESULTS: The overall response rate to the survey was 55% with 6310 parents/carers of eligible households participating in the survey. In addition, 2967 or 89% of young people aged 11-17 years in these participating households completed a questionnaire. The survey sample was found to be broadly representative of the Australian population on major demographic characteristics when compared with data from the Census of Population and Housing. However, adjustments were made for an over-representation of younger children aged 4 to 7 years and also families with more than one eligible child in the household. CONCLUSION: Young Minds Matter provides updated national prevalence estimates of common child and adolescent mental disorders, describes patterns of service use and will help to guide future decisions in the development of policy and provision of mental health services for children and adolescents. Advancements in interviewing methodology, addition of a data linkage component and informed content development contributed to improved breadth and quality of the data collected.

Key findings from the second Australian Child and Adolescent Survey of Mental Health and Wellbeing.

OBJECTIVE: To estimate the prevalence of mental disorders in children and adolescents in Australia, and the severity and impact of those mental disorders. METHOD: Seven mental disorders were assessed using the parent- or carer-completed version of the Diagnostic Interview Schedule for Children Version IV, and major depressive disorder was also assessed using the youth self-report version of the Diagnostic Interview Schedule for Children Version IV. Severity and impact were assessed using an extended version of the Diagnostic Interview Schedule for Children Version IV impact on functioning questions, and days absent from school due to symptoms of mental disorders. Data were collected in a national face-to-face survey of 6310 parents or carers of children and adolescents aged 4-17 years, with 2969 young people aged 11-17 years also completing a self-report questionnaire. RESULTS: Twelve-month prevalence of mental disorders was 13.9%, with 2.1% of children and adolescents having severe disorders, 3.5% having moderate disorders and 8.3% having mild disorders. The most common class of disorders was attention-deficit/hyperactivity disorder followed by anxiety disorders. Mental disorders were more common in step-, blended- or one-parent families, in families living in rented accommodation and families where one or both carers were not in employment. Mental disorders were associated with a substantial number of days absent from school particularly in adolescents. CONCLUSION: Mental disorders are common in children and adolescents, often have significant impact and are associated with substantial absences from school. Child and adolescent mental disorders remain an important public health problem in Australia. Accurate information about prevalence and severity of child and adolescent mental disorders is an essential prerequisite for effective mental health policy and service planning.

Reliability and validity of a short version of the general functioning subscale of the McMaster Family Assessment Device.

The General Functioning 12-item subscale (GF12) of The McMaster Family Assessment Device (FAD) has been validated as a single index measure to assess family functioning. This study reports on the reliability and validity of using only the six positive items from the General Functioning subscale (GF6+). Existing data from two Western Australian studies, the Raine Study (RS) and the Western Australian Child Health Survey (WACHS), was used to analyze the psychometric properties of the GF6+ subscale. The results demonstrated that the GF6+ subscale had virtually equivalent psychometric properties and was able to identify almost all of the same families who had healthy or unhealthy levels of functioning as the full GF12 subscale. In consideration of the constraints faced by large-scale population-based surveys, the findings of this study support the use of a GF6+ subscale from the FAD, as a quick and effective tool to assess the overall functioning of families.

Smoking, mental illness and socioeconomic disadvantage: analysis of the Australian National Survey of Mental Health and Wellbeing.

BACKGROUND: High rates of smoking and lower rates of smoking cessation are known to be associated with common mental disorders such as anxiety and depression, and with individual and community measures of socioeconomic status. It is not known to what extent mental illness and socioeconomic status might be jointly associated with smoking behaviour. We set out to examine the relationship between mental illness, measures of socioeconomic disadvantage and both current smoking and smoking cessation rates. METHODS: We used data from the 2007 Australian National Survey of Mental Health and Wellbeing to examine the relationship between mental illness, socioeconomic status and both current smoking and smoking cessation. We used cross-classified tables and logistic regression to examine the relationship between psychosocial and sociodemographic predictors and current smoking. We also used proportional hazards regression to examine the relationship between the factors and smoking cessation. RESULTS: Both mental illness and socioeconomic status were independently associated with current smoking and with lower likelihood of smoking cessation, with gradients in smoking by mental health status being observed within levels of socioeconomic indicators and vice versa. Having a mental illness in the past 12 months was the most prevalent factor strongly associated with smoking, affecting 20.0% of the population, associated with increased current smoking (OR 2.43; 95% CI: 1.97-3.01) and reduced likelihood of smoking cessation (HR: 0.77; 95% CI: 0.65-0.91). CONCLUSIONS: The association between mental illness and smoking is not explained by the association between mental illness and socioeconomic status. There are strong socioeconomic and psychosocial gradients in both current smoking and smoking cessation. Incorporating knowledge of the other adverse factors in smokers' lives may increase the penetration of tobacco control interventions in population groups that have historically benefitted less from these activities.

The continuity and duration of depression and its relationship to non-suicidal self-harm and suicidal ideation and behavior in adolescents 12-17.

BACKGROUND: There is a significant overlap between non-suicidal self-harm and suicidal ideation and behavior in young people with both symptom continuity and symptom duration implicated in this association. METHODS: A population sample of Australian 12-17 year olds. Interviewers collected measures for DSM disorders, symptom duration and continuity, and background information from their parents, while young people self-reported symptoms of depression, non-suicidal self-harm and suicidal ideation and behaviors. This report focusses on the 265 young people who met the DSM criteria for Major Depressive Disorder based on their own self-reports. RESULTS: Relative to young people who had at least one period 2 months or longer without symptoms since first onset, young people who had the continuous presence of depressive symptoms since their first onset had significantly higher odds for life-time self-harm, 12-month self-harm, multiple self-harm, suicidal ideation and suicide attempt within the past 12 months. The duration of depressive symptoms and the continuity of these symptoms each independently contribute to elevating the risks of non-suicidal self-harming and suicidal ideation and behaviors. LIMITATIONS: Reliance on self-report from the young people and time constraints prohibiting administering diagnostic modules other than the Major Depressive Disorder and estimating self-reported co-morbidity. CONCLUSIONS: Among young people with a Major Depressive Disorder, self-reports about duration of depressive symptoms as well as the continuity of symptoms, each independently contributes to elevated risks of non-suicidal self-harming and suicidal ideation and behaviors. As well, un-remitting as opposed to episodic symptoms in this group of young people are common and are a powerful indicator of suffering associated with both self-harm and suicidal behavior.