Case identification of non-traumatic brain injury in youth using linked population data.

BACKGROUND: Population-level administrative data provides a cost-effective means of monitoring health outcomes and service needs of clinical populations. This study aimed to present a method for case identification of non-traumatic brain injury in population-level data and to examine the association with sociodemographic factors. METHODS: An estimated resident population of youth aged 0-24 years was constructed using population-level datasets within the New Zealand Integrated Data Infrastructure. A clinical consensus committee reviewed the International Classification of Diseases Ninth and Tenth Editions codes and Read codes for inclusion in a case definition. Cases were those with at least one non-traumatic brain injury code present in the five years up until 30 June 2018 in one of four databases in the Integrated Data Infrastructure. Rates of non-traumatic brain injury were examined, both including and excluding birth injury codes and across age, sex, ethnicity, and socioeconomic deprivation groups. RESULTS: Of the 1 579 089 youth aged 0-24 years on 30 June 2018, 8154 (0.52%) were identified as having one of the brain injury codes in the five-years to 30 June 2018. Rates of non-traumatic brain injury were higher in males, children aged 0-4 years, Maori and Pacific young people, and youth living with high levels of social deprivation. CONCLUSION: This study presents a comprehensive method for case identification of non-traumatic brain injury using national population-level administrative data.

Not heading in the right direction: Five hundred psychiatrists' views on resourcing, demand, and workforce across New Zealand mental health services.

OBJECTIVE: To explore the views of psychiatrists (including trainees) regarding the current state and future direction of specialist mental health and addictions services in Aotearoa New Zealand. METHODS: Psychiatrists and trainee psychiatrists (registrars) in Aotearoa New Zealand were surveyed in August 2021. Of 879 eligible doctors, 540 participated (83% qualified and 17% trainee psychiatrists), a response rate of over 60%. Data were analysed quantitatively and with content analysis. RESULTS: Psychiatrists thought specialist mental health and addictions services had been neglected during recent reforms, with 94% believing current resourcing was insufficient, and only 3% considering future planning was heading in the right direction. The demand and complexity of on-call work had markedly increased in the preceding 2 years. Ninety-eight percent reported that people needing specialist treatment were often (85%) or sometimes (13%) unable to access the right care due to resourcing constraints. The pressures were similar across sub-specialties. A key theme was the distress (sometimes termed 'moral injury') experienced by psychiatrists unable to provide adequate care due to resource limitations, 'knowing what would be a good thing to do and being unable to do it . . . is soul destroying'. Recommendations were made for addressing workforce, service design and wider issues. CONCLUSION: Most psychiatrists in Aotearoa New Zealand believe the mental health system is not currently fit for purpose and that it is not heading in the right direction. Remedies include urgently addressing identified staffing challenges and boosting designated funding to adequately care for the 5% of New Zealanders with severe mental health and addiction needs.

Proximity of alcohol outlets and presentation to hospital by young people after self-harm: A retrospective geospatial study using the integrated data infrastructure.

OBJECTIVES: There is a well-established association between alcohol use, misuse, intoxication and self-harm, the latter of which is associated with suicide. This study aimed to better understand the association between proximity to alcohol outlets and the likelihood of young people presenting to hospital following self-harm. METHODS: This was a nationwide retrospective geospatial study using data from the New Zealand Integrated Data Infrastructure using population-level data for 10-29-year-olds for the 2018 and 2017 calendar years. Presentations to hospital following self-harm were identified using the national minimum data set. Proximity to alcohol outlets was defined in road network distance (in kilometres) and ascertained using Integrated Data Infrastructure geospatial data. Alternative measures of proximity were employed in sensitivity analyses. Complete-case two-level random intercept logistic regression models were used to estimate the relationship between alcohol outlet proximity and hospital presentation for self-harm. Adjusted models included sex, age, ethnicity, area-level deprivation, urbanicity and distance to nearest medical facility. Analyses were also stratified by urbanicity. RESULTS: Of the 1,285,368 individuals (mean [standard deviation] age 20.0 [5.9] years), 7944 (0.6%) were admitted to hospital for self-harm. Overall, the odds of presenting to hospital for self-harm significantly decreased as the distance from the nearest alcohol outlet increased, including in adjusted models (adjusted odds ratio 0.980; 95% confidence interval = [0.969-0.992]); the association was robust to changes in the measure of alcohol proximity. The effect direction was consistent across all categorisations of urbanicity, but only statistically significant in large urban areas and rural areas. CONCLUSIONS: The findings of this study show a clear association between young people's access to alcohol outlets and presentation to hospital for self-harm and may provide a mandate for government policies and universal interventions to reduce young people's access to alcohol outlets. Further research regarding causative mechanisms is needed.

Identifying neurodevelopmental disabilities from nationalised preschool health check.

OBJECTIVE: Models of psychometric screening to identify individuals with neurodevelopmental disabilities (NDDs) have had limited success. In Aotearoa/New Zealand, routine developmental surveillance of preschool children is undertaken using the Before School Check (B4SC), which includes psychometric and physical health screening instruments. This study aimed to determine whether combining multiple screening measures could improve the prediction of NDDs. METHODS: Linked administrative health data were used to identify NDDs, including attention deficit hyperactivity disorder, autism spectrum disorder and intellectual disability, within a multi-year national cohort of children who undertook the B4SC. Cox proportional hazards models, with different combinations of potential predictors, were used to predict onset of a NDD. Harrell's c-statistic for composite models were compared with a model representing recommended cutoff psychometric scores for referral in New Zealand. RESULTS: Data were examined for 287,754 children, and NDDs were identified in 10,953 (3.8%). The best-performing composite model combining the Strengths and Difficulties Questionnaire, the Parental Evaluation of Developmental Status, vision screening and biological sex had 'excellent' predictive power (C-statistic: 0.83) compared with existing referral pathways which had 'poor' predictive power (C-statistic: 0.68). In addition, the composite model was able to improve the sensitivity of NDD diagnosis detection by 13% without any reduction in specificity. CONCLUSIONS: Combination of B4SC screening measures using composite modelling could lead to significantly improved identification of preschool children with NDDs when compared with surveillance that rely on individual psychometric test results alone. This may optimise access to academic, personal and family support for children with NDDs.

Editorial: Control alt delete - technology and children's mental health.

With international contributions from Denmark, Peru, Italy, Turkey, Estonia, Russia, Canada, the USA, Australia and the UK, this special issue offers insights and evidence about the technology's ability to act as a force of good and a source of harm for young people's mental health. As we better understand the complex and bidirectional relationship between technology and mental health, we need to move beyond dichotomous narratives about it being good or bad; it is both, depending on how it is used. Collective responsibility across technology companies, researchers, public services and community organisations, parents and the young people themselves can make a difference in the way technology is used to protect and improve mental health.

Young people don't tend to ask for help more than once: Child and adolescent psychiatrists' views on ailing mental health services for young New Zealanders.

OBJECTIVES: To explore the views of New Zealand doctors working in child and adolescent psychiatry regarding the state of public mental health services. METHODS: All practicing child and adolescent psychiatrists/advanced trainees were electronically surveyed in August 2021. Quantitative and qualitative analysis of feedback was undertaken. RESULTS: Almost 100 specialists responded, an 80% response rate. High levels of dissatisfaction with current services and future service plans were identified. Content analysis identified an overarching theme that child and adolescent services were under great pressure, with subthemes of increased demand, a stretched workforce and social issues driving complex presentations. Recommendations were made for addressing workforce, service design and wider issues. CONCLUSIONS: Multiple measures are needed to improve currently ailing child mental health services, including urgently expanding the number of psychiatrists and other clinical staff.

Order out of chaos? Autism spectrum disorder coordinators' impact on service delivery in New Zealand.

OBJECTIVE: To evaluate the impact of autism spectrum disorder (ASD) coordinators (ASDCs) on key aspects of the experience of obtaining an ASD diagnosis and post-diagnostic supports in New Zealand. METHOD: Members of New Zealand ASD parent support groups were surveyed. RESULTS: Of 516 parents, 41.3% had seen an ASDC. The majority were satisfied. Parents who saw ASDCs pre-diagnosis were more likely to be satisfied with the diagnostic process (p = .04) and saw fewer professionals before receiving a diagnosis (p = .04). Parents who had seen ASDCs post-diagnosis were more likely to be satisfied with post-diagnostic supports (p < .001) and their coordination (p < .001). CONCLUSIONS: ASDCs are well regarded by parents and improve key aspects of the process of obtaining an ASD diagnosis and post-diagnostic supports. Given the particularly low rates of parent satisfaction with post-diagnostic supports (23%) and their coordination (19%), ASDCs may be of most value when employed post-diagnosis to assist parents in navigating key supports and co-developing comprehensive individualised care plans.

Youth version, Case-finding and Help Assessment Tool (YouthCHAT): An electronic, psychosocial screener for young people with long-term physical conditions.

AIM: This study investigated the acceptability, clinical utility and preliminary effectiveness of Youth version, Case-finding and Help Assessment Tool (YouthCHAT), a novel electronic, tablet-based screener designed to identify issues similar to Home, Education/Employment, Activity, Drugs, Sexuality, Suicide/Depression, Safety assessment. METHODS: YouthCHAT was administered to a group of 30 young people aged 13-17 years with different long-term physical conditions attending outpatient clinics between September and December 2017. Outcome measures were: (i) acceptability and feasibility of YouthCHAT as assessed via feedback from young people and clinicians and the time taken to complete YouthCHAT screening; and (ii) detection rates for each domain of YouthCHAT measured by mental health or life-style issues 'present' or 'absent', and where relevant, validated symptom scores. RESULTS: YouthCHAT was quick to administer and positively received by both young people and clinicians. Rates of anxiety (37%) and depression (13%) detected using YouthCHAT were similar to those in previous studies of young people with long-term physical conditions. Rates of other problems were similar to a previously screened high school sample. CONCLUSIONS: YouthCHAT is a viable and acceptable psychosocial screener with the potential to improve the holistic care of young people with long-term physical conditions attending outpatient clinics. TRIAL REGISTRATION: This study has been registered with the Australian New Zealand Clinical Trials Network Registry ACTRN12616001243404p.

Young people's experiences of brief inpatient treatment for anorexia nervosa.

AIM: To understand the experiences of young people with anorexia admitted to hospital for brief stays and to inform the design of contemporary inpatient treatment to better suit their needs in the context of a significant shift in practice from longer hospital admissions to shorter stays. METHODS: A qualitative study was undertaken with young people within a few months of discharge from a specialist inpatient eating disorder service, Auckland, New Zealand. Audiotaped, semi-structured interviews were conducted with participants within a few months of their discharge from hospital and transcribed for coding. RESULTS: Nine young people, all female, of mixed ethnicity (seven New Zealand European and two Asian) and aged between 15 and 17 years participated in the study. Five main themes were identified from the data, namely: (i) benefits of admission; (ii) sources of stress; (iii) control and power; (iv) having a voice and being heard; and (v) comparison of oneself with others. CONCLUSIONS: Although many of the benefits and challenges associated with brief treatment were similar to those during longer inpatient care, the impact of certain issues was more strongly experienced by participants and highlighted the need for greater attention to be paid to making young people feel better supported and included during predominantly medically focused admissions.

Correction: Comparison of YouthCHAT, an Electronic Composite Psychosocial Screener, With a Clinician Interview Assessment for Young People: Randomized Trial.

[This corrects the article DOI: 10.2196/13911.].

Case identification of mental health and related problems in children and young people using the New Zealand Integrated Data Infrastructure.

BACKGROUND: In a novel endeavour we aimed to develop a clinically relevant case identification method for use in research about the mental health of children and young people in New Zealand using the Integrated Data Infrastructure (IDI). The IDI is a linked individual-level database containing New Zealand government and survey microdata. METHODS: We drew on diagnostic and pharmaceutical information contained within five secondary care service use and medication dispensing datasets to identify probable cases of mental health and related problems. A systematic classification and refinement of codes, including restrictions by age, was undertaken to assign cases into 13 different mental health problem categories. This process was carried out by a panel of eight specialists covering a diverse range of mental health disciplines (a clinical psychologist, four child and adolescent psychiatrists and three academic researchers in child and adolescent mental health). The case identification method was applied to the New Zealand youth estimated resident population for the 2014/15 fiscal year. RESULTS: Over 82,000 unique individuals aged 0-24 with at least one specified mental health or related problem were identified using the case identification method for the 2014/15 fiscal year. The most prevalent mental health problem subgroups were emotional problems (31,266 individuals), substance problems (16,314), and disruptive behaviours (13,758). Overall, the pharmaceutical collection was the largest source of case identification data (59,862). CONCLUSION: This study demonstrates the value of utilising IDI data for mental health research. Although the method is yet to be fully validated, it moves beyond incidence rates based on single data sources, and provides directions for future use, including further linkage of data to the IDI.

Same proof, different pudding: comparative views of New Zealand child psychiatrists, child psychologists and child psychotherapists regarding a proposed national child and adolescent research network.

OBJECTIVES: This study was undertaken to evaluate the views of New Zealand clinicians regarding a proposed national child and adolescent mental health research network. METHODS: Child psychiatrists, child psychologists and child psychotherapists were invited to participate in an electronic survey describing their previous experience of research, current interest in research, barriers to undertaking research and interest in a national research network. RESULTS: Responses were received from child psychiatrists (N = 33), child psychologists (N = 58) and child psychotherapists (N = 8), many of whom were clinicians and few of whom were researchers. Although most clinicians were interested in participating in future research, areas of interest differed between clinical groups. Clinician barriers to research included lack of time, lack of confidence and lack of research skills. Researcher barriers included lack of funding, time and administrative support. All groups were supportive of the development of a national research network. CONCLUSIONS: Despite some different areas of interest, there appears to be sufficient combined support from New Zealand child psychiatrists, child psychologists and child psychotherapists to pursue the establishment of a national child and adolescent mental health research network.

Comparison of YouthCHAT, an Electronic Composite Psychosocial Screener, With a Clinician Interview Assessment for Young People: Randomized Controlled Trial.

BACKGROUND: Psychosocial problems such as depression, anxiety, and substance abuse are common and burdensome in young people. In New Zealand, screening for such problems is undertaken routinely only with year 9 students in low-decile schools and opportunistically in pediatric settings using a nonvalidated and time-consuming clinician-administered Home, Education, Eating, Activities, Drugs and Alcohol, Sexuality, Suicide and Depression, Safety (HEEADSSS) interview. The Youth version, Case-finding and Help Assessment Tool (YouthCHAT) is a relatively new, locally developed, electronic tablet-based composite screener for identifying similar psychosocial issues to HEEADSSS. OBJECTIVE: This study aimed to compare the performance and acceptability of YouthCHAT with face-to-face HEEADSSS assessment among 13-year-old high school students. METHODS: A counterbalanced randomized trial of YouthCHAT screening either before or after face-to-face HEEADSSS assessment was undertaken with 129 13-year-old New Zealand high school students of predominantly Maori and Pacific Island ethnicity. Main outcome measures were comparability of YouthCHAT and HEEADSSS completion times, detection rates, and acceptability to students and school nurses. RESULTS: YouthCHAT screening was more than twice as fast as HEEADSSS assessment (mean 8.57 min vs mean 17.22 min; mean difference 8 min 25 seconds [range 6 min 20 seconds to 11 min 10 seconds]; P<.01) and detected more issues overall on comparable domains. For substance misuse and problems at home, both instruments were roughly comparable. YouthCHAT detected significantly more problems with eating or body image perception (70/110, 63.6% vs 25/110, 22.7%; P<.01), sexual health (24/110, 21.8% vs 10/110, 9.1%; P=.01), safety (65/110, 59.1% vs 17/110, 15.5%; P<.01), and physical inactivity (43/110, 39.1% vs 21/110, 19.1%; P<.01). HEEADSSS had a greater rate of detection for a broader set of mental health issues (30/110, 27%) than YouthCHAT (11/110, 10%; P=.001), which only assessed clinically relevant anxiety and depression. Assessment order made no significant difference to the duration of assessment or to the rates of YouthCHAT-detected positive screens for anxiety and depression. There were no significant differences in student acceptability survey results between the two assessments. Nurses identified that students found YouthCHAT easy to answer and that it helped students answer face-to-face questions, especially those of a sensitive nature. Difficulties encountered with YouthCHAT included occasional Wi-Fi connectivity and student literacy issues. CONCLUSIONS: This study provides preliminary evidence regarding the shorter administration time, detection rates, and acceptability of YouthCHAT as a school-based psychosocial screener for young people. Although further research is needed to confirm its effectiveness in other age and ethnic groups, YouthCHAT shows promise for aiding earlier identification and treatment of common psychosocial problems in young people, including possible use as part of an annual, school-based, holistic health check. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Network Registry (ACTRN) ACTRN12616001243404p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371422.

E-Health interventions for anxiety and depression in children and adolescents with long-term physical conditions.

BACKGROUND: Long-term physical conditions affect 10% to 12% of children and adolescents worldwide; these individuals are at greater risk of developing psychological problems, particularly anxiety and depression. Access to face-to-face treatment for such problems is often limited, and available interventions usually have not been tested with this population. As technology improves, e-health interventions (delivered via digital means, such as computers and smart phones and ranging from simple text-based programmes through to multimedia and interactive programmes, serious games, virtual reality and biofeedback programmes) offer a potential solution to address the psychological needs of this group of young people. OBJECTIVES: To assess the effectiveness of e-health interventions in comparison with attention placebos, psychological placebos, treatment as usual, waiting-list controls, or non-psychological treatments for treating anxiety and depression in children and adolescents with long-term physical conditions. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Group's Controlled Trials Register (CCMDTR to May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 8, 2017), Web of Science (1900 - 18 August 2016, updated 31 August 2017) and Ovid MEDLINE, Embase, PsycINFO (cross-search 2016 to 18 Aug 2017). We hand-searched relevant conference proceedings, reference lists of included articles, and the grey literature to May 2016. We also searched international trial registries to identify unpublished or ongoing trials. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster-randomised trials, and cross-over trials of e-health interventions for treating any type of long-term physical condition in children and adolescents (aged 0 to 18 years), and that measured changes in symptoms or diagnoses of anxiety, depression, or subthreshold depression. We defined long-term physical conditions as those that were more than three-months' duration. We assessed symptoms of anxiety and depression using patient- or clinician-administered validated rating scales based on DSM III, IV or 5 (American Psychological Association 2013), or ICD 9 or 10 criteria (World Health Organization 1992). Formal depressive and anxiety disorders were diagnosed using structured clinical interviews. Attention placebo, treatment as usual, waiting list, psychological placebo, and other non-psychological therapies were eligible comparators. DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed titles, abstracts, and full-text articles; discrepancies were resolved through discussion or addressed by a third author. When available, we used odds ratio (OR) to compare dichotomous data and standardised mean differences (SMD) to analyse continuous data, both with 95% confidence intervals (CI). We undertook meta-analysis when treatments, participants, and the underlying clinical question were adequately similar. Otherwise, we undertook a narrative analysis. MAIN RESULTS: We included five trials of three interventions (Breathe Easier Online, Web-MAP, and multimodal cognitive behavioural therapy (CBT)), which included 463 participants aged 10 to 18 years. Each trial contributed to at least one meta-analysis. Trials involved children and adolescents with long-term physical conditions, such as chronic headache (migraine, tension headache, and others), chronic pain conditions (abdominal, musculoskeletal, and others), chronic respiratory illness (asthma, cystic fibrosis, and others), and symptoms of anxiety or depression. Participants were recruited from community settings and hospital clinics in high income countries.For the primary outcome of change in depression symptoms versus any control, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.06, 95% CI -0.35 to 0.23; five RCTs, 441 participants). For the primary outcome of change in anxiety symptoms versus any comparator, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.07, 95% CI -0.29 to 0.14; two RCTs, 324 participants). For the primary outcome of treatment acceptability, there was very low-quality evidence that e-health interventions were less acceptable than any comparator (SMD 0.46, 95% CI 0.23 to 0.69; two RCTs, 304 participants).For the secondary outcome of quality of life, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.83, 95% CI -1.53 to -0.12; one RCT, 34 participants). For the secondary outcome of functioning, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.08, 95% CI -0.33 to 0.18; three RCTs, 368 participants). For the secondary outcome of status of long-term physical condition, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD 0.06, 95% CI -0.12 to 0.24; five RCTs, 463 participants).The risk of selection bias was considered low in most trials. However, the risk of bias due to inadequate blinding of participants or outcome assessors was considered unclear or high in all trials. Only one study had a published protocol; two trials had incomplete outcome data. All trials were conducted by the intervention developers, introducing another possible bias. No adverse effects were reported by any authors. AUTHORS' CONCLUSIONS: At present, the field of e-health interventions for the treatment of anxiety or depression in children and adolescents with long-term physical conditions is limited to five low quality trials. The very low-quality of the evidence means the effects of e-health interventions are uncertain at this time, especially in children aged under 10 years.Although it is too early to recommend e-health interventions for this clinical population, given their growing number, and the global improvement in access to technology, there appears to be room for the development and evaluation of acceptable and effective technologically-based treatments to suit children and adolescents with long-term physical conditions.

Psychological therapies for anxiety and depression in children and adolescents with long-term physical conditions.

BACKGROUND: Long-term physical conditions affect 10% to 12% of children and adolescents worldwide. These individuals are at greater risk of developing psychological problems, particularly anxiety and depression, sometimes directly related to their illness or medical care (e.g. health-related anxiety). There is limited evidence regarding the effectiveness of psychological therapies for treating anxiety and depression in this population. Therapies designed for children and adolescents without medical issues may or may not be appropriate for use with those who have long-term physical conditions. OBJECTIVES: This review was undertaken to assess the effectiveness and acceptability of psychological therapies in comparison with controls (treatment-as-usual, waiting list, attention placebo, psychological placebo, or non-psychological treatment) for treating anxiety and depression in children and adolescents with long-term physical conditions. SEARCH METHODS: We searched Ovid MEDLINE (1950- ), Embase (1974- ), PsycINFO (1967- ) and the Cochrane Central Register of Controlled Trials (CENTRAL) to 27 September 2018. An earlier search of these databases was conducted via the Cochrane Common Mental Disorders Controlled Trial Register (CCMD-CTR) (all years to May 2016). In addition we searched the Web of Science (Core Collection) (12 October 2018) and conducted a cited reference search for reports of all included trials. We handsearched relevant conference proceedings, reference lists of included articles, and grey literature. SELECTION CRITERIA: Randomised controlled trials (RCTs), cluster-randomised trials and cross-over trials of psychological therapies for treating anxiety or depression in children with long-term physical conditions were included. DATA COLLECTION AND ANALYSIS: Abstracts and complete articles were independently reviewed by two authors. Discrepancies were addressed by a third author. Odds ratio (OR) was used for comparing dichotomous data and standardised mean differences (SMD) for comparing continuous data. Meta-analysis was undertaken when treatments, participants, and the underlying clinical question were similar. Otherwise, narrative analysis of data was undertaken. MAIN RESULTS: Twenty-eight RCTs and one cross-over trial with 1349 participants were included in the review. Most participants were recruited from community settings and hospital clinics in high-income countries. For the primary outcome of treatment efficacy, short-term depression (versus any control), there was low-quality evidence from 16 trials involving 1121 participants suggesting that psychological therapies may be more effective than control therapies (SMD -0.31, 95% CI -0.59 to -0.03; I2 = 79%). For the primary outcome of treatment efficacy, short-term anxiety (versus any control), there was inadequate evidence of moderate-quality from 13 studies involving 578 participants to determine whether psychological therapies were more effective than control conditions (SMD -0.26, CI -0.59 to 0.07, I2 = 72%). Planned sensitivity analyses could not be undertaken for risk of bias due to the small number of trials that rated high for each domain. Additional sensitivity analysis demonstrated that psychological interventions specifically designed to reduce anxiety or depression were more effective than psychological therapies designed to improve other symptoms or general coping. There was some suggestion from subgroup analyses that they type of intervention (Chi² = 14.75, df = 5 (P = 0.01), I² = 66.1%), the severity of depression (Chi² = 23.29, df = 4 (P = 0.0001), I² = 82.8%) and the type of long-term physical condition (Chi² = 10.55, df = 4 (P = 0.03), I² = 62.1%) may have an impact on the overall treatment effect.There was qualitative (reported), but not quantitative evidence confirming the acceptability of selected psychological therapies for anxiety and depression. There was low-quality evidence that psychological therapies were more effective than control conditions in improving quality of life (SMD 1.13, CI 0.44 to 1.82, I2 = 89%) and symptoms of long-term physical conditions (SMD -0.34, CI -0.6 to -0.06, I2 = 70%), but only in the short term. There was inadequate low-quality evidence to determine whether psychological therapies were more effective than control conditions at improving functioning in either the short term or long term. No trials of therapies for addressing health-related anxiety were identified and only two trials reported adverse effects; these were unrelated to psychological therapies. Overall, the evidence was of low to moderate quality, results were heterogeneous, and only one trial had an available protocol. AUTHORS' CONCLUSIONS: A limited number of trials of variable quality have been undertaken to assess whether psychological therapies are effective for treating anxiety and depression in children and adolescents with long-term physical conditions. According to the available evidence, therapies specifically designed to treat anxiety or depression (especially those based on principles of cognitive behaviour therapy (CBT)) may be more likely to work in children and adolescents who have mild to moderate levels of symptoms of these disorders, at least in the short term. There is a dearth of therapies specifically designed to treat health-related anxiety in this age group.

Systematic Review of Biofeedback Interventions for Addressing Anxiety and Depression in Children and Adolescents with Long-Term Physical Conditions.

Children and adolescents with long-term physical conditions are at increased risk of psychological problems, particularly anxiety and depression, and they have limited access to evidence-based treatment for these issues. Biofeedback interventions may be useful for treating symptoms of both psychological and physical conditions. A systematic review of studies of biofeedback interventions that addressed anxiety or depression in this population was undertaken via MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Central Register of Controlled Trials databases. Primary outcomes included changes in anxiety and depression symptoms and 'caseness'. Secondary outcomes included changes in symptoms of the associated physical condition and acceptability of the biofeedback intervention. Of 1876 identified citations, 9 studies (4 RCTs, 5 non-RCTs; of which all measured changes in anxiety and 3 of which measured changes in depression) were included in the final analysis and involved participants aged 8-25 years with a range of long-term physical conditions. Due to the heterogeneity of study design and reporting, risk of bias was judged as unclear for all studies and meta-analysis of findings was not undertaken. Within the identified sample, multiple modalities of biofeedback including heart rate variability (HRV), biofeedback assisted relaxation therapy and electroencephalography were found to be effective in reducing symptoms of anxiety. HRV was also found to be effective in reducing symptoms of depression in two studies. A range of modalities was effective in improving symptoms of long-term physical conditions. Two studies that assessed acceptability provided generally positive feedback. There is currently limited evidence to support the use of biofeedback interventions for addressing anxiety and depression in children and adolescents with long-term physical conditions. Although promising, further research using more stringent methodology and reporting is required before biofeedback interventions can be recommended for clinical use instead or in addition to existing evidence-based modalities of treatment.

Patient-Targeted Googling by New Zealand Mental Health Professionals: A New Field of Ethical Consideration in the Internet Age.

BACKGROUND: Patient-targeted Googling (PTG) describes the searching on the Internet by healthcare professionals for information about patients with or without their knowledge. INTRODUCTION: Little research has been conducted into PTG internationally. PTG can have particular ethical implications within the field of mental health. This study was undertaken to identify the extent of PTG by New Zealand mental healthcare professionals and needs for further guidance regarding this issue. MATERIALS AND METHODS: All (1,850) psychiatrists, clinical psychologists, and psychotherapists working in New Zealand were electronically surveyed about their experience of PTG and knowledge about the associated practice of therapist-targeted Googling (TTG) using a questionnaire that had previously been developed with a German sample. Due to ethics and advertising restrictions, only one indirect approach was made to potential participants. RESULTS: Eighty-eight clinicians (5%) responded to the survey invitation. More than half (53.4%, N = 47) of respondents reportedly being engaged in PTG, but only a minority (10.3%, N = 9) had ever received any education about the subject. Reasons for undertaking PTG included facilitating the therapeutic process, information being in the public domain, and mitigating risks. Reasons against undertaking PTG included impairment of therapeutic relationship, unethical invasion of privacy, and concerns regarding the accuracy and clinical relevance of online information. Two-thirds of participants reported being the subject of TTG. DISCUSSION: New Zealand psychiatrists, clinical psychologists, and psychotherapists are engaging in PTG with limited education and professional guidance. Further discussion and research are required, and so, PTG is undertaken in a manner that is safe and useful for patients and health practitioners.

Family Systems Training for Medical Students.

OBJECTIVES: To evaluate whether a workshop on family systems delivered to medical students could improve participants' understanding of families from a systemic point of view and help them recognise and address systemic issues that may be affecting their patients. METHOD: Fifth year (senior) medical students ( n = 36) from the University of Auckland participated in a 90-min workshop about family systems. Pre- and post-workshop, self-reported measures of knowledge and confidence were completed and qualitative feedback was also obtained from participants. RESULTS: The workshop was well received and its interactive and role-play based nature were particularly appreciated. Participants reported gains in all explored areas of knowledge and understanding, suggesting that the workshop met its desired aims. CONCLUSIONS: This workshop is an educationally effective and expedient way to equip medical students with some knowledge and understanding about family systems. It may benefit their future work with individual patients and families.

Spectrum of care: Current management of childhood autism spectrum disorder (ASD) in New Zealand.

OBJECTIVES: The purpose of this research was to compare the current status of assessment and intervention for New Zealand children and adolescents who have autism spectrum disorder (ASD) with recommendations outlined in the 2008 New Zealand ASD Guideline. METHODS: ASD coordinators and New Zealand District Health Board (DHB) staff working with children and adolescents who have ASD were electronically surveyed. RESULTS: Responses were received from 32 staff in 17 (85%) surveyed DHBs. Positive findings included the presence of ASD coordinators in 85% of DHBs, clear pathways for management in 73.1% of DHBs and good communications between paediatric, psychiatric and educational teams in some DHBs regions. Areas for improvement included wait times to assessment, access to longer-term support and intervention for families, and training for staff in ASD and cultural issues. CONCLUSIONS: Since the launch of the NZ ASD Guidelines, significant progress has been made. However, further work is needed to ensure services for children and adolescents with ASD are accessible, well-coordinated and focussed on both assessment and intervention.

The management of young people who self-harm by New Zealand Infant, Child and Adolescent Mental Health Services: cutting-edge or cutting corners?

OBJECTIVES: Self-harm is common in New Zealand (NZ) young people and can have short-term and long-term consequences, including suicide. This study was undertaken to examine the extent to which evidence-based approaches for addressing self-harm are offered by Infant, Child and Adolescent Mental Health Services (ICAMHS). METHODS: A national survey of ICAMHS practitioners working with young people who self-harm was undertaken between May and July 2016. RESULTS: Responses from 23 out of 30 ICAMHS confirmed self-harm was a familiar presentation and most commonly associated with diagnoses of depression, anxiety and borderline personality disorder. Cognitive behavioural therapy (47.1%, n = 8), dialectical behaviour therapy (47.1%, n = 8) and acceptance and commitment therapy (5.9%, n = 1) were the treatments of choice, but variably delivered. There were significant training gaps for all types of therapy. CONCLUSIONS: Although it is reassuring that many ICAMHS are using evidence-based approaches to address self-harm in young people, there is concerning variability in the way these therapies are delivered. Improvement in training in key modalities, further research into therapist performance and continuous evaluation of workforce development are needed to maximise the effectiveness of proven interventions and provide NZ young people with the state-of-the-art service they deserve.