Changes in alcohol-related emergency department presentations-a comparison of three waves in 2013, 2017 and 2022.

AIMS: Emergency departments (EDs) around the world are increasingly overcrowded, which is associated with significant patient harm. Alcohol use is a known contributor to ED overcrowding. This study aimed to assess trends in the characteristics of alcohol-related ED presentations over time. METHODS: A cross-sectional observational study of Christchurch ED attendances during 3-week waves of data collection in November-December 2013, 2017 and 2022 was conducted. Potential participants were those patients attending the Christchurch Hospital ED who had ingested alcohol in the 4 hours prior to arrival, and/or the presentation was thought to be related to alcohol. Those who consented to take part were interviewed to examine amount and source of alcohol. RESULTS: There has been a change in the age profile towards a greater proportion of older patients attending the ED with alcohol-related issues. In 2022, a greater proportion of alcohol was purchased from on-licence venues compared to previous years, although off-licence alcohol purchase and consumption in private locations remained the most common. CONCLUSION: Alcohol use and harm places a significant, yet preventable, burden on EDs and the wider healthcare system. Implementation of evidence-based alcohol policies is urgently needed to reduce the impact of alcohol in the ED and improve the health of communities.

Hippocampal phase precession is preserved under ketamine, but the range of precession across a theta cycle is reduced.

BACKGROUND: Hippocampal phase precession, which depends on the precise spike timing of place cells relative to local theta oscillations, has been proposed to underlie sequential memory. N-methyl-D-asparate (NMDA) receptor antagonists such as ketamine disrupt memory and also reproduce several schizophrenia-like symptoms, including spatial memory impairments and disorganized cognition. It is possible that these impairments result from disruptions to phase precession. AIMS/METHODS: We used an ABA design to test whether an acute, subanesthetic dose (7.5 mg/kg) of ketamine disrupted phase precession in CA1 of male rats as they navigated around a rectangular track for a food reward. RESULTS/OUTCOMES: Ketamine did not affect the ability of CA1 place cells to precess despite changes to place cell firing rates, local field potential properties and locomotor speed. However, ketamine reduced the range of phase precession that occurred across a theta cycle. CONCLUSION: Phase precession is largely robust to acute NMDA receptor antagonism by ketamine, but the reduced range of precession could have important implications for learning and memory.

The New Zealand drug harms ranking study: A multi-criteria decision analysis.

AIMS: The harms arising from psychoactive drug use are complex, and harm reduction strategies should be informed by a detailed understanding of the extent and nature of that harm. Drug harm is also context specific, and so any comprehensive assessment of drug harm should be relevant to the characteristics of the population in question. This study aimed to evaluate and rank drug harms within Aotearoa New Zealand using a multi-criteria decision analysis (MCDA) framework, and to separately consider harm within the total population, and among youth. METHODS: Two facilitated workshops involved the separate ranking of harm for the total population, and then for youth aged 12-17, by two expert panels. In the total population workshop, 23 drugs were scored against 17 harm criteria, and those criteria were then evaluated using a swing weighting process. Scoring and weighting were subsequently updated during the youth-specific workshop. All results were recorded and analysed using specialised MCDA software. RESULTS: When considering overall harm, the MCDA modelling results indicated that alcohol, methamphetamine and synthetic cannabinoids were the most harmful to both the overall population and the youth, followed by tobacco in the total population. Alcohol remained the most harmful drug for the total population when separately considering harm to those who use it, and harm to others. CONCLUSIONS: The results provide detailed and context-specific insight into the harm associated with psychoactive drugs use within Aotearoa New Zealand. The findings also demonstrate the value of separately considering harm for different countries, and for different population subgroups.

Eating disorders, disordered eating, and body image research in New Zealand: a scoping review.

BACKGROUND: The prevention and treatment of eating disorders relies on an extensive body of research that includes various foci and methodologies. This scoping review identified relevant studies of eating disorders, body image, and disordered eating with New Zealand samples; charted the methodologies, sample characteristics, and findings reported; and identified several gaps that should be addressed by further research. METHODS: Using scoping review methodology, two databases were searched for studies examining eating disorders, disordered eating, or body image with New Zealand samples. Snowball methods were further used to identify additional relevant articles that did not appear in initial searches. Two independent reviewers screened the titles and abstracts of 473 records. Full text assessment of the remaining 251 records resulted in 148 peer-reviewed articles being identified as eligible for the final review. A search of institutional databases yielded 106 Masters and Doctoral theses for assessment, with a total of 47 theses being identified as eligible for the final review. The included studies were classified by methodology, and the extracted information included the study foci, data collected, sample size, demographic information, and key findings. RESULTS: The eligible studies examined a variety of eating disorder categories including binge-eating disorder, bulimia nervosa, and anorexia nervosa, in addition to disordered eating behaviours and body image in nonclinical or community samples. Methodologies included treatment trials, secondary analysis of existing datasets, non-treatment experimental interventions, cross-sectional observation, case-control studies, qualitative and mixed-methods studies, and case studies or series. Across all of the studies, questionnaire and interview data were most commonly utilised. A wide range of sample sizes were evident, and studies often reported all-female or mostly-female participants, with minimal inclusion of males and gender minorities. There was also an underrepresentation of minority ethnicities in many studies, highlighting the need for future research to increase diversity within samples. CONCLUSION: This study provides a comprehensive and detailed overview of research into eating disorders and body image in New Zealand, while highlighting important considerations for both local and international research.

Recommendations to encourage participation of individuals from diverse backgrounds in psychiatric genetic studies.

We present innovative research practices in psychiatric genetic studies to ensure representation of individuals from diverse ancestry, sex assigned at birth, gender identity, age, body shape and size, and socioeconomic backgrounds. Due to histories of inappropriate and harmful practices against marginalized groups in both psychiatry and genetics, people of certain identities may be hesitant to participate in research studies. Yet their participation is essential to ensure diverse representation, as it is incorrect to assume that the same genetic and environmental factors influence the risk for various psychiatric disorders across all demographic groups. We present approaches developed as part of the Eating Disorders Genetics Initiative (EDGI), a study that required tailored approaches to recruit diverse populations across many countries. Considerations include research priorities and design, recruitment and study branding, transparency, and community investment and ownership. Ensuring representation in participants is costly and funders need to provide adequate support to achieve diversity in recruitment in prime awards, not just as supplemental afterthoughts. The need for diverse samples in genetic studies is critical to minimize the risk of perpetuating health disparities in psychiatry and other health research. Although the EDGI strategies were designed specifically to attract and enroll individuals with eating disorders, our approach is broadly applicable across psychiatry and other fields.

Childhood maltreatment and the menopause transition in a cohort of midlife New Zealand women.

OBJECTIVE: Knowledge surrounding the link between childhood adversity and reproductive outcomes at midlife is limited. The present study examined the relationship between childhood maltreatment (childhood sexual abuse [CSA], childhood physical punishment [CPP]), and menopause status at age 40. METHODS: Data were gathered from female members of the Christchurch Health and Development Study, a longitudinal birth cohort of 1,265 individuals (630 females) born in Christchurch, New Zealand in 1977. Menopause status was defined by categorizing the female cohort at age 40 as either: 1) premenopausal, or 2) peri/ postmenopausal. Retrospective reports of CSA (<16 y) and CPP (<16 y) were obtained at ages 18 and 21 years. RESULTS: The analysis sample comprised n = 468 women with data recorded on both their menopause status at age 40 and history of maltreatment (<16 y), of whom 22% (n = 104) were classified as peri/postmenopausal. A statistically significant association was found between and severity of CSA and menopause status, but not between CPP and menopause status. The association with CSA was robust to control for both childhood confounding factors (<16 y) and intervening adult factors (18-40 y) associated with the menopause transition. In the fully adjusted model, women who had experienced severe CSA involving attempted/completed sexual penetration had twice the rate of entering peri/postmenopause compared with those who reported no CSA (39.0% vs 18.8%). CONCLUSIONS: Severity of CSA exposure was associated with earlier menopausal transition in this female cohort. These findings are consistent with the emerging literature on the long-term health and developmental impacts of CSA.

Acute alcohol use and suicide deaths: an analysis of New Zealand coronial data from 2007-2020.

AIMS: Acute alcohol use is a proximal risk factor for suicide. However, the proportion of suicide deaths involving acute alcohol use has not been quantified in New Zealand. We sought to quantify and characterise the association between acute alcohol use and suicide. METHODS: Data for all suicides (≥15 years) between July 2007 and December 2020 were drawn from the National Coronial Information System. Acute alcohol use was defined as blood alcohol concentration (BAC) >50mg/100mL. Logistic regression was used to compare characteristics between suicide deaths with and without acute alcohol use. RESULTS: Twenty-six point six percent of suicide deaths involved acute alcohol use. No difference in the association was found by sex (male AOR: 0.87 (95%CI: 0.74,1.02)). Ethnicity differences were identified (Maori AOR: 1.20 (95%CI: 1.01,1.42), Pacific AOR: 1.46 (95%CI: 1.10,2.00)). Those aged 15-54 years had similar risks of suicide involving acute alcohol use, with a lower association in older age groups. CONCLUSIONS: Acute alcohol use was identified in approximately one quarter of suicides, with stronger associations in those of Maori and Pasifika ethnicity, and those aged <55 years. Acute alcohol use is a significant but modifiable risk factor for suicide in New Zealand.

Measuring drug harm in New Zealand: a stocktake of current data sources.

AIMS: The availability of legal and illegal drugs is widespread across New Zealand. All drugs have the potential to cause harm to those who use them, and to others. Understanding the nature and extent of these harms depends upon the ongoing and systematic collection of relevant data, which is crucial in achieving the current national policy goal of minimising drug harm. Thus, we aim to describe how information on drug harm is currently collected and measured in New Zealand. METHODS: This article maps and evaluates harm data within New Zealand, explores data collection methods and timing, and identifies the substances and types of harm assessed to date. We review large and predominantly administrative datasets that provide a measure of harm, which are collected more than once and/or are updated periodically. RESULTS: We highlight a number of key gaps and limitations that exist within the current data landscape, and outline barriers to ensuring greater utilisation. We recommend more frequent data collection, including improved data on harms to others, and inclusion of a wider range of drugs. CONCLUSIONS: Implementation of these recommendations will improve the understanding of comprehensive drug harm in New Zealand, to guide effective local harm reduction policies and interventions.

The association between alcohol use disorder and suicidal ideation in a New Zealand birth cohort.

BACKGROUND: Alcohol use disorder is associated with increased suicide risk; however, both alcohol use disorder and suicide share risk factors which must be accounted for in order to understand this relationship. This study aimed to explore the longitudinal relationship between alcohol use disorder and suicidal ideation in adulthood, while accounting for both child background and adult covariate factors. METHOD: Data were collected from the Christchurch Health and Development Study, a birth cohort of 1265 children born in Christchurch (New Zealand) in mid-1977. Alcohol use disorder (operationalised as alcohol abuse and alcohol dependence) was quantified between age 18 and 40 in five data waves. The outcome measure suicidal ideation was reported over the same time periods. Childhood confounding variables were controlled for, as well as time-dynamic covariates collected in adulthood, including internalising disorders, distress due to relationship dissolutions and other substance use disorders. RESULTS: The association between alcohol abuse and suicidal ideation was not statistically significant before or after adjusting for childhood confounding and adulthood covariate factors, when compared to no alcohol disorder. However, the association between alcohol dependence and suicidal ideation was significant both before and after adjustment (unadjusted odds ratio = 2.89, 95% confidence interval = [2.09, 3.99]; adjusted odds ratio = 1.52, 95% confidence interval = [1.04, 2.23]), when compared to no alcohol disorder. Furthermore, alcohol dependence remained significant when compared to alcohol abuse (unadjusted odds ratio = 2.33, 95% confidence interval = [1.61, 3.37]; adjusted odds ratio = 1.54, 95% confidence interval = [1.00, 2.37]). CONCLUSION: This analysis found an association between alcohol dependence and suicidal ideation within a New Zealand birth cohort, which persists even after adjustment for childhood confounding and adulthood covariate factors. Given the high rates of suicide and heavy drinking within the New Zealand population, any comprehensive national or regional suicide prevention plan should seek to reduce risky alcohol consumption at an individual and population level, as this represents a modifiable risk factor for suicide.

The Eating Disorders Genetics Initiative (EDGI): study protocol.

BACKGROUND: The Eating Disorders Genetics Initiative (EDGI) is an international investigation exploring the role of genes and environment in anorexia nervosa, bulimia nervosa, and binge-eating disorder. METHODS: A total of 14,500 individuals with eating disorders and 1500 controls will be included from the United States (US), Australia (AU), New Zealand (NZ), and Denmark (DK). In the US, AU, and NZ, participants will complete comprehensive online phenotyping and will submit a saliva sample for genotyping. In DK, individuals with eating disorders will be identified by the National Patient Register, and genotyping will occur using bloodspots archived from birth. A genome-wide association study will be conducted within EDGI and via meta-analysis with other data from the Eating Disorders Working Group of the Psychiatric Genomics Consortium (PGC-ED). DISCUSSION: EDGI represents the largest genetic study of eating disorders ever to be conducted and is designed to rapidly advance the study of the genetics of the three major eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorder). We will explicate the genetic architecture of eating disorders relative to each other and to other psychiatric and metabolic disorders and traits. Our goal is for EDGI to deliver "actionable" findings that can be transformed into clinically meaningful insights. TRIAL REGISTRATION: EDGI is a registered clinical trial: clinicaltrials.gov NCT04378101 .

Attitudes towards cannabis and cannabis law change in a New Zealand birth cohort.

AIMS: Personal cannabis use is common across New Zealand, and an upcoming referendum will enable the public to vote on whether this should be legalised. The present research aimed to examine the attitudes of midlife New Zealand adults on cannabis use and legalisation, and to identify potential predictors of those attitudes. METHODS: At age 40, 899 participants drawn from the Christchurch Health and Development Study were interviewed about the perceived harmfulness of cannabis use, opinions on legalisation for recreational use and supply, and the use of cannabis for medicinal purposes. In addition, a range of potential predictors of legislative attitudes were examined. RESULTS: We identified a wide range of attitudes across the cohort, however the majority tended to hold a neutral view. More than 80% of the cohort expressed support for medicinal cannabis, while 47.8% supported decriminalisation, and 26.8% expressed support for legalisation for recreational use. The strongest predictors of support for legalisation were prior use of cannabis and other drugs, while additional positive predictors included a history of depression, Maori ancestry, parental drug use, novelty seeking and higher educational attainment. Predictors of more negative attitudes were also identified, and included female gender and having dependent children. CONCLUSIONS: These findings provide insight into cannabis-related views within the New Zealand context, and may help to predict voting behaviour during the 2020 Cannabis Referendum.

Is there systemic bias for Maori with eating disorders? A need for greater awareness in the healthcare system.

The New Zealand Mental Health Survey, Te Rau Hinengaro, indicated that eating disorders are at least as common in Maori as non-Maori, which is consistent with international findings that eating disorders exist in other indigenous and ethnic minority groups. Specific factors may be relevant to the development and treatment of eating disorders in the Maori population. We suggest this may include differential exposure to risk factors, the impact of acculturation, changing body image ideals and systemic bias reducing access to treatment and research participation. However, an absence of high-quality research regarding eating disorders in Maori makes it difficult to be certain about this. We suspect that Maori do not receive treatment in specialist eating disorders services at a level commensurate with comparable prevalence data in New Zealand and that a significant contributory factor to the apparent unmet need for Maori with eating disorders is likely to be systemic bias. Urgent attention to this area of research is required.